Men's Health Guide: Clinical Diagnostic Criteria and Multiple Treatment Options for Erectile Dysfunction (ED)

Clinical Diagnosis of Erectile Dysfunction

1. A thorough medical history is essential. This includes inquiring about any of the aforementioned causes of erectile dysfunction, whether the individual has taken any medications affecting sexual function, the presence of hypertension or diabetes, and whether they experience morning erections or erections while holding urine.

2. Ancillary Examinations

① General Examinations: Liver and kidney function tests, potassium, sodium, chloride, blood glucose, blood lipids, testosterone, etc., to determine if there is insufficient sex hormone secretion due to diabetes, liver or kidney dysfunction, or electrolyte imbalance.

② Papaverine Test: This test is crucial for determining the normality of local penile vascular function. Generally, a normal person should achieve an erection within 1-3 minutes of papaverine injection, with an erection angle greater than 90 degrees, lasting for more than 20 minutes. Otherwise, local vascular dysfunction is considered, requiring further investigation. However, sometimes insufficient dosage or inaccurate injection site can lead to unsatisfactory erections. Therefore, the results of this test should be carefully analyzed to avoid hasty conclusions.

3. Penile Cavernosography: This can determine if there is a penile venous fistula.

4. Internal pudendal artery angiography: Cannulation is performed via the femoral artery, selectively angiographically analyzing both internal pudendal arteries. This not only clarifies the presence of arterial vascular lesions but also allows for appropriate treatment during the procedure, such as vasodilation and local thrombolysis to dilate microcirculation. These treatments often achieve results that oral medications and physical therapy cannot.

5. Penile glans microcirculation observation: This assesses the local microcirculation of the penis and allows for the appropriate use of vasodilators.

6. Endocrine examination: This primarily checks serum FSH, LH, PRL, and testosterone levels. If sex hormone secretion is insufficient, exogenous supplementation may be considered.

7. Penile vascular receptor radionuclide scanning: Intravenous injection of isotopes and scanning with a gamma-ray camera reveals the distribution of vascular receptors in the corpora cavernosa of the penis. This method is relatively objective and accurate, holding significant clinical value in diagnosing vascular erectile dysfunction. It is also non-invasive and minimally painful.

8. Penile arterial pressure/brachial arterial pressure index measurement: A penile arterial pressure/brachial arterial pressure index greater than 1 is normal; less than 0.6 indicates insufficient local arterial blood supply.

9. Doppler ultrasound examination: This simple and effective non-invasive examination method can display the condition of the penile arteries on an ultrasound screen.

10. Nocturnal penile tumescence and rigidity test (NPT): Normal individuals experience regular penile erections during sleep and dreaming. NPT can be used to monitor penile erections during sleep. If the NPT result is normal, psychological or psychogenic erectile dysfunction is more likely. If the NPT result is abnormal, it may indicate an organic lesion, requiring further investigation.

Clinical Treatment of Erectile Dysfunction

1. General treatment: For patients with non-organic erectile dysfunction, psychological counseling is the primary treatment, supplemented by medication. The main focus is on relieving psychological and mental stress.

2. Drug treatment

①Yohimbine: 5.4 mg orally three times daily. Yohimbine is an alpha-2 receptor antagonist that dilates the internal pudendal artery, improving local blood circulation and increasing blood flow to achieve therapeutic effects.

② Triolandren 250mg intramuscular injection, once a month. This is a synthetic, fast-acting, intermediate-acting, and long-acting testosterone preparation. After injection, it exerts its effects in the body for a prolonged period, lasting 30-45 days. Therefore, once-monthly injection is sufficient. Combining this drug with Yohimbine often yields better therapeutic results.

③ Strong. 2 tablets three times daily. This is an aphrodisiac drug that has been used clinically for many years. It selectively acts on the erection center, spinal nerves, and perineal blood vessels, promoting the erection process through multi-site action, resulting in good comprehensive therapeutic effects. This drug does not contain sex hormones and has no side effects with long-term use.

④ Chemical prosthesis therapy: Primarily using vasoactive drugs such as papaverine, phentolamine, and prostaglandin E (PGE1), regular injections into the corpora cavernosa dilate local blood vessels to achieve therapeutic goals. Injections can also be administered before sexual activity.

⑤ Thrombolytic therapy: Intravenous infusion of thrombolytic drugs reduces blood viscosity, improves local microcirculation, and promotes the recovery of organ function.

⑥ Other medications: Medicated wines, topical sprays, and traditional Chinese medicine can be used as appropriate.

3. Physical therapy

Erectile dysfunction treatment devices utilize negative pressure suction to passively dilate penile blood vessels, promoting functional recovery and achieving therapeutic goals. Other physical therapy and massage devices can also be used.

4. Surgical treatment

Primarily penile prosthesis implantation surgery. Inflatable and malleable prostheses are available and can be selected as appropriate. Alternatively, the internal iliac artery and internal pudendal artery can be dilated via femoral artery catheterization. At the same time, vasoactive drugs or thrombolytic drugs can be injected into the internal pudendal artery through the catheter to improve local blood circulation, increase blood flow, and achieve the therapeutic goal.