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Erectile dysfunction: what is the problem and how to get rid of it?

erectile disfunction
ICD-10F 52.2 52.2, N 48.4 48.4
ICD-9302.72 302.72 , 607.84 607.84
Diseasesdb21555
eMedicinemed / 3023
MeshD007172
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Erectile disfunction, impotence (Latin impotens - impotent) - an erection dysfunction in which the volume of a man’s penis, its hardness and directness are insufficient for sexual intercourse.

The Latin term “impotentia coeundi” describes a man’s inability to enter the penis during any form of penetrative sexual intercourse and complete copulation due to the absence or termination of sufficient penile tension. However, this term has become obsolete and has not been used in international literature in the last decade. It is considered outdated, inaccurate and having unreasonably condemning overtones. Instead of “impotence” they speak of “erectile dysfunction” or “erectile dysfunction”. Erectile dysfunction is not directly related to a man’s ability to perform ejaculation - ejaculation. There are many causes of erectile dysfunction, such as diabetes. Some causes of erectile dysfunction are irreversible.

Since the Middle Ages, doctors and pharmacists have attempted to develop drugs for the treatment of erectile dysfunction, but such a drug was developed only in the mid-1930s. The emergence of a significant number of new drugs opened up new aspects of the influence of drugs on the sexual function of a person. In the 1990s, with the discovery of new properties of sildenafil, interest in the treatment of erectile dysfunction increased.

Medical symptoms

Erectile dysfunction - a persistent inability of a man to have sexual intercourse in full. With normal sexual function, sexual intercourse (for men) consists of sex drive (libido), lovemaking for at least 5 minutes, an erection, insertion of the penis, dozens of frictions within a few minutes, completed by ejaculation - ejaculation and the appearance of an orgasm. The absence of any component determines the impossibility of a full sexual intercourse and gradually leads to a violation of the remaining components. Most often this is due to impaired erection or ejaculation.

Usually, disorders of sexual function are not independent diseases, but exist and develop as concomitant. So, erectile dysfunction can occur with endocrine disorders, for example, diabetes mellitus (it causes neuropathy), hypogonadism (a decrease in testosterone due to impaired pituitary or testicular functions). It can also be associated with various urological diseases, lesions of the centers of regulation of sexual functions located in the cerebral cortex. Erectile dysfunction caused by these causes is classified as organic.

A common cause of erectile dysfunction is painful intercourse, either for a penetrating partner or for a receiving partner.

However, in most cases, erectile dysfunction is associated with neuropsychiatric disorders (neurosis, neurotic state in various diseases, depression, etc.). This is the so-called psychogenic erectile dysfunction. Erectile dysfunction can manifest itself as a side effect of taking many common medications: antihypertensive, psychotropic, drugs that suppress the central nervous system, some estrogens, and anti-cancer drugs. Organic and psychogenic impotence manifest themselves in different ways.

Psychogenic Erectile DysfunctionOrganic Erectile Dysfunction
Sudden startGradual onset
PeriodicProgressive
SituationalConstant
Associated with any psychological stressIt is associated with any disease or taking certain drugs.
Night / morning erection savedNo night / morning erection
During intercourse, penile tension persistsDuring intercourse, penile tension may disappear
Normal erection during masturbationProblems with erection, including masturbation

Types of Erectile Dysfunction

In normal condition, intercourse in men consists of several stages. First comes sexual attraction and foreplay. Then comes an erection and the subsequent introduction of the penis into the partner. Further, the fulfillment of a certain amount of frictions over a certain amount of time follows, leading to ejaculation and the onset of orgasm. If something is violated or missing in this chain, it entails the impossibility of having normal sexual intercourse and violates the rest of the components. Most often it affects erection and ejaculation.

The simplest to treat is a temporary (weak) erectile dysfunction in a man, and the most common cause in this case is alcohol abuse or some kind of fear.

With such manifestations, it is necessary to remove the root cause and the normal functioning of the body will restore by itself. In other words, you need to stop drinking, smoke, more likely to be in the fresh air and be optimistic about the future.

It is much worse when erectile dysfunction becomes permanent, chronic.

According to recent studies in this area, more than half of all manifestations of this dysfunction are due to physiological causes.

Next, there are the psychological causes of impotence, which may be stress or fear, dissatisfaction with yourself, your life, some emotional breakdowns. In medicine, erectile dysfunction in men is divided into three types (for reasons of occurrence): organic, psychogenic and mixed (their manifestations and methods of treatment are also different).

