Dr. Josep Torremadé: “Erectile dysfunction is an early sign of latent cardiovascular disease"

Andrology is a subspecialty of urology, which is dedicated to treating sexual dysfunctions, reproductive and genitourinary reconstructive medicine.  It is a part of medicine that focuses on men’s sexual health.  

Well, erectile dysfunction, prosthetic surgery associated with erectile dysfunction and Peyronie’s disease–a rare disease that affects 3-8% of the population and causes damage to the penis–ejaculatory disorders, genitourinary reconstruction, etc.  

The persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.   It is not just a matter of firmness.  

Yes, of course! There are well-studied risk factors; especially cardiovascular risks. Smoking, obesity, hypertension, cholesterol are all risk factors for erectile dysfunction.  We also see cases of erectile dysfunction that are caused by cancer surgery (prostate cancer, bladder cancer, colorectal cancer).  These are cancers that we can ‘control’ and with which we have good oncological results. However, it is true that in some cases these types of dysfunction end up affecting the patient’s quality of life.  

We have two types of erectile dysfunction: first of all we talk about the psychogenic type, which normally affects young boys and can sometimes be caused by a bad sexual experience.  Normally, however, it is not a problem with the penis, but related to the field of sexology.  We also have organic erectile dysfunction, which—as andrologists—is our specialty, and it can be caused by treatment for cancer or associated to cardiovascular risk factors. 

Erectile dysfunction is an early sign of latent cardiovascular disease. That means that when this dysfunction appears, if we don't act, in 3 or 5 years the patient could have a heart attack or an embolism, for example.  Often, when we diagnose erectile dysfunction in a patient, we end up diagnosing hypertension or high cholesterol levels that the patient was unaware of. So, it is important to have a healthy lifestyle, in order to avoid major cardiovascular problems, as well as to control and minimize erectile dysfunction.  

The first thing we do is to change the patient’s lifestyle.  With simple things like changing their diet and promoting physical activity, 25% of patients already see improvements in their erectile dysfunction. When this is not sufficient, the next step would be to use drugs that increase erection and phosphodiesterase type 5 inhibitors (derivatives of Viagra) - safe drugs with very few side-effects and highly effective.  

The next step would be to try alternative options to increase the blood flow to the penis and, thus, make it firmer.  We also have other treatments such as intracavernosal injections or intraurethral drugs, which have a good therapeutic response. However, we should also be aware that they are a bit more aggressive.  

There are patients for whom the other treatment options do not work. So, we need to consider a prosthetic penis.  First of all, we might imagine this is some kind of orthopaedic device. But it is a hydraulic system that is implanted into the penis using minimally invasive surgery, with very few complications. After the surgery, the patient can go home the same day.  The prosthesis allows the patient to have an erection whenever he wants.  In 2022, the Hospital Clínic implanted 58 penile prostheses.   

When a person has been sexually active and has enjoyed sex and suddenly loses it, this has a major psychological and emotional impact, which ends up affecting their quality of life.  In short, it results in greater anxiety, more depression, and more absenteeism in the workplace.  Society is ageing and people are living longer, and we want to enjoy these years with a good quality of life.  Maintaining an active sex life means maintaining a good quality of life.   

Between 20-50% of the male population may suffer erectile dysfunction after the age of 50.  But if we look at those in the population with diabetes, or who have been undergone prostate cancer surgery or who are obese, this percentage increases and erectile dysfunction is more common in these men.  

Partners are a great ally in the treatment. In fact, after the implantation of a prosthetic penis, patients require some time to adapt.  Their partners can help them greatly in coping with this postoperative period and reduce the anxiety associated with this dysfunction.   

No. Young people get information on sex that is often based on pornography and does not reflect a healthy view of sexuality. Our job is also to promote free, fulfilling, respectful sexuality that brings pleasure… and also to dispel myths. A lot of frustration comes from aspects we have seen, or we have been told about, that do not give pleasure.  People want to reproduce in their own sex life behaviour that they have seen in pornography, and that can give rise to frustration. Pornography can provide sexual responses that are abnormal and then people get frustrated when they see that they are not able to have a sexual relationship like the ones they might have seen. We need to educate citizens to have healthy sexual habits, and in this respect we have a long way to go.  

The future of the treatment of erectile dysfunction lies in regenerative therapies.  At present, we are trying to treat the penis when it has already degenerated, and what we have to do is to try to treat it before the problem starts, or when the first symptoms appear. In terms of research, we are making progress with stem cell therapy and platelet-rich plasma therapy, but at a clinical level we still have a lot of work to do.   

The future of prosthetic penis treatment will involve better prostheses, going from today’s hydraulic prostheses to electronic prosthetic penises. And this means it will be possible to activate or deactivate it with an external system—through a telephone or a watch, for example—and modulate the intensity of the firmness of the penis.  We are not far away from achieving this.