Erectile disorder or impotence means that the male is unable to achieve a satisfactory erection of the penis during sexual intercourse. Its frequency among the male population is higher than is reported because there is still a reluctance to talk about this kind of disorder. It�s an understandable reaction, though just a little absurd given that nowadays there are psychological and pharmacological ways of treating it.

What treatments are there?
� Psychotherapy or behavioural therapy. Suitable for patients whose problem appears to have a psychological rather than an organic cause. The idea is to boost self esteem and deal with obsessions.
� Mechanical devices. Penile prostheses and vacuum devices, while they may be reasonably effective, are not popular with patients due to the fact that they are awkward to use and so they are rarely requested.
� Hormonal treatment. Suitable for those patients who suffer from a lack of testosterone. This treatment is only applicable to 5% of erectile dysfunction sufferers and consists of a course of intramuscular injections of testosterone ester.
� Pharmacological treatment. This has proved to be effective in cases of psychogenic or organic impotence, and has therefore become the treatment of choice. In 1998 a drug was launched which has given sufferers new hope. Viagra is a type-5 phosphodiesterase inhibitor which enhances blood flow to the penis. It is the first drug of its kind to be administered orally and a dose of 100 mg (maximum daily recommended dose) can restore the body�s natural response to sexual stimulation. But it should be by medical prescription only, since it can have dangerous side effects: headaches, dyspepsia, facial reddening, interaction with other drugs, interaction with alcohol, impaired eyesight, priapism (an erection which won�t go away), or haemorrhaging .

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A miracle called "Viagra"
According to data currently available sildenafil (Viagra) has proved to be effective for 80% of all patients with erectile dysfunction, by raising levels of cyclic GMP or cyclic guanosine monophosphate, a substance which is produced in response to sexual stimuli. When levels of this mediator are high it enables blood to flow into the penis causing an erection.
Can Viagra improve the sex life of men who have no problem with impotence?� Well, in order to get authorisation from the FDA (US Food and Drugs Administration), the company marketing Viagra, Pfizer, carried out tests with 3,000 men, all of whom had suffered from erectile dysfunction in the previous five years. That is to say, Viagra was used only as a treatment for erectile dysfunction, and both Pfizer and the FDA insist that it should only be prescribed for men suffering from this disorder.
Besides, Viagra does not produce erections that are any thicker or longer in men who have no problem getting an erection, nor does it stimulate, excite or prolong sexual arousal of those genuine sufferers, since for it to work, sexual stimulation is necessary before the act. It has to be taken at least one hour before this is going to happen.

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CAUSE OF ERECTILE DYSFUNCTION
Physiological disorder. In 70% of cases erectile dysfunction appears for organic reasons.
Psychological disorder. In 30% of cases erectile dysfunction is caused by disorders such as obsession, depression, excessive anxiety, loss of self confidence, etc.
Mixed cause. When psychological causes interact with an organic cause.
Pharmacological cause. The consumption of drugs to combat high blood pressure or of tranquillizers slows down the body�s metabolic rate.
Hormonal cause. When the testicles fail to produce enough testosterone.
Neurological problems. Trauma to the spinal cord as caused by multiple sclerosis, degenerative illnesses such as Alzheimer�s or some types of cancer surgery may be the cause of erectile dysfunction.