Be careful, taboo! 18 to 20 Million men in USA may be affected, but erectile dysfunction remains a difficult subject to discuss. And the consequences for the couple can be disastrous. Synonymous with personal weakness, impotence is simply a physiological disorder.


  • The erection mechanism
  • The causes of the malfunction
  • Erectile dysfunction: how to fix it?
  • Penile prosthesis
  • The sexologist to the rescue
  • Erectile dysfunction: a new cream treatment


The erection mechanism

Erectile dysfunction is a topic that concerns men, but also women. In a study conducted by the IFOP, 64% of men reported that they had already been confronted with it.

The penis consists of three erectile bodies: two so-called cavernous bodies and one spongy body. The two cavernous bodies are large cylinder-shaped reservoirs, containing veins and arteries. The spongy body contains the urethra, through which urine and semen can flow.
Most of the time, the cavernous bodies are poor in blood and the penis volume is low. During an excitation, sensory signals reach the brain. Erectile dysfunction centres send orders that pass through the spinal cord to the penis through the erectile nerves. These nerves are directly connected to the arteries and cavernous bodies of the penis. As a result, the arteries dilate, the spongy tissues fill with blood and the penis gradually becomes erect.

Many causes can make erections difficult: cardiovascular disease such as high blood pressure, neurological damage following a stroke, erectile nerve damage following prostate surgery, or simply age, which causes a decrease in testosterone production.

The causes of the malfunction

Any abnormality of the vessels or nerves that play a role in erection can lead to erectile dysfunction. High blood pressure and cardiovascular disease are often involved. Neurological disorders, such as multiple sclerosis or Parkinson’s disease, can also lead to impotence; metabolic diseases, such as metabolic syndrome, dyslipidemia (excess lipid), are also involved, and among them, diabetes remains the main cause of impotence. It attacks blood vessels and nerves. Erectile dysfunction is three to four times more common in people with diabetes. Pelvic surgery, especially prostate removal, also alters erection. Depression is often accompanied by sexual problems.
Some treatments, such as antidepressants or prostate treatments, can also help the development of impotence. Some transient erectile dysfunction can be caused by a poor lifestyle: smoking, alcohol, drugs, fatigue and stress go hand in hand with a fulfilling sex life!

Erectile dysfunction: how to fix it?

The first solution is to take drugs, such as the famous molecule, sildenafil, that strengthen the erection. If this is not enough, injections of erectile stimulating substances, alprostadil, should be given directly into a cavernous body. This active ingredient can now be applied as a cream to the urinary meatus (the opening through which sperm and urine flow).
There is also a technique called vacuum, which creates a vacuum around the penis and allows it to swell during sexual intercourse. A latex ring is installed at the end of a tube, it will block the reflux of blood from the penis once the erection is sufficient. The patient then only has to push the air out of the tube, thanks to a pump that he operates, until he gets an erection. This inexpensive system requires some learning and good communication between partners.

Penile prosthesis

For some men, it is no longer possible to have natural erections after cancer, diabetes or trauma. It is then possible to implant a penile prosthesis in the penis. This is a heavy, irreversible and ultimately proposed surgical procedure to allow these men to regain an erection.

The penile prosthesis is the last resort (about 750 operations per year in France). But accepted if it is proposed from the outset, patients put all their hopes in surgical treatment, after having unsuccessfully tested other therapies.

The sexologist to the rescue

Erection disorders, premature ejaculation, difficulty ejaculating, decreased desire, difficulty reaching orgasm, pain during penetration… are the most frequent reasons for consultation.
Many couples encounter difficulties in their sexual lives, never daring to talk about them, often for months or even years. A sexologist, a practitioner specializing in sexual disorders, can help solve the sexual problems of all those who do not experience fulfilling sexuality.

Erectile dysfunction: a new cream treatment

Since June 1, 2015, a new treatment has been available in pharmacies on prescription. It is a cream to be applied locally to the penis.

For the moment, this treatment is not reimbursed but according to the laboratory, a reimbursement of 15% is expected in July 2015 on the same conditions as for intra-cavernous injections: diabetics, prostate cancer, multiple sclerosis, paralysis…

“This cream contains a product called alprostadil, which corresponds to prostaglandin E1, and which is known to have a vasodilating effect, i.e. this cream will promote the opening of the arteries. And by promoting the opening of the arteries, it will promote blood filling of the penis and therefore facilitate erection,” explains Dr. Gilbert Bou Jaoudé, sexologist.

Using a small syringe, a drop of cream is placed on the urinary opening. The cream is absorbed in the glans, then passes from the urethra to the spongy body and spreads to the cavernous bodies. The effect appears within five to thirty minutes. Accompanied by sexual stimulation, erection is facilitated for one to two hours depending on the patient.

As with all erectile dysfunction treatments, the cream is contraindicated in people with cardiovascular problems. Its use is also prohibited in the event of injury, injury or local infection. In addition to these contraindications, the cream has some undesirable effects such as burns, tingling…

Adverse reactions pointed out by the High Authority for Health but nothing alarming according to Dr Bou Jaoudé, who was asked by the laboratory to give his opinion on the proper use of this new treatment: “According to studies, only 5% of users stop the treatment because of side effects. This means that in 95% of cases, the person can tolerate the treatment even if you notice a little bit of unpleasant sensations.

And even though it is not recommended to use this cream more than three times a week, it makes a big difference for patients with erectile dysfunction. Available only by prescription, each dose of cream costs 10 euros and several uses are necessary before an optimal erection result can be observed.

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