There are basically five categories:

The dysfunctional

• male libido (sexual over- or under-stimulation)
• erection (erectile dysfunction, erection problems, chordeic penis)
• ejaculation (preterm, retrograde, none)
• orgasm (none)
• sensitivity

The WHO definition of the erectile dysfunction (potency disorder) says: It is the Incapability of having an erection necessary to start and carry out sexual intercourse”.

How does an erection work?

Erotic stimuli (visual, tactile, imaginary ones) cause a stimulation of neural receptors in the central switching points of an erection. It is dopamine receptors as well as melanocortin receptors, and, to some extent also serotonin ones that play a decisive role with the erectile induction. By stimulating the receptors sexual switching points are being activated while simultaneously an emission of erection stimulating via spinal tracts happens. In the first plays this goes to the reflexogenic parasympathetic erection centre in the sacral marrow.

After the transformation of these erotic stimuli they are directed to the nerve endings in the cavernous body of the penis via special nerve pathways (nervi erigentis, hypogastricus inferior, and nervi cavernosi). Nitric oxide (NO), the most essential carrier substance for the erection is released. This very process activates the enzyme guanylate cyclase in the cavernous muscle cells. Following various processes the level of a special substance called guanosine-monophosphate (cGMP) is increased, which, in turn, causes the relaxation of the smooth muscle cells. This, finally, causes the arterial blood flow to increase in the cavernous body and the initiation of the erection is started.

What causes erectile dysfunctions?

In the first place it is a circulatory disorder caused by arteriosclerosis, diabetes mellitus or high blood pressure that have first led to capillary changes. Smoking or heavy drinking have similar effects. Then there are neurological diseases, medication by-effects, diseases of the thyroid gland or anatomic changes on the penis (induratio penis plastic) which may also be made responsible here.

Such psychic troubles as unspecific anxiety states fears of failure or psychiatric diseases (depression…) come in here as well.

Of course it is often a combination of all of these that puts heavy weights on male shoulders as manliness is still being defined via sexual potency.

What about its frequency of occurrence?

It is not only YOU that suffers here. The erectile dysfunction can undoubtedly linked with age. The “Kölner Studie” (Cologne Studies) asked more than 8000 men of age 30-80. The response rate was about 60% (4489 responds).

Age group results were as follows:

• Ages 30-80: 19,2%
• 40-49: almost 19%
• 60-70: 33%
• 70-80: more than 50%

(Braun et al.: Int I Impotence Res 2000; 12; 305-311)

What happens in the surgery?

First, you have got to be ready to talk. Wrong shame, fear, and wrong information cause men to push aside this problem, partnerships to erode or even break up and, more often than not, alcohol is taken as the only way out. Profound conversation and a routine check-up follow. If necessary there is also a blood analysis done and special medication prescribed. (Sildenafil, Vardenafil, Avanafil, Tadalafil) Erection reliably improved by them. Also shock wave treatment is offered by me. Ultra-sonic waves on the penis further the local blood circulation. This procedure has been available for years and its efficiency has been proved in many studies.