There are three types of treatment for erectile dysfunction available in Portugal: oral therapy, penile injections, and, as a last resort, reconstructive surgery with penile prosthesis implantation.

Improvement in male sexual function in men with erectile dysfunction is often associated with the use of medications such as Sildenafil and Tadalafil. However, these medications are not always effective, depending on each case.

Although this is the first-line treatment available, there are also clinical alternatives, such as intracavernosal injections, which may be considered in certain situations.

The choice of the most appropriate therapeutic approach should always be based on an individualized medical evaluation. For this reason, men should never self-medicate, in order to avoid the risk of side effects such as priapism and the formation of fibrosis.

Oral medication or penile injection?

When the patient arrives for consultation, what the urologist aims to do is prioritize erectile dysfunction treatments that do not require surgery — that is, clinical treatments. However, it is important to emphasize that this is not always feasible.

Thus, after the clinical evaluation, the discussion with the patient, and the performance of tests, if the clinical situation allows, the urologist may indicate first-line treatment, consisting of phosphodiesterase type 5 inhibitors (PDE5 inhibitors), such as Sildenafil and Tadalafil.

If there is improvement in erectile function with these drugs, treatment is maintained. If there is no progress, even after medication adjustments, the urologist may consider a second-line therapy, namely through intracavernosal injections.

Treatment may be carried out through intracavernosal injections, using individualized formulations based on medications such as Alprostadil, Papaverine, and Phentolamine. The patient carefully applies the injections into the corpora cavernosa of the penis a few minutes before sexual intercourse.

If injectable treatment does not produce a positive effect, even after adjustments to the formulation, there may be an indication to proceed to surgical treatment.

Clinical treatments work by increasing or improving blood flow to the corpora cavernosa of the penis, potentially contributing to sufficient penile rigidity for satisfactory sexual intercourse.

Side effects of Sildenafil and Tadalafil

Oral medications for weak erections are effective in most mild to moderate cases. However, the patient and the physician should not overlook the disadvantages of these drugs.

In general, Sildenafil and Tadalafil may cause some side effects:

• Headaches;
• Nasal congestion;
• Facial flushing;
• Muscle pain;
• Back and leg pain.

It is worth remembering that side effects may vary from patient to patient, and some patients may not experience any symptoms at all.

The urologist should adjust the most appropriate medication to reduce side effects. The goal is to find the lowest effective dose that may provide adequate penile rigidity for penetration and that can be maintained until orgasm.

In addition, coronary artery disease may contraindicate these medications. For this reason, the urologist and the cardiologist should work together to determine whether the patient can or cannot use this type of drug.

For them to work, the patient should take the tablets some time before sexual activity, allowing the body to absorb the substance. In some cases, taking them on an empty stomach may favor absorption, and this guidance should be individualized.

Disadvantages of Intracavernosal Injection

There are some negative aspects that should be considered before opting for injectable treatment, although this is a type of erectile dysfunction treatment used in certain clinical cases.

In addition, when used at doses higher than recommended, it may favor the occurrence of priapism, a urological emergency. In this situation, the penis remains erect for more than three hours, even without erotic stimulation. Consequently, the blood inside the penis is no longer adequately renewed, and the tissues may undergo cell death, potentially progressing to permanent erectile dysfunction.

Some men prefer that their partner not be aware of the applications. As some medications need to be stored in the refrigerator, maintaining discretion may become more difficult, which may generate some embarrassment.

Penile injection is an erection-inducing method. This means that, in order to achieve an erection with this treatment, erotic stimulation is not required, which may reduce spontaneity in sexual life. However, when erotic stimulation is present, the sexual response and the quality of the intimate moment tend to be better.

Erectile dysfunction treatment in Portugal

There are different types of erectile dysfunction treatment in Portugal, which vary according to the cause and severity of the problem. In many cases, clinical approaches help improve blood flow to the penis, allowing sufficient rigidity for satisfactory sexual intercourse.

To better understand how these therapeutic options work, you may watch the video below about the differences between intracavernosal injection, Tadalafil, and Sildenafil.

It is worth remembering that when clinical treatments do not produce the desired results, there is also a surgical option that may be considered in certain cases, with penile prosthesis implantation.

If you have doubts about which treatment may be most appropriate for your case, schedule an evaluation with a urologist in Lisbon or Porto. Contact our men’s health clinic and arrange your appointment.