Causes of Erectile Dysfunction

Psychological (psychogenic), organic and mixed forms of ED are distinguished. Most men explain erectile dysfunction problems with organic disorders. Indeed, ED in some cases arises as a complication of various somatic diseases. These include diabetes mellitus, vascular diseases, neurological disorders, hormonal disorders, physical trauma, hypothermia, or burns in the pelvic area. The connection between impaired sexual functionality and the poor environment where a person lives, for example, when exposed to radiation, chemicals, etc., has been proven. In addition, sexual dysfunction can be a side effect of certain medications, a consequence of surgery and injuries in the pelvic area.

It is a common misconception among men that erectile dysfunction appears with age. This is not so - age as such is in no way associated with impaired potency. The likelihood of various diseases increasing with age increases, but diseases turn out to be the true “culprits” of potency disorders. Alcohol abuse, smoking, a sedentary lifestyle also negatively affect erection and can lead to erectile dysfunction.

The older the man - the higher the likelihood of having chronic diseases that are not directly related to the genital area, but require a long (or constant) medical treatment. Many drugs are characterized by a negative effect on potency, and the mechanisms of development of such a side effect are different. Most often, erectile dysfunction is caused by the effect of drugs on the central nervous system. Such a mechanism is characteristic of psychotropic drugs (antipsychotics, tranquilizers, some antidepressants), many antihypertensives (beta-blockers, central adrenergic agonists), first-generation antihistamines (diphenhydramine, chloropyramine, clemastine, etc.).

Symptoms and manifestation

Organic erectile dysfunction can occur with endocrine disorders or a decrease in testosterone levels, and its manifestation can be affected by various urological diseases or disorders responsible for this, receptors in the brain. The effects of certain diseases, such as prostatitis or prostate cancer, may also affect.

Usually, this type of erectile dysfunction manifests itself gradually and its first signs are hardly noticeable. She occurs constantly and progresses over time. At the same time, there is no night or morning erection, and during sexual intercourse it can suddenly disappear. At the same time, sex drive and ejaculation remain normal.

Venous erectile dysfunction occurs in case of violation of the mechanism of regulation of blood outflow from the tissues of the penis. It can also occur with arterial and vascular disorders. The so-called disturbance of microcirculation. The cause of this type of erectile dysfunction may be hypertension, smoking, etc.

The manifestation of such erectile dysfunction is markedly different from organic. She has not a gradual but a sudden onset. However, it appears periodically, but does not progress. At the same time, night or morning erections are present and during intercourse an erection is maintained.

With mixed manifestations, both organic and psychological factors may be present.

For a long time it was believed that the main cause of erectile dysfunction is psychological problems. Men attributed their failures to stress, depression, turmoil and disagreement in family life. However, recent studies in this area have shown that psychogenic dysfunction occurs in only 20% of cases. Most of them are organic.

Taking certain medications can also affect its manifestation.

These are mainly psychotropic medications and drugs that affect the functioning of the central nervous system. Anabolic drugs, the so-called anabolics, can also have side effects. The same intake of steroids can adversely affect potency.

Another popular misconception is related to the age at which this disease can manifest itself.

By itself, age is in no way associated with these manifestations. Diseases that appear in men with age can affect. But these diseases may appear earlier.

Also the older a person becomes, the higher his risk of chronic diseases leading to this result. erectile disfunction at a young age can be associated with both the factors described above and with increased consumption of alcohol, cigarettes, and, in some cases, narcotic substances.

Erectile dysfunction can also be a symptom of another, more serious disease that the patient may not notice at an early stage.

Ultrasound diagnosis is used to identify organic causes of erectile dysfunction.

In this case, an analysis of blood flow in the tissues of the penis and the size of the venous outflow.

The penis is examined for impaired microcirculation in its vessels and tissues. After examining the non-erect penis, a special stimulant is introduced into the body, which causes an erection. Further, under ultrasound, they observe how the vessels expand, measure the blood pressure in them.

After that, the results obtained are compared with those that were obtained at rest, and on this basis a conclusion is drawn.

Ultrasound

Ultrasound examination (pharmacodopplerography of the penile vessels) is used to assess blood flow in the cavernous bodies of the penis, determine the magnitude of the venous outflow, signs of vascular atherosclerosis, scarring or calcification of erectile tissue. After the introduction of an erection-causing drug (papaverine, alprostadil, etc.), ultrasound is used to observe vasodilation and measure blood pressure in the vessels of the penis. The results are compared with the results taken when the member is in a non-erect state.

Cavernosography is a type of contrast x-ray study, which is an x-ray of the erect penis in several projections after the introduction of radiopaque drugs. Cavernosography is used to identify veins through which pathological venous blood outflow occurs during venogenic erectile dysfunction. Cavernosography also helps assess the structure of the cavernous bodies of the penis, the presence of foci of sclerosis or atrophy, and plaques in Peyronie's disease.

