“Since the pandemic broke out, we have been inundated with requests for help from men with erectile dysfunction problems.” To speak is Fabio Castiglione, 37 years old, andrologist and urologist of Sicilian origins. Today he works at the University College Of London Hospitals (UCLH) and was most recently awarded the European Society for Sexual Medicine’s 2022 Award of Excellence. Castiglione reports an increase of “at least 40%” in requests for help in the last two years, precisely coinciding with the Covid-19 emergency. Requests come from all over the world, even from very young men. We look for the best, that is, quick, effective and lasting treatments. Like those promised by new therapeutic approaches, such as PRP, shock waves and stem cells.
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Why have requests for help increased with the pandemic?
“Basically for two reasons. The first has to do with the stress of living a difficult and complicated situation: it has long been known that psycho-emotional disorders can have an impact on the sexual sphere, causing a disorder and aggravating an already existing one. the second reason is linked to lockdowns and the greater time spent at home with the partner. It is possible that the greater opportunities for contact with the partner have brought to light old problems, which may have been underestimated before. a third reason, but still today it is only a hypothesis under study and that is that the Covid-19 infection may have directly or almost directly caused erectile dysfunction problems “.
What are the problems for which men ask for help?
“Usually they are problems with erectile dysfunction or in general due to the appearance of one’s genitals. The real question we should be asking ourselves: how long does it take before a man decides to go to a specialist to deal with a problem that concerns the sexual sphere “I’m sorry to say but it goes a long way. Too much. And in the meantime they try to look for dubious solutions on the web, which is a sort of wild west, in which treatments are boasted that at best are useless and in many cases are harmful. I often have to remedy these damages. It is not even easy to find the right specialist, the one who has the skills to tackle certain problems “.
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A degree and a qualification are not enough?
“Unfortunately not. Our work is in some ways” artisanal “, in the sense that the results depend a lot on the experience and sensitivity of the individual specialist. And then in this far west there are also cowboys with no qualifications and no skills. ‘so that I found myself visiting patients who have taken drugs for horses or who have undergone silicone injections in the genitals. Often “do it yourself” is used, other times the mistakes depend on poorly trained specialists, such as urologists with poor andrological preparation “.
Are there no therapeutic protocols?
“Yes, there are new therapies, but at the moment we do not have precise and standardized recommendations because not enough scientific studies have been done. Sometimes the patient needs combinations of different therapies or could solve problems with a specific treatment that the specialist does not. it performs or does not consider. This is why we are working on the creation of new guidelines capable of directing doctors towards therapeutic approaches that are more appropriate to the situations “.
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In addition to the classic drugs for erectile dysfunction, such as the famous ones that are taken a few hours before sexual intercourse, are there any definitive or at least lasting treatments?
“In reality there are also drugs that can be taken every day as you do with the ‘aspirinetta’, to always be ready. But there are also new therapies that, both individually and in combination, are proving to be very effective. sometimes they are decisive, other times they last for years and then need some reminder “.
What are the main innovations for the treatment of erectile dysfunction?
“PRP, schockwave and stem cells. They can be used singly or, better yet, in combination. Platelet-enriched plasma (PRP) is a preparation that is obtained by centrifuging the patient’s blood to remove red blood cells. The plasma obtained is rich in platelets containing various growth factors. PRP injection is applied in andrology for the treatment of erectile dysfunction due to penile vascularity deficiency, with possible fibrosis of the corpora cavernosa and for the treatment of curved penis (or La disease Peyronie). The scientific data available to date are limited but promising. The scientific results are instead much more solid for treatment with shockwave, low intensity shock waves that act on the arteries mainly determining the release of vascular growth factors and activating stem cells. This reduces fibrosis and improves blood flow to the penis. Promising, but still in the experimental phase, the treatment based on stem cells: although not having much data on humans, animal studies show that the injection of these cells into a diseased system helps to restore and regenerate the tissues “.
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Which of these therapies can be considered the best?
“We cannot say that one treatment is better than another in general. Much depends on the individual patient and also on the skills of the specialist. Not infrequently they are used in combination, an approach that we have been studying for some time now and that seems to be very promising” .