Erectile dysfunction

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The definition of erectile dysfunction (ED) refers to the inability to achieve and / or maintain an erection necessary for sexual intercourse. The relationship between a man and a woman is an important component of human life from the very beginning. At the same time, the sexual component of these relationships is of great importance for representatives of both sexes. One of the main characteristics of masculinity in the cultures of various peoples at all times was the ability of a man to perform a full sexual act, and the problem of the lack of this ability or erectile dysfunction has been known to medicine since ancient times. Historical documents of the Qing Dynasty (III–IV century AD) indicate that this condition in ancient Chinese medicine was well known and has long been regarded as a disease.

Erectile dysfunction is a common pathological condition.

ED is a very common pathological condition. It affects hundreds of millions of men around the world, and there is a persistent trend towards an increase in the number of patients. This is due to many reasons, including the deterioration of the ecological situation on the planet, the growth of urbanization, as well as the increase in the average age of the inhabitants of the Earth. The Massachusetts Male Aging Study (MMAS, 1994) found that 52% of men between the ages of 40 and 70 had some degree of ED. At the same time, the complete absence of an erection was revealed in 10% of men, moderate ED in 25%, minimal in 17%. 40% of men aged 40 to 50 years suffer from some kind of erectile dysfunction. Among men aged 50 to 60 years, erectile dysfunction occurred in almost half of the surveyed (48-57%), and in the older age group, 70% of men suffered from this disorder. Complete ED was detected in 5% of men under the age of 50, and in the older age group (70 years and older) in 15% of the examined patients. According to the German study (Cologne Male Survey), the frequency of ED was 10% in men aged 40-49 years, 16% – at the age of 50-59 years, 34% – at the age of 60-69 years and more than 50% – at the age of 70 to 80 years. In general, the frequency of occurrence of ED (age from 30 to 80 years) it was 19.2%.

Erectile Dysfunction

The importance of erectile dysfunction for men of different ages is difficult to overestimate. Erectile dysfunction (will buying viagra help in this matter?) leads to the development of anxiety, self-doubt and even depression, significantly reducing the quality of life of both patients and their partners. It is important to note that ED is not a necessary and inevitable consequence of aging and at any age is considered as a pathology that can and should be treated. Given the increasing trend towards later marriages, and therefore later births, ED is often the cause of infertility.

Erectile dysfunction is divided into groups depending on the causes of its development, that is, violations of certain mechanisms of erection. At the same time, psychogenic and organic erectile dysfunction are distinguished. The psychological causes of erectile dysfunction occupy a special place in the development of this disease. They can independently lead to erectile dysfunction, but more often psychological factors are layered on the organic cause of erectile dysfunction, which significantly complicates the diagnosis and treatment of this condition. The psychological causes of erectile dysfunction can be anxiety and depression, indifference to the partner, fear of the inability to perform sexual intercourse, conflicts between partners, inconsistency of sexual habits of partners, strong excitement before performing sexual intercourse, fatigue, in general poor health and health of the man. In favor of the psychological causes of erectile dysfunction, symptoms such as selective erection, the preservation of spontaneous erections, erections during masturbation, nocturnal erections (when a man notes an erection when he wakes up in the morning) speak.

The psychogenic form can be generalized and situationally dependent. Such patients need the help of an experienced sexologist or psychotherapist. Currently, it is proved that organic changes in the mechanism of erection are leading in the development of erectile dysfunction. All organic causes of erectile dysfunction are divided into endocrine, drug, local, neurological and vascular. Neurogenic erectile dysfunction is noted in various neurological diseases, such as spinal cord injuries, multiple sclerosis, neuropathies, epilepsy, and strokes. And also with damage to the nerve plexuses of the pelvis after radical operations on the rectum, bladder and prostate. The basis of hormonal erectile dysfunction is a violation of the synthesis and the relationship between different sex hormones. This form occurs relatively rarely, while being potentially curable. Hormonal disorders are usually manifested not only by erectile dysfunction itself, but also by other signs, including a decrease in libido. Replacement therapy, as a rule, allows you to restore the level of testoteron, libido and erectile function.

ED – Occurrence

It is believed that 25% of cases of ED are somehow associated with taking medications. For example, a Massachusetts study on male aging [2] found that the frequency of ED is 28% among patients receiving treatment for diabetes, 39% among cardiac patients, and 15% among hypertensive men receiving drug therapy. Currently, a large number of drugs are known that negatively affect various parts of sexual intercourse. Some of them have an effect on the central mechanisms of erection (antidepressants, hypotensive drugs of central action), others interact with the peripheral components of the arc at the level of the cavernous bodies (adrenoblockers). Clinical signs of drug-induced ED are a relatively rapid onset, a temporary association with the use of a drug that negatively affects various parts of sexual intercourse, and a decrease in the severity of the disorder or its complete disappearance after discontinuation of the drug. Most often, the occurrence of ED is associated with the use of antihypertensive agents, in particular, diuretics of the thiazide series and b – blockers.

A special place in the pathogenesis of erectile dysfunction is occupied by such diseases as arterial hypertension and diabetes mellitus. The main factor in the development of ED in this case is microangiopathy, which leads to a violation of blood circulation in the cavernous bodies. The flow of arterial blood to the penis is carried out through the dorsal and cavernous arteries, originating from the internal sacral artery. Further, the relaxation of the smooth muscle elements of the cavernous tissue leads to the filling of the lacunae with arterial blood. This, in turn, leads to compression of the subtunical and emissary venules and blocking the outflow of blood from the penis. This phenomenon is known as the veno-occlusive mechanism.

Hypoxia, hypercholesterolemia, hyperglycemia lead to phenotypic changes in the cavernous tissue, namely, to increased synthesis and accumulation of collagen with the outcome in cavernous fibrosis. Cavernous fibrosis is the main link in the pathogenesis of ED. 48 hours after the erection, the degree of hypoxia develops in the cavernous tissue, in which collagen synthesis is induced in the cavernous tissue. Oxygenation of the cavernous tissue occurs during the erection of the penis. In a man with normal sexual function, even if he is not sexually active, 4-8 episodes of spontaneous erection during a night’s sleep provide sufficient oxygenation of the cavernous tissue to prevent changes leading to fibrosis. In diabetes mellitus, existing microcirculation disorders are aggravated by progressive autonomic neuropathy. There is a correlation between ED and coronary artery atherosclerosis. These diseases have common risk factors – arterial hypertension, dyslipidemia, diabetes, smoking, “sedentary” lifestyle.

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