Testing the nerve endings of the penis (erectile dysfunction test)

To identify dysfunction of the nerve endings of the penis test a specific reflex. Pressing the head of the penis should cause an instant reduction of the anus. In this case, the doctor, at this moment, can palpate the hole with a finger, checking the reaction of nerve endings.

If during this procedure any violations were detected, then the doctor may prescribe additional tests to check the functioning of the nerve.

Read about the effects of varicocele. Perhaps you should check for the presence of this disease.

And here read about the causes of varicocele.

Penis innervation testing

To determine the functional state of the nerves of the penis, a bulbocavernos reflex is tested. The doctor presses on the head of the penis, which normally should immediately cause a reduction in the anus. The doctor measures the latency of this reflex, observing the contraction of the anal sphincter, or palpating the sphincter with a finger. If there is a suspicion of nerve damage or diabetes, special tests are performed to check the function of the nerve.

Registration of nocturnal erections

Four to six erections can occur in men over night. This especially occurs in the phase of deep sleep.

To research this area use a special sensor. It is attached to the penis and nightly erections are recorded. If their absence is detected, then this indicates a problem with the blood circulation of the penis or problems with its nerve endings.

At a young age, there is mainly hypersensitivity, which leads to early ejaculation.

What it is?

Every young man, starting from adulthood, at least once noted symptoms of erectile dysfunction, expressed in insufficient stiffness of the penis at the time of arousal. But the disease is ascertained only when a qualitative erection in a man does not occur in every fourth sexual intercourse.

Nocturnal erections

In a healthy man, an erection occurs during sleep. This happens about five to six times, especially during paradoxical sleep. The absence of nocturnal erections indicates a problem with the innervation of the penis or with its blood circulation. There are techniques that allow you to register a nightly erection. They consist in the fact that a sensitive sensor is attached to the member.

Risk factors

With age, the risk of getting sick increases: if the patient's symptoms of impotence after the onset of 21 years occur in 10% of cases, then after overcoming the 60-year milestone this figure increases to 30%.

According to statistics, only 20% of men with weak erectile function come with complaints to a specialist. But the majority of the male population of the planet does not see this as necessary, since they do not know that there are ways to treat impotence.

Many tend to believe that impotence is a phenomenon that inevitably accompanies aging.As a result of this, more than half of the male population with weak erectile function do not seek help from qualified medical centers.

It often happens that the symptoms of impotence in men are a consequence of the development of a chronic disease in the body (for example, diabetes mellitus, atherosclerotic processes, pre-stroke conditions, etc.). That is why most impotent people are elderly patients.

Male impotence is a very serious test, as it is not only a physiological, but also a psychological problem. In order to clearly understand what erectile dysfunction is, what are the symptoms, problems, due to which internal and external factors impotence can occur in men, causes, treatment, it is necessary to understand how an erection occurs normally.

Penis Biothesiometry

This test uses vibration to evaluate the sensitivity of the penis and its innervation. A decrease in sensitivity to vibration may indicate that the inversion is violated, which may be due to diabetes mellitus, neuropathy or aging of the body. Sensitization occurs at a young age and is often the cause of early ejaculation in adolescents. source not specified 1805 days

A few words about physiology

There are 2 key elements in the structure of the penis - the cavernous and spongy bodies.

The tissues of the cavernous body are spindle-shaped and lie close to each other. The spongy body, which gives rise to the head of the penis, is surrounded by tissues of the corpus cavernosum. These 2 structures do not have common blood vessels, each of them has its own separate circulatory system.

The spongy and cavernous bodies are similar in structure to a sponge. This similarity is ensured by the mass of small lacunae (caverns) in the tissues of these bodies. A similar device of the penis and provides the phenomenon of erection.

An erection is a process accompanied by an increase in the size of the penis with a simultaneous increase in its elasticity. This modification of the organ occurs due to the filling and stretching of the tissues of the corpus cavernosum at the time of excitation. Erection is a complex complex process in which 3 body systems simultaneously participate: the central and peripheral nervous system, as well as the smooth muscles of blood vessels and the cavernous body of the penis.

Penis tension and relaxation is a vascular phenomenon controlled by the central nervous system. At the time of excitement, the structures of the peripheral nervous system are activated in the male body, which entails a cascade of complex chemical transformations, as a result of which the vascular walls of the cavernous body relax and blood enters into them.

The pressure in the vessels of the penis increases, which leads to compression of the veins and slowing down the outflow of blood. These 2 processes - an increase in pressure in the cavernous body and a slowdown in blood circulation - stimulate a condition called an erection.

