It affects about 40% of the over 50 and half of the over 70, but it also affects younger men with some frequency, especially when exposed to cardiovascular risk factors. It is erectile dysfunction, a male bogeyman which, in 75% of cases, leads to the impossibility of having an erection and which is often the alarm bell from the point of view of atherosclerotic diseases. That’s why treating and identifying it becomes fundamental, as is prevention, which is based mainly on a visit to the andrologist. In this regard, we interviewed Dr. Alessandro Pizzocaro, Andrologist in charge of the new Andrology clinics at Humanitas Medical Care Rozzano-Fiordaliso, at the “Fiordaliso” shopping centre, and at the clinics in Milan, in Viale Premuda and Via Domodossola.

The man and his andrologist: a cultural question

While women regularly go to the gynaecologist and this is considered normal, for men the reticence to go to the andrologist is in fact a cultural issue. If the male is affected by symptoms that affect the exercise of virility, they usually close in on themselves and do not have the courage to ask the specialist questions, or rather hope that the doctor himself will ask them. Very often in a couple it is the woman who pushes the partner to go to the doctor, since erectile dysfunction is a problem that can undermine the serenity of the relationship.

Which age is the right one to contact the andrologist?

An andrologist should be consulted by a male since he is a teenager. The 50-55 year old man who gains weight has a decrease in sexual desire and erection problems, and is likely to be a patient who starts to have risk factors not only psychological but also cardiovascular and metabolic. So, in this case, he must necessarily resort to the andrologist if he does not want a worsening of the conditions. At that age, in fact, the level of testosterone begins to decrease, the hormone that not only characterizes sexuality, but regulates metabolism, improves blood sugar, weight, the calcium content in the bones, mood. From the age of forty, testosterone drops by 2% per year and decreases further if the subject becomes diabetic and hypertensive.

The erectile dysfunction is a symptom

Erectile dysfunction is not a disease but a symptom that the body is not well. It is not only a matter of psychological problems, such as stress, tension in the couple or problems at work, but also of numerous very common vascular risk factors, such as cardiovascular diseases such as heart attack and ischaemic heart disease. People with high blood pressure, cholesterol problems, sedentary lifestyle, alcohol abuse and smoking, or diabetes, have a higher risk of developing atherosclerosis and dysplasia. The blood vessels tend to close and, as less blood arrives at the heart and brain, so less blood arrives also for an erection and, as a result, erectile dysfunction develops. Medications taken to facilitate erection are not curative, but act on the symptom. Only by resolving the problem upstream is it possible to suspend the medication.

In patients who have a sexual disorder, the testosterone check should be done: it is a very simple test, a simple blood sample that is taken early in the morning on an empty stomach, along with blood sugar and cholesterol.

The age group most affected by erectile dysfunction?

It affects about 13% of the population, but age is an independent risk factor: the older the person becomes, the greater the risk of having this problem. Almost 40% of the patients aged 50-55 and 50% of those over 70 have erectile dysfunction problems. The reason for this is that from that age onwards there is an increase in all cardiovascular risk factors and also in the use of drugs. For this reason, a healthy lifestyle is recommended, which includes physical activity, mainly aerobic, which helps the metabolism, but which is regular and constant over time.

What are the possible treatments for erectile dysfunction?

The most common treatment today is shockwave treatment, but it is only effective in cases of mild vascularity. It is an absolutely painless methodology, with no contraindications or side effects. It has a mechanism of action that tends to improve vascular activity, i.e. the circulation of blood in the penis, and therefore promotes erection. However, the effectiveness of this treatment is still under study; above all, it is necessary to understand which types of patients can benefit from it, undoubtedly the younger ones.

Can erectile drugs hurt the heart?

The specialist replied: “Absolutely not. Oral erection medications were born as coronarodilators. Then it was seen that they also worked very well for the pulmonary circulation, so much so that patients with heart failure, who have pulmonary hypertension, benefit from the drugs for erection. The contraindication exists when the patients are already taking cardiac circulation drugs, because the erection drugs increase their vasodilator action. Other than that, they are harmless”.