Because most patients with erectile dysfunction have psychological factors, psychotherapy is very necessary, and it is best for both husband and wife to participate in psychotherapy. Sexy concentrated training is the most important treatment method for psychological erectile dysfunction at present, which is suitable for the treatment of almost all sexual dysfunction. Its purpose is to relieve anxiety, enhance communication between husband and wife, improve the skills from verbal communication to nonverbal communication, and gradually improve the relationship and sexual function between husband and wife. The improvement rate of this method in treating erectile dysfunction is 20% ~ 81%.
2. Drug therapy
Oral medication is the simplest and most acceptable first-line treatment for erectile dysfunction.
(1) Non-hormonal drugs can be roughly divided into the following categories according to the site of drug action. ① Oral drugs acting on the central system: such as adrenal receptor antagonists; Dopamine drugs; Serotonin receptor antagonist. ② Oral drugs acting on periphery: PDE5 inhibitors (such as sildenafil, tadalafil, vardenafil, etc.) are specific phosphodiesterase inhibitors, which can inhibit cGMP degradation and increase cGMP concentration, thus relaxing smooth muscle and causing penile erection. These drugs are the first choice for the treatment of ED at present, and the total effective rate is over 70%. Topical drugs: cream and ointment are the oldest methods in the treatment of erectile dysfunction, but the effect is not exact.
(2) Androgen replacement therapy is mainly used to treat endocrine erectile dysfunction, including ED caused by primary and secondary hypogonadism. ① Primary hypogonadism: Testicular tumor, Creutzfeldt-Jakob syndrome, trauma, surgery and other diseases can lead to the decrease of testosterone levels and the increase of FSH and LH levels. Exogenous testosterone replacement therapy is the best for such patients. ② Secondary hypogonadism: secondary to hypothalamic and pituitary lesions. Due to the lack of gonadotropin, gonadal development stagnated, and the levels of testosterone, FSH and LH in the body decreased. After supplementing gonadotropin or gonadotropin-releasing hormone, it can improve sexual desire and erectile function. Androgen used for ED treatment mainly includes testosterone undecanoate capsules, injections and patches. For patients with prostate cancer or suspected prostate cancer, androgen replacement therapy is contraindicated.
3. Vacuum narrowing device (VCD)
Vacuum constriction device (VCD) can be used for erectile dysfunction caused by any reason, and it is a second-line method to treat ED. However, the hemodynamics of erection is different from that of normal erection, and there is no active relaxation of cavernous body and smooth muscle. Animal experiments showed that the arterial blood flow did not increase after VCD was used, but the venous reflux decreased obviously, and the blood filling of cavernous body and penis skin led to penis enlargement. This method is suitable for patients who are ineffective in PDE5 inhibitor treatment or can not tolerate drug treatment, especially for elderly patients who occasionally have sex. Adverse reactions include penile pain, numbness, delayed ejaculation, etc., and patients should be informed. The time of negative pressure assistance should not exceed 30 minutes. Contraindications include patients with spontaneous abnormal erection, intermittent abnormal erection and severe penile deformity.
4. cavernous injection therapy (ICI)
Drug injection in the corpus cavernosum is to inject vasodilators into the corpus cavernosum of penis to make the corpus cavernosum hyperemia so as to achieve the purpose of penis erection. At present, the most commonly used drugs for the treatment of erectile dysfunction in clinic are papaverine, phentolamine and prostaglandin E 1, etc. This method has obvious effect and rapid onset. With the extensive use of oral drugs, this method is less and less used in clinic because it is an invasive operation and has side effects such as pain, bleeding, abnormal erection of penis and penile fibrosis.
5. Surgical treatment
With the advent of new drugs and the increasing understanding of the pathogenesis of erectile dysfunction, surgical treatment is gradually decreasing, but there are still some patients with erectile dysfunction who need surgery to solve them, and they are generally ineffective after other treatments. Surgical treatment includes prosthesis implantation, arterial reconstruction and vein ligation.