Potency As an expert in the field of the male reproductive system the andrologist is a specialist for men seeking help concerning fertility problems.

Potency and a good penile function are necessary to have a full erection for a satisfying sex life.
 
Erectile dysfunction or impotence can have devastating psychological consequences such as a feeling of shame, weakness or inadequacy.
 
There is a taboo to talk about potency and erectile dysfunction although 1 in 10 men will experience recurring impotence problems.

The underlying causes can be various and are often treatable (e.g. cardiovascular disease, diabetes, side effect from medication, hypogonadism). The causes can also be psychological. The diagnostics and treatment of erectile dysfunction are covered by the andrologist.
 

 
During an erection the Corpora cavernosa inside the penis fill with blood by an increased arterial inflow and reduced venous outflow. The erection is eigther induced by an reflex that is achieved by directly touching the penis, or it can also be induced by erotic stimuli that are transformed by the brain. Both pathways need intact peripheral nerves. The nerves secret NO which leads to a relaxation of smooth muscles of the corpora cavernosa and results in an erection.

An adequate level of testosterone and an intact pituitary gland are also necessary for the development of a healthy male erectile system.



As a consequence reduced erection quality can be a result of hormonal deficiency, neurologic disorders (e.g. neurologic diseases, diabetic polyneuropathy etc.), lack of penile blood flow (e.g. arteriosclerosis) or psychologic disorders.
Sometimes erectile dysfunction can be caused by medications: Several antihypertensive drugs and also psychiatic medications (such as SSRIs) are known to have impotence as a possible sideeffect.
 
Surgical procedures (pelvic surgery for cancer or after accidents) can damage the penile nervous system or the blood suppy (or both) and are a common reason for reduced eretile function.
 
Complete removal of the prostate, beam radiation or hormonal therapy for prostate cancer are frequently combined with the loss of potency.
Environmental factors can also impair the erection: Excessive consumption of alcohol as well as excessive smoking often leads to erectile dysfunction.
'What is good for your heart is good for your erectile function!'.

Examinations:
 

 
The experienced andrologist does have several test to diagnose the causes of an erectile dysfunction. After a detailed discussion concerning risk factors as diabetes, physical health, dietary habits and history of surgeries the expert will normally do serveral blood tests to rule out hormonal disorders.
 
The examination will normally include a duplex sonography of the penile arteries (during a medically induced erection = SKIT).


Specific neurologic tests can be done to get information about diseases that can affect the nervous system.

It is possible to measure night erections during the sleep to find out about the quality and duration of nocturnal erections.
 
More invasive examinations such as radiographic cavernosogram and a penile angiogram are only done in selected rare cases.

Some centers use magnetic resonance angiography to get insights of the penile vessels.
 
Treatments
Oral medications:
The application of oral medications (such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)) will in many cases result in an improved erection. All these medications increase the NO levels which results in a better relaxation of the smooth muscle tissue in the corpora cavernosa / blood vessels. One should be careful not to combine these so called PDE5-inhibitors with cardiac medications that work with NO (mostly named Nitrates or similar) - severe blood pressure side effects can occure.

In cases of hormonal disorders rebalancing the hormone system can lead to a recovery of the erectile function. (e.g. application of testosterone, treatment of hyperprolactinemia etc.)

Vacuum pumps are used to draw blood into the penis. An elastic ring at the base of the penis keep the blood in the penis. Many patients and female partners do not feel comfortable with erections achieved with a vacuum pump, but in individual cases (e.g. after radical prostate surgery also resulting in continence problems) a vacuum pump might be the best choice.

Severe cases of erectile dysfunction can be treated with penile implants - normally leading to an almost normal function and a very satisfactory cosmetic result.

Dr. Petsch is an experienced surgeon implanting penile implants
(as well as artificial sphincter systems). There are several types of penile implants: Semirigid implants resulting in a constant erection (the penis with the implants can be 'bended' but is always more or less erect).
 

 
In most cases Dr. Petsch recommends and implants hydraulic 3-piece systems. These implants lead to the best functinal and cosmtic results. The implant is normally 'deflatet', the fluid is stored in a reservoir inside the abdomen. Using a small little 'pump' that will be placed inside the scortum the patient can bring up a very natural erection - the penis gains rigidity and size. The erection looks and feels very natural and some female partners will not notice that the patient does have an implant.

If you are interested in penile implants, in potency diagnostics and a treatment plan please don't hesitate to contact Dr. Petsch via androdoc.com. We can guarantee you medical confidentiality and a professional and experienced help for your problem.