Erectile dysfunction ( ED ), also known as impotence , is a type of sexual dysfunction characterized by an inability to develop or maintain an erection of the penis during sexual activity. Erectile dysfunction can have psychological consequences because it can be attributed to relationship difficulties and self-image.
The most important organic causes of impotence are cardiovascular disease and diabetes, neurological problems (eg, trauma from prostatectomy surgery), hormone insufficiency (hypogonadism) and drug side effects. Psychological impotence is where the erection or penetration fails because of thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In psychological impotence, there is a strong response to placebo treatment.
In addition to treating underlying causes such as potassium deficiency or drinking water arsenic contamination, first-line treatment of erectile dysfunction consists of trials of PDE5 inhibitors (such as sildenafil). In some cases, treatment may involve prostaglandin tablets in the urethra, injections to the penis, penile prosthesis, penile pump or vascular reconstruction surgery.
Video Erectile dysfunction
Signs and symptoms
Erectile dysfunction is characterized by regular or recurrent inability to obtain or maintain an erection.
Maps Erectile dysfunction
Cause
- Drugs (antidepressants, like SSRIs, and nicotine are the most common)
- Neurogenic disorders
- Cavernosal disorder (Peyronie's disease)
- Psychological causes: anxiety, stress, and mental disorders
- Surgery
- Aged. This is four times more common in men in their 60s than those in their 40s.
- Kidney failure
- Diseases such as diabetes mellitus and multiple sclerosis (MS). Although both of these causes have not been proven, they are likely to be suspected of causing problems with blood flow and the nervous system.
- Lifestyle: smoking is a major cause of erectile dysfunction. Smoking causes impotence because it promotes artery narrowing.
Surgical intervention for a number of conditions can eliminate the anatomical structures needed for erection, nerve damage, or interfere with the blood supply. Erectile dysfunction is a common complication of treatment for prostate cancer, including prostatectomy and prostate destruction by external beam radiation, although the prostate gland itself is not required to achieve an erection. As far as inguinal surgical hernia is concerned, in many cases, and in the absence of postoperative complications, surgical repair may lead to recovery of the sexual life of patients with preoperative sexual dysfunction, while, in most cases, it does not affect patients with normal preoperative sexual life.
ED can also be associated with cycling due to neurological and vascular problems due to compression. The increased risk appears to be about 1.7-fold.
Concern that the use of pornography may lead to erectile dysfunction has not been demonstrated in epidemiologic studies according to a 2015 literature review. However, other reviews and case study articles suggest that the use of pornography does cause erectile dysfunction, and criticized the literature review described earlier.
Pathophysiology
Penile erection is managed by two mechanisms: the erectile reflex, which is achieved by directly touching the shaft of the penis, and psychogenic erections, achieved by erotic or emotional stimulation. The former uses peripheral nerves and the lower part of the spinal cord, while the latter uses the limbic system of the brain. In both cases, a complete nervous system is required for a successful and complete erection. Stimulation of the penis by the nervous system leads to the secretion of nitric oxide (NO), which causes smooth muscle relaxation of the corpora cavernosa (penile erectile tissue), and then penile erection. In addition, adequate testosterone levels (produced by the testes) and the intact pituitary gland are needed for the development of a healthy erection system. As can be understood from normal erection mechanisms, impotence can develop due to hormone deficiency, nervous system disorders, lack of adequate penile blood supply or psychological problems. Spinal cord injury causes sexual dysfunction including ED. Blood flow restriction may arise from endothelial dysfunction due to causes commonly associated with coronary artery disease, but may also be caused by prolonged exposure to light.
Diagnosis
It is analyzed in several ways:
- Getting a full erection at some time, such as nocturnal penis enlargement when falling asleep (when thoughts and psychological problems, if any, lack there), tends to show that the physical structure functions functionally.
- Another factor that causes erectile dysfunction is diabetes mellitus (causing neuropathy).
There is no formal test to diagnose erectile dysfunction. Some blood tests are generally performed to rule out underlying diseases, such as hypogonadism and prolactinoma. Impotence is also associated with poor physical health in general, poor dietary habits, obesity, and cardiovascular diseases are most specialized such as coronary artery disease and peripheral vascular disease. Therefore, a thorough physical examination is helpful, especially a simple search for an undetectable groin hernia as it affects men's sexual function and is easy to cure.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether or not the patient has had an erection. Otherwise, the problem may be physiological; if sometimes (but rarely), it can be physiological or psychological. The current diagnostic and statistical disease management manual (DSM-IV) has included a list of impotencies.
