Erectile Dysfunction

Definition

Called erectile dysfunction erection insufficient for full sexual intercourse. Said diagnosis is based on patient complaints at a constant or periodic manifestation of the violation within 3 months or more. Formerly called impotence, erectile dysfunction, but the general solution experts this name was removed from use in medical practice. This was due to the fact that this disease patient called impotent that psychologically traumatized many patients.

Prevalence

According to current data, erectile dysfunction affects about 16% of the male population in the world. But among men over 40 years old said sexual violation is found in almost half the cases.

Classification and Diagnosis

When stating the erectile dysfunction much attention is paid by the subjective assessment of her man. Today, thanks to the existence of a question - 5 questionnaire International Index of Erectile Function (IIEF -5) and the doctor and the patient can quickly get an answer to the main question: whether there is erectile dysfunction and what their severity? Regardless of the degree of erectile dysfunction drugs will always help to increase potency. Here is a link.

Once the diagnosis of erectile dysfunction is made, it is important to determine what the causal factors of this condition. In general, erectile dysfunction can be divided into a number of organic and psychogenic. Initiated psychogenic erectile dysfunction occurs when a strong emotional impact. They can be caused unflattering remarks against sexual opportunities by male partner, strong shocks (eg, death of a loved one or close), sexual violence experienced in childhood, errors in education, etc. Diagnosis and treatment of these conditions is the lot of the sexologist (psychiatrist specialization), which directs the patient androlog or urologist with a corresponding suspicion that arose during the first consultation.

Organic causes of erectile dysfunction are subdivided into vascular, neurogenic, hormonal and iatrogenic. The most frequently (in 40 % of cases) erectile dysfunction occurs when blood circulation disorders in the penis. In this regard it should be noted that the changes are quite common in the arterial vessels, bringing blood to the penis . In most cases, this is due to a narrowing of the lumen when an atherosclerotic lesion. The reason for this is the increased level of cholesterol, which is one of the major fractions of blood fat. Atherosclerosis is by far the primary cause of cardiovascular mortality in the male population. Myocardial infarction occurs when atherosclerotic plaque filled arterial vessels of the heart. However, the coronary artery in 4 times wider in diameter than the arteries of the penis and it is therefore preceded erectile dysfunction circulatory disorders in the cardiac muscle. It's worth to know every man and not delay seeking medical attention if Erection disorders, especially at risk - over 40 years.

Arteriogenic erectile dysfunction occurs frequently and with such serious diseases as diabetes and final (terminal ) stage renal failure. As in this and the other case, the mechanism is implemented toxic lesions of arterial vessels in the penis. Furthermore, patients with these diseases usually have severe atherosclerosis. In connection with the above, to avoid diabetes and severe renal insufficiency in patients with erectile dysfunction examination is important to conduct research on blood glucose and nitrogenous wastes.

Violations of penile blood flow may also due to changes in the veins of the penis. However, they typically lose valve function, thereby leakage of blood and prevents an erect organ erection. Sometimes it's a congenital condition associated with the so-called weakness of the connective tissue. These patients often occurs varicose veins of the lower extremities, hemorrhoids and other venous diseases.

In some cases venogennye erectile dysfunction associated with trauma legs penis, located in the perineum. Such injuries frequently occur when riding a bicycle, motorcycle or horse, as well as in case of accidental blunt trauma of the perineum.

Often excessive outflow of venous blood from the penis accompanied by testosterone deficiency, which is the primary male sex hormone. This is explained by excessive development of adipose tissue around the veins of the penis, as a result they can not carry out the function of the valve.

It should be emphasized that the arteriogenic and venogennye erectile dysfunction can be combined. In this regard, the evaluation of patients with erectile dysfunction should be used the most informative methods for estimating the blood supply of the penis. To date, such is the Doppler blood vessels of the penis. This method allows to evaluate blood flow in the body at rest and during erection, stimulated by a special drug that is administered by injection painless.

Neurogenic erectile dysfunction occurs when damaged cavernous nerves involved in erection. Usually it happens in traumatic lesions of the pelvic bones with rupture of the urethra. As is known, the cavernous nerves accompany him and inevitably damaged by trauma.

Non-traumatic nature of the damage to these nerves is possible with such severe suffering as diabetes and end-stage renal failure. In both cases we are talking about a toxic lesion of the cavernous nerves, which leads to severe erectile dysfunction.

For the diagnosis of neurogenic erectile dysfunction used electromyography penis. Currently in Russia, this technique shows little, owing to its complexity and the need for skilled personnel and expensive equipment . Electromyography of the penis to determine not only the presence but also the severity of the neural structures involved in erection. In this connection, it is expedient to use this method at the slightest hint neurogenic erectile dysfunction.

Hormonal causes of erectile dysfunction are most commonly associated with testosterone deficiency . This condition is called hypogonadism, which often occurs in middle and old age (after 45 years), but can also occur in young men. Testosterone deficiency leads to inhibition of the cascade of biochemical reactions that provide an erection. Therefore, the diagnosis of the causes of erectile dysfunction should necessarily determine testosterone levels. In addition, it is necessary to define the hormones that directly affect its production (luteinizing hormone) and defining its transformation into tissues (estradiol).

Endocrine erectile dysfunction may be also linked excessive production of prolactin. This hormone allows the production of milk in nursing mothers, but in men it does not perform any important functions. Excess release of prolactin (hyperprolactinemia) can be observed in benign pituitary tumor (prolactinoma); that requires mandatory implementation of special studies - magnetic resonance imaging, to rule out malignancy in the brain. Slight increase in the content of this hormone in the blood may occur with prolonged emotional stress. Therefore, prolactin hormone substance called stress.

The mechanism of inhibition of erection in hyperprolactinemia associated with antagonistic activity against testosterone. The level of the latter can be completely normal. That's why, when diagnosing the cause of erectile dysfunction should necessarily determine the level of blood prolactin levels.

Detrimental effect on the endocrine erections may also have thyroid hormones. How to find the same effect described is realized through antagonism testosterone. For this reason, in the range of diagnostic methods for erectile dysfunction include necessarily determine the level of thyroid hormones.

Iatrogenic causes of erectile dysfunction are a particular topic. Iatrogeny - this injury caused during those or other therapeutic measures. In most cases, it is the unintended harm associated with the side effects of some drugs used, such as cardiovascular and mental diseases, ulcers, gout and other pathological conditions. Cancellation or replacement drug degrades erection problem usually exhausts.

But there are situations when cancel product having antierektogennym action impossible. For example, prostate cancer is often used medications that suppress the development and implementation of the physiological effects of testosterone. Absolutely clear that the abolition of these funds will lead to rapid progression of cancer process and the patient's death.

It is noted that treatment of prostate cancer are often accompanied by erectile dysfunction. When you try a more aggressive treatment modalities associated with the destruction of (hi- fu therapy kriolechenie, radiotherapy) or removal of the tumor (radical prostatectomy) is damage to the cavernous nerves, which lie on the surface of the prostate gland. Usually this entails severe neurogenic erectile dysfunction severity. These " side effects" of the patient tell you beforehand. But, unfortunately, in most domestic clinics while not offering effective and timely approach for correction of erectile function. In order to avoid this, oncologists and andrology should jointly conduct prostate cancer patients wishing to maintain an erection after treatment of prostate cancer lesions.