Las diferentes clases de disfunción.

Hay varias clasificaciones de la disfunción eréctil. La psicógena es característica de los pacientes jóvenes, sin factores de riesgo cardiovascular, en los que los mecanismos fisiológicos de la erección están íntegros; el paciente tiene erecciones matutinas o puede tener relaciones sexuales en determinadas situaciones. Esta disfunción puede deberse a la inhibición de la erección refleja por anticipación negativa, miedo al fracaso, a situaciones de estrés o de elevada ansiedad. Es también característico de pacientes que tienen una nueva pareja y llevan tiempo sin relaciones.

La disfunción eréctil de causa orgánica es la más frecuente y se da en pacientes a partir de los 40 años. En este caso, existen factores de riesgo que determinan el menor aporte vascular al pene. Estos pacientes pueden tener, además, una respuesta psicológica (pérdida de autoestima, miedo a las consecuencias de la actividad sexual,…) que empeora su situación.

Una de las preguntas clave para discriminar entre ambas situaciones es la presencia de erecciones matutinas o nocturnas claramente apreciadas por el paciente. Además, la presencia de erección en circunstancias sexuales no coitales, como son el juego previo o la masturbación permite diferenciar una disfunción psicógena u orgánica. Otros elementos diferenciadores son la edad y la forma de presentación, que suele ser brusca para la disfunción psicógena y lenta o insidiosa para la orgánica.
El estudio básico en consulta consiste en realizar una minuciosa historia clínica. Los antecedentes sexuales, las relaciones sexuales presentes, el estado emocional actual, el inicio y la duración del problema de erección, las consultas y los tratamientos previos son determinantes en la historia clínica del paciente.

Todos los pacientes deben ser evaluados para el estudio de sus niveles de testosterona (menor energía, libido, fatiga o dificultades cognitivas) además de enfermedades crónicas como la diabetes, HTA, enfermedades cardiovasculares o enfermedades psiquiátricas.

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