Management of Erectile Dysfunction in Paris
Dr Adam Vardi - Urological surgeon
Treatment of erectile disorders in Paris
Erectile dysfunction (ED)
Erectile dysfunction (ED) is defined as the persistent or recurrent inability to obtain or maintain an erection sufficient to allow satisfactory sexual activity. Although often perceived as a simple quality-of-life issue, it is now recognized by the scientific community as a genuine marker of overall health, particularly cardiovascular health.
Dr Adam Vardi, urologist and andrologist, offers a structured diagnostic and therapeutic approach aimed at identifying the underlying causes and restoring harmonious sexual function through tailored treatments.
Physiology of erection: a complex vascular mechanism
Urological Surgery in Paris & Neuilly
Erection is not a simple mechanical phenomenon, but the result of a complex interaction between neurological, hormonal, vascular and psychological factors. Upon stimulation, the nervous system releases neurotransmitters (notably nitric oxide) which cause relaxation of the smooth muscle in the cavernous arteries and the spongy tissues of the penis. This relaxation allows a massive influx of blood into the corpora cavernosa.
As these tissues become engorged with blood, they compress the peripheral veins, preventing the blood from flowing back out: this is the veno-occlusive mechanism that maintains rigidity. Any condition affecting one of these elements may result in erectile dysfunction.
The various causes of erectile disorders
Dr. Adam Vardi - Urologist & Andrologist in Paris
he pragmatic approach in andrology distinguishes between organic causes — predominant after 50 — and psychogenic causes, more frequent in younger patients.
Vascular and metabolic causes
Atherosclerosis (narrowing of the arteries) is the most common organic cause. As the cavernous arteries are of small caliber, erectile dysfunction may be the first sign of a more global cardiovascular condition. Diabetes, arterial hypertension, and excess cholesterol are major risk factors that damage the endothelium (the inner lining of the vessels).
Neurological and hormonal causes
Certain pelvic surgical procedures (radical prostatectomy, rectal surgery) may damage the nerves involved in erection. On the hormonal level, late-onset hypogonadism (LOH), characterized by a decrease in testosterone, may reduce libido, and impair the quality of erections.
Psychogenic and environmental factors
Stress, performance anxiety, depression, or relationship difficulties may inhibit the neurological mechanisms of erection, even in the absence of an organic lesion. Smoking, obesity, and a sedentary lifestyle systematically aggravate these disorders.
Diagnosis and treatment of erectile dysfunction in Paris
Urologist in Paris
The diagnostic work-up in andrology consultation
The consultation begins with a detailed history-taking to assess the onset of the disorder and its impact on quality of life (often using the IIEF-5 score). The clinical work-up systematically includes:
- Investigation of cardiovascular risk factors.
- Examination of external genitalia.
- Biological work-up (blood glucose, lipid panel, total and bioavailable testosterone).
In some complex cases, more advanced investigation such as a Doppler ultrasound of the corpora cavernosa with injection of a vaso-active substance may be required to precisely assess arterial flow quality and the efficiency of the maintenance system (veno-occlusion).
Therapeutic options: from medical treatment to shockwave therapy
The therapeutic strategy is graduated, ranging from the least invasive solutions to more specialized techniques.
Oral treatments (PDE5 inhibitors)
Phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, etc.) are the first-line treatment. They do not cause erection artificially but amplify the physiological response to sexual stimulation. Their use requires prior medical evaluation, particularly to rule out contraindications related to the use of nitrate derivatives (cardiac treatments).
Focused shockwave therapy (ESWT)
This is a major innovation in the treatment of vascular ED. Low-intensity shockwaves induce a micro-traumatization of cavernous tissue, stimulating the secretion of growth factors and the formation of new blood vessels (neo-angiogenesis). Advantages: It is a non-invasive, painless treatment that aims to restore physiological function rather than simply treating the symptoms.
Intracavernous injections (ICI)
In the event of failure of oral treatments, direct injection of a vaso-active substance (alprostadil) into the corpora cavernosa allows a mechanical erection within 10 to 15 minutes. The patient is trained in self-injection at the clinic.
Vacuum devices and penile prostheses
The vacuum device is a manual pump producing a blood inflow into the penis. Finally, for severe erectile dysfunction refractory to all medical treatments, the implantation of a penile prosthesis (inflatable implants) may be considered. This is a last-resort surgery offering a remarkably high satisfaction rate.
Conclusion and care philosophy
Erectile dysfunction should no longer be regarded as an inevitable or taboo subject. Early management not only restores a fulfilling sex life but also enables an essential overall health assessment. Dr. Vardi seeks to offer each patient a personalized, pragmatic, and scientifically validated solution, tailored to their expectations and health status.