By contributing to the invention of Viagra (Sildenafil) tablets, Dr. Ronald Virag remove the taboo of erectile dysfunction. Co-author Gender Male*tells us everything, everything, everything about erection and balances effective treatment in case of dysfunction.
What causes erectile problems?
From the age of 40 onwards, it is estimated that men lose an average of 1% testosterone per year. If this hormonal drop has no consequences for some, others experience it head on. They experience a decrease in libido, sometimes accompanied by more or less significant difficulties in achieving and maintaining a satisfactory erection. Therefore, a blood sample is always taken to evaluate testosterone dosage to detect a possible deficiency.
Another very prevalent cause with age is penile vascular abnormalities that prevent the penis from remaining rigid. Either not enough blood gets to the penis because some arteries are damaged or blocked. Either the blood gets in in sufficient quantity, but does not stay there: the cause is very frequent cavernous-venous leaks. “To identify them, doppler ultrasound under pharmacological stimulation (EDSP) is necessary, the doctor emphasizes. This test is for the penis the equivalent of a stress test on a treadmill for the heart. But above all, it is the easiest way to assess the erection, vascularization and structure of a functional organ. For for this purpose, a painless injection of papaverine with a vasodilating effect is applied to the penis, which will quickly allow you to find out if the erection is firm and durable. normal is then ensured, if necessary, by injecting a preparation with the opposite effect”, reassures Ronald Virag.
But the hormonal cause and the vascular cause can add up. When the latter is diagnosed with a lesion of the penile arteries, an examination of the entire vascular system is recommended. Especially the heart arteries, where in more than 80% of cases we find silently developing lesions.
Who is prescribed Viagra, an erectile dysfunction drug?
There has been a drug for erectile dysfunction for several decades: Viagra. “This erectile facilitator only works well in men with sufficient testosterone levels and with current sexual stimulation, because desire is essential!”, claims the doctor. On the other hand, little blue pills can’t do anything against vascular causes.
When are self-injections necessary?
They are indicated in case of contraindication, intolerance or failure of oral treatment, whether it is a testosterone supplement or Viagra. “It’s an ideal solution for men who don’t have enough testosterone because it creates an erection without the need for sexual stimulation!” explains Dr. Virag.
In what cases is surgery recommended to combat erectile dysfunction?
There are two surgical solutions.
- Surgery
In case of vascular problems, vascular surgery performed in certain centers in France treats any abnormality. For example, this may involve restoring blood flow to a blocked artery under local anaesthetic. This helps restore a natural erection.
For patients over 50 years of age, whose erectile tissue is too tired or if the induced erection test shows the absence of an erection, the installation of inflatable penile implants is recommended. Silicone prostheses are inserted into the corpora cavernosa by some specialized urologists. To induce an erection, the patient simply activates a mini-inflator placed under the testicles. “Despite its undeniable effectiveness, the implant remains an unloved therapeutic solution for erectile dysfunction, regrets the surgeon. This is mostly because it is poorly explained or is considered a dildo. It’s a shame, because complications are rare and the satisfaction rate of the patient, as well as his partner, reaches 90% .
*Male sex – Erection without taboos, by Drs Hélène Sussman and Ronald Virag, ed. du Cherche Midi, 2023.