Methods of therapy of patients with sexual disorders

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The topic that always arouses the constant interest of urologists, andrologists, psychologists, cardiologists and many other specialists is the diagnosis and treatment of patients with erectile dysfunction (ED). At one of the sessions of the XVII Congress “Men’s Health“, experts discussed methods of therapy for patients with sexual disorders, including those associated with COVID-19.

From drug therapy of symptoms to combined pathogenetic treatment

A leading researcher of the Department of Uroandrology said that conservative treatment of patients with ED includes therapy with phosphodiesterase type 5 inhibitors (PDE-5), the introduction of intracavernous injections, the use of vacuum and shock wave therapy, autoplasm enriched with platelet growth factors (AOT), treatment with stromal vascular fraction (SVF) cells. Today there are 5 potentially selective molecules of PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil and udenafil) having different duration of action, intensity and effectiveness, which is generally determined at 70%. The speaker also spoke about the reasons for the decrease in the effect of therapy with PDE-5 inhibitors in patients: “These are delayed evacuation of gastric contents, increased or decreased liver metabolism, decreased work of the circulatory system, deficiency of neuronal or endothelial nitric oxide synthase (after radical prostatectomy, in diabetes mellitus), differences in the permeability of the cell membrane for PDE-5 inhibitors, differences in sensitivity to phosphodiesterase at the molecular level.”

As for intracavernous injections of prostaglandin E1, their disadvantages include the complexity of teaching the patient autoinjections, the possibility of priapism and low patient adherence to treatment. In addition to prostaglandin E1, there are bi-mixes, tri-mixes, as well as tetra- and super-tetra-mixes involving a combination of either papaverine and phentolamine, or a combination of alprostadil with phentolamine and papaverine, or a combination of a vasoactive intestinal polypeptide with phentolamine. “The most effective (up to 90%) are quadro- and supra-quadro-mixes, which include papaverine, phentolamine, atropine and prostagladin. An alternative method is the form of alprostadil in the form of microsuppositories with intraurethral administration, which has not been widespread,” the speaker said.

Application of the thermal heliox method for the treatment of patients with ED: “Helium-oxygen mixtures have low density, high penetrating power, high thermal conductivity and heat transfer coefficient, low solubility in fats and water. The physiological effects of thermal heliox include their ability to improve the diffusion of oxygen through the alveolar membrane by increasing the capillary blood flow of the lungs, reducing respiratory resistance and reducing the work of the respiratory muscles due to the low density of the helium-oxygen gas mixture, relaxing smooth muscles and reducing the viscosity of sputum due to the high thermal conductivity of the heated gas mixture.”

Clinical experience of using the thermal helios method in the treatment of patients with ED, which has shown that in complex therapy this technique is effective and pathogenetically justified.

Shock wave therapy: obsessive advertising or the only pathogenetic treatment?

There are several devices on the modern market that perform shock wave therapy. The most common of them are piezoelectric: in them piezoceramic elements are embedded in a spherical device immersed in a liquid medium. When the voltage is applied to the ceramic elements, they expand, causing a mechanical disturbance in the medium, leading to the propagation of a shock wave, while water cooling is not used.

Sexual disorders in COVID-19

In an electrohydraulic device, the electrode tips are immersed in a liquid: when voltage is applied, the liquid evaporates, which causes rapid expansion of the surrounding liquid, leading to the propagation of a shock wave. The electromagnetic generator is based on an electromagnetic coil that generates an electromagnetic pulse. When a voltage is applied in the coil, a magnetic field occurs, causing a sharp movement of the metal membrane, which leads to a fluctuation of the liquid and the corresponding propagation of the shock wave. Water cooling is used here, which is often also used to correct the depth of focus through polymer lenses. Usually the depth of focus is regulated by a water cushion or using silicone lenses. There are also pneumatic devices that are not used in urology.

Psychogenic and vasculogenic ED

Urologist, andrologist of the Urology clinic noted: “While for many years there has been a belief that ED is primarily a psychogenic disorder, advances and advances in understanding the physiology of erection over the past three decades have made it possible to establish the organic causes of the problem. Currently, it is known that in more than 80% of patients with ED, the diagnosis is based on organic etiology. Among the organic causes, the most common is vasculogenic ED, which includes both insufficient arterial inflow and veno-occlusive dysfunction, also known as venous leakage.”

Sexual disorders in COVID-19

A sex therapist at the sexopathology clinic reported that during the pandemic, the risks of developing an anxiety spectrum of disorders, or more precisely, viral anxiety, including health anxiety and cyber–hypochondria as a repetitive or excessive search on the Internet for health-related information, are increasing. The presence of viral anxiety, which is disproportionate in its intensity or duration, significantly affects the quality of life.

Any stress is always associated with a deficiency of sex hormones, while sex hormones are always necessary to adapt to stress. Stress primarily affects the endocrine system, so the hormone prolactin is the first to react to stress, an increased level of which later leads to violations of both sexual and reproductive functions. With prolonged stress, hyperprolactinemia syndrome occurs: when competing with testosterone, this condition leads to a decrease in libido. Another key hormone cortisol (also an antagonist of testosterone) is produced by the body in response to stressful situations and diseases. It disrupts the functioning of the heart and immune system, as well as metabolism, moreover, high levels of cortisol can be life-threatening. It is not for nothing that during the pandemic there were works where it was shown that an increased concentration of cortisol increases the risk of death from Covid-19.

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