[Erectile dysfunction from a urological perspective]

Erectile dysfunction is the continuous or recurring inability to get or to maintain an erection rigid enough for sexual activity. Non-urologists will often restrict themselves to counselling, lifestyle advice or the prescription of an erection pill. However, most erection pills are manufactured and traded illegally. The Dutch Institute for Rational Use of Medicine has repeatedly pleaded the case for over-the-counter trading, but the Dutch College of General Practitioners opposes this. It is the needs expressed by the patient and the appropriate expertise rather than the cause of the problem that determine referral. For some patients intracavernous self-injection with vasoactive substances may be an acceptable solution. Implantation of a penile prosthesis is currently carried out under stringent conditions at a limited number of healthcare centres. In the 2018 Dutch urological training programme, residents are able to apply for an internship in andrological urology and engage in the diagnosis and treatment of sexual dysfunction.