Erectile dysfunction (ED), also known as impotence, is one of the most common male sexual problems. It occurs when there is trouble getting an erection or maintaining an erection most of the time.

It is normal to have erection problems occasionally, but there may be a significant underlying cause if it occurs too often.

ED often leads to stress, changes in male self-perception, and relationship problems. Fortunately, today several treatment options are continually improving, from medications to stem cell therapy to enhance your quality of life. This article will review the basic concepts of erectile dysfunction and the latest advances in its therapy.

What is erectile dysfunction?

Erectile dysfunction is the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse. This condition negatively affects a man's sex life and impairs his confidence and quality of life.

There are two main types of erectile dysfunction:

Primary erectile dysfunction, where the man has never been able to achieve or maintain an erection.

Secondary erectile dysfunction is acquired later in life in a man who was previously able to achieve erections.

Primary erectile dysfunction is rare and is almost always due to psychological factors or penile problems. Whereas secondary erectile dysfunction is more common, and in over 90% of cases, has an organic cause.

Many men with secondary erectile dysfunction develop psychological struggles that worsen the initial problem.


It is important to clarify that not getting an erection once does not mean erectile dysfunction. Therefore, the main scenarios that define an ED are:

  1. Being able to have an erection from time to time, but not every time you want to have sex.
  2. Being able to have an erection, but not for long enough to have sex.
  3. Not being able to have an erection at any time.

First-line treatments

The treatment of ED is wide nowadays because, in addition to addressing the main cause, it also seeks to improve erection. Today's most effective treatments include:

Lifestyle changes

Lifestyle changes have a positive impact on youth with ED. Consulting with a specialist will allow you to identify reversible risk factors that contribute to erectile dysfunction, such as medications, poor diet, lack of exercise, endocrine imbalances, and anxiety.

Giving up habits such as smoking, heavy drinking, not sleeping, or sleeping too little can significantly improve erectile dysfunction. As well as exercising 30 minutes at least 5 days a week.


Phosphodiesterase-5 (PD5) enzyme inhibitors are the first-choice oral medication for erectile dysfunction, including Sildenafil, Tadalafil, and follow-on products.

These work by inhibiting the phosphodiesterase-5 enzyme from promoting arterial smooth muscle relaxation and facilitating the necessary blood flow for an erection.

These medications are generally well-tolerated and do not induce an automatic erection after taking them. You will likely need sexual stimulation to achieve an erection.

Vacuum erection devices (VEDs)

Like the above medications, vacuum erection devices are another first-line option for erectile dysfunction.

They consist of a cylinder or ring mechanical device placed around the penis to maintain the erection. Once placed around the penis, the device is pumped, creating a negative pressure vacuum to deliver blood to the penis.

It should be noted that several adverse reactions have been reported with the use of VED. These adverse effects include small blood spots on the skin from capillary bleeding and swelling of clotted blood (hematomas).

The future in ED management

There are currently many ongoing research treatments that look promising for erectile dysfunction. Among them:

Stem cells

Stem cell therapy has emerged as a promising regenerative option because it can reproduce and differentiate multiple times into specific cells to repair damaged tissues.

During repair and regeneration, stem cells release exosomes, cytokines, and growth and neurotrophic factors, and thus play a crucial role in restoring the main pelvic ganglion that provides neurological signals to the penis.

In general, the regeneration of the structures involved in the erection process is promoted by injecting stem cells into the penis.

Regenerative treatment with extracellular vesicles (EVs)

As mentioned above, stem cells, in turn, release products called exosomes that function as vesicles transporting information and substances. The exosomes can enhance collagen production in the corpus cavernosum, endothelial cells of the penile arteries, and the regeneration of the dorsal nerve of the penis.

Although this method looks promising, it is not yet applied in clinical practice while still being studied.

Low-intensity extracorporeal shockwave therapy (LI-ESWT)

It consists of a shock wave therapy that can improve blood vessel function and promote the growth of new blood vessels.

In addition, LI-ESWT has recently been shown to improve patient response to oral PDE-5 inhibitors and may allow patients previously unresponsive to these medications to have better erections using them after LI-ESWT.

Basically, shockwave therapy improves the drugs' efficacy while stimulating new blood vessels necessary for erection.

Platelet-rich plasma

Platelet-rich plasma is probably the most chosen treatment to promote cell regeneration. The benefits of plasma are that it is full of growth factors from your own blood, generates no reaction, and is completely safe.

In this case, the plasma after centrifugation is injected directly into the corpus cavernosum to improve nerve function in the penis. It also improves healing and promotes the formation of new blood vessels.

External penile prosthesis

The external penile prosthesis is a prosthetic phallus that is strapped around the patient's waist. While it may seem difficult to conceive that a prosthetic phallus could reward penetrative intercourse, neurophysiology goes beyond organic barriers. According to a study, it has been shown that incorporating other senses can allow a sensation that the prosthetic phallus is the patient's own phallus.

Do not hesitate to seek medical assistance.

All these therapies are still under study, but we are sure that soon the therapeutic horizons for erectile dysfunction will be much broader, which will allow for better management and a higher rate of satisfaction and efficacy.

If you think you have erectile dysfunction, you must contact your medical provider to immediately start the treatment that best suits your needs.

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