Erectile dysfunction affects about 40% of those over 50 and half of those over 70, but it also affects younger men with a certain frequency, especially when exposed to cardiovascular risk factors. It is still often considered a taboo which in 75% of cases leads to the impossibility of having an erection and which is often the wake-up call even for atherosclerotic diseases.

It is therefore essential to talk to the doctor about it, in order to have an early diagnosis, and to work on raising the awareness of patients to accustom them to prevention.

For this reason we talked with Dr. Alessandro Pizzocaro, Andrologist in charge of the Andrology clinics in Humanitas Medical Care Rozzano-Fiordaliso and in the clinics in Milan (viale Premuda and via Domodossola).

Going to the andrologist: a cultural issue

While women tend to have regular check-ups and visits to the gynaecologist, for men the reluctance to go to the andrologist is in fact a cultural issue and a taboo. When men, regardless of age, are affected by symptoms that impair sexual activity, they usually close in on themselves and do not have the courage to ask questions and seek advice from a specialist.

Checks and prevention: right age to go to the andrologist

Checkups and visits to the andrologist should become a habit as early as adolescence. In the case of patients over 50, alarm bells should be the weight gain, a decrease in sexual desire and of course erection problems: these are symptoms that the patient starts to have risk factors not only psychological and erectile dysfunction, but also cardiovascular and metabolic. Testosterone, in fact, is the hormone that regulates not only sexuality, but also metabolism, improves blood sugar, weight, calcium content in the bones, mood. From the age of forty, testosterone drops by 2% per year and decreases further if the subject becomes diabetic and hypertensive.

Erectile dysfunction: not a disease but a symptom

Erectile dysfunction is not a disease but a symptom of the body not being well. It is not only a matter of psychological problems – such as stress, tension in the couple or problems at work – but it is also due to a number of very common vascular risk factors, such as cardiovascular diseases such as heart attack and ischemic heart disease. People with high blood pressure, cholesterol problems, sedentary lifestyle, alcohol abuse and smoking, or diabetes, have a higher risk of developing atherosclerosis, for example. The blood vessels tend to close and, as less blood arrives at the heart and brain, also less blood arrives at the erection and, as a result, erectile dysfunction develops.

Medications taken to facilitate an erection are not curative, but act on the symptom. Only by resolving the problem upstream is it possible to suspend the medication.

In patients who have a sexual disorder, testosterone control should be done: it is a very simple test, a trivial blood sample that is taken early in the morning on an empty stomach, along with blood sugar and cholesterol.

Which are the most vulnerable men to erectile dysfunction?

Erectile dysfunction affects about 13% of the population, but age is an independent risk factor: the older the person becomes, the greater the risk of having this problem. Almost 40% of patients aged 50-55 and 50% of those over 70 have erectile dysfunction problems. The reason for this is that from that age onwards there is an increase in all cardiovascular risk factors and also in the use of drugs. For this reason, a healthy lifestyle is recommended, which also includes physical activity, mainly aerobic, which helps the metabolism, but which is regular and constant over time.

What are the treatments available for erectile dysfunction?

Shock waves are the treatment that is currently going for the most part even if it is only effective in cases of mild vascular disease. It is an absolutely painless method, with no contraindications or side effects. It has a mechanism of action that tends to improve vascular activity, i.e. the circulation of blood in the penis, and thus promotes erection.

However, the effectiveness of this treatment remains a matter of study: above all, it is necessary to understand which types of patients can benefit from it, certainly the younger ones.

Erection medications: can they hurt the heart?

The specialist replied, “Absolutely not. Oral erection medications were born as coronarodilators. Then it was seen that they also worked very well for the pulmonary circulation, so much so that patients with heart failure, who have pulmonary hypertension, benefit from these drugs. The contraindication exists when patients are already taking cardiac circulation drugs, because those for an erection increase their vasodilator action. For the rest, they are harmless”.