- Duplex ultrasound
- Ultrasound Duplex is used to evaluate blood flow, vein leak, signs of atherosclerosis, and scar tissue or erectile tissue calcification. Inject prostaglandins, hormone-like stimulants produced in the body, triggering an erection. Ultrasound is then used to look at vascular widening and measure penile blood pressure.
- Penile nerves function
- Tests such as the bulbocavernosus reflex test are used to determine whether there is enough neuronal sensation in the penis. The doctor squeezes the gland (head) of the penis, which immediately causes the anus to contract if normal nerve function. A doctor measures the latency between pressure and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted through the anus.
- Nocturnal penile tumescence (NPT)
- It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods to measure the changes in penile rigidity and circumference during nocturnal erection: measuring snap and stretch gauge. Most men who do not have sexual dysfunction still have no regular nocturnal erections.
- Biothesiometry penis
- This test uses electromagnetic vibrations to evaluate the sensitivity and nerve function in the glans and penis.
- Cavernosometry dynamic infusion (DICC)
- techniques in which fluids are pumped into the penis at known levels and pressures. It provides a measurement of vascular pressure in the corpus cavernosum during erection.
- Corpus cavernosometry
- Measurement of vascular pressure cavernosography in the corpus cavernosum. Saline is infused under pressure to the corpus cavernosum with the butterfly needle, and the flow rate required to maintain an erection indicates the rate of venous leakage. The leaky vein responsible can be visualized by inserting a mixture of saline contrast media and x-ray and performing a cavernosogram. In Digital Subtraction Angiography (DSA), images are obtained digitally.
- Magnetic resonance angiography (MRA)
- This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide a detailed picture of blood vessels. The doctor may inject "contrast agents" into the patient's bloodstream, causing vascular tissue to stand out against other tissues. Contrast agents provide enhanced information about blood supply and vascular anomalies.
Treatment
Treatment depends on the cause.
Exercise, especially middle-aged aerobic exercise is effective to prevent ED; exercise as a treatment is being investigated. For tobacco smokers, the cessation results in a significant increase.
Oral pharmacotherapy and vacuum erection tools are first-line treatments, followed by injections of the drug into the penis, and penile implants.
Medication
The PDE5 inhibitor sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs taken orally.
Creams that combine alprostadil with permeation enhancers, DDAIP has been approved in Canada as first-line treatment for erectile dysfunction.
One of the following medications may be injected into the penis: papaverine, phentolamine, and prostaglandin E1.
Pump
Vacuum erection tools help draw blood to the penis by applying negative pressure. This type of device is sometimes referred to as a penis pump and can be used just before sexual intercourse. Some types of FDA-approved vacuum therapies are available with a prescription. When pharmacological methods fail, a specially designed external vacuum pump can be used to achieve an erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penile pumps (provided without compression rings) which, instead of being used for temporary treatment of impotence, are claimed to increase penis length when used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants can be surgically removed.
Surgery
Often, as a last resort if other treatments fail, the most common procedure is a prosthetic implant involving the insertion of an artificial stem into the penis.
Alternative medicine
The FDA does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but there are no clinical trials or scientific studies supporting the effectiveness of these products for the treatment of erectile dysfunction, and synthetic chemical compounds similar to sildenafil have been found as adulterers in many of these products. The US Food and Drug Administration has warned consumers that any sexual enhancement product claiming to work as well as prescribed products tends to contain such contaminants.
History
During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as the legal basis for divorce. The practice, which involves the examination of complainants by court experts, was declared indecent in 1677.
John R. Brinkley started an explosion on male impotence drugs in the US in the 1920s and 1930s. His radio program recommends expensive goat gland implants and "mercurochrome" injections as a way to restore male virility, including surgery by surgeon Serge Voronoff.
Modern drug therapy for DE made significant progress in 1983, when British physiologist Giles Brindley dropped his trousers and showed the audience of the Urodynamics Society who was shocked about papaverine-induced erection. The Brindley drug injected into the penis is a non-specific vasodilator, an alpha-blocking agent, and a mechanism of action is clearly a smooth muscle relaxation of the body. The effects Brindley found formed the foundations for the development of effective, safe, and effective oral therapy drugs.
Lexics
The Latin term impotentia coeundi describes the simple inability to insert the penis into the vagina; now mostly replaced with more precise terms, such as erectile dysfunction (ED). The study of erectile dysfunction in medicine is covered by andrology, a subfield of urology. Research shows that erectile dysfunction is common, and it is recommended that about 40% of men with erectile dysfunction or impotence, at least occasionally. This condition is also on occasion called phallic impotence . Anonymous or otherwise conditions are priapism.
References
External links
- Erectile dysfunction in Curlie (based on DMOZ)
Source of the article : Wikipedia
0 Comments