The causes of impotence in men lie in the violation of one or a complex of the processes described above. If they progress, impotence occurs.

Signs of impotence

Erectile dysfunction, the symptoms of which are conditionally divided into 3 groups:

  • lack of sexual desire (libido),
  • absence or weak erection,
  • lack of orgasm (anorgasmia) and ejaculation.

Problems with libido are the most common symptom of erectile function in men. This symptom is directly related to emotional experiences, fatigue and general malaise.

Unwillingness to intimacy can be caused by several reasons:

  • misunderstanding between partners,
  • depression
  • violations of the endocrine system (in particular, a decrease in testosterone synthesis).

Impotence signs can occur against the background of pathologies of the circulatory system. Lack of ejaculation can occur due to psychological problems in the patient.

The rarest disorder with impotence is anorgasmia. It can be temporary or permanent and is usually caused by severe stress in a man.

Video: "Erectile Dysfunction - Causes"

Pathophysiology

An erection is controlled by two mechanisms. The first is a reflex erection that occurs when you touch the penis. The second is a psychogenic erection, which occurs as a result of erotic stimuli. Reflex erection is controlled by peripheral nerves and parts of the lower part of the spinal cord. Psychogenic erection is controlled by the limbic system of the brain. Neurological disorders of these reactions can lead to impotence. With the development of a reflex erection, stimulation of the penis causes the release of nitric oxide, which in turn leads to relaxation of the vessel walls source not specified 3587 days in the cavernous bodies of the penis. The cavernous bodies are filled with blood and an erection occurs. An adequate level of testosterone in the blood is also necessary for the development of an erection. Thus, impotence can occur due to a disorder of the hormonal system, diseases of the nervous system, insufficient blood supply to the penis, or psychological problems.

Types of Erectile Dysfunction

Experts classify impotence depending on the causes and approaches to its treatment.

Erectile dysfunction may be:

  • psychological (psychogenic) (20% of cases),
  • organic (75%),
  • mixed.

Each type of impotence has its own characteristics.

For example, the psychological type is characterized by a sudden onset. This is due to difficult experiences, psychological stress, or problems between sexual partners. At the same time, the man retains an erection in the morning and the state of the penis during sexual contact.

Organic type of pathology develops in stages, it becomes more difficult for a person to maintain a normal erection every time. This is due to the development of diseases of other organs and systems that need to be cured.

From the erectile dysfunction of the organic type, the patient remains sexually attracted and able to ejaculate, but erections disappear at night.

In addition, during sexual intercourse, the tissues of the penis can suddenly lose their necessary elasticity and tension.

The combined organic and psychological signs of impotence in men indicate a mixed type of pathology. It is necessary to treat it comprehensively, using several methods.

Prevention of Erection Disorders

To prevent the development of erectile dysfunction, it is required:

  • lead a healthy lifestyle, eat right and regularly, play sports, monitor your health,
  • do not smoke, do not abuse alcohol (or rather, stop drinking it), do not use drugs,
  • do not use medications that can cause erectile dysfunction, or use them only strictly as directed by a doctor and coordinate the appointment with instructions for their use,
  • do not have a long pronounced sexual tension, if you resort to ejaculation
  • be sure to consult a urologist if you have been injured in the pelvic area, perineum, if you have surgery on the pelvis, if you are sick with diabetes or hypertension.

Why can erectile dysfunction develop?

Effective treatment of erectile dysfunction in men is possible only after the exact determination of the cause of the disorders.

There are several factors that can lead to impotence in men:

  • Causes of erectile dysfunction of endocrine nature. The main one is a violation of the synthesis of testosterone - the main male hormone. This is possible with mutations in the genome, mechanical damage, infectious diseases and malignant tumors. To resume normal sex life, if there are such causes of impotence, it is possible after undergoing a course of hormonal therapy.
  • Erectile dysfunction due to the use of certain medications. These are groups of drugs that inhibit the production of testosterone while inhibiting the functioning of the cerebral cortex. The diagnosis of “impotent” can be obtained by a man who regularly uses drugs and alcohol.
  • Neurological reasons. These can be pathologies of the peripheral or central nervous system: injuries, autoimmune diseases, blockage of cerebral vessels, epilepsy, damage to the pelvic and perineal regions, and sclerosis.
  • Psychological factors. A man can be overcome by prolonged stresses, neurosises, a depressed state, a misunderstanding between him and a sexual partner, as well as a mismatch of sexual preferences. The reasons for a weak erection also lie in the ordinary tiredness of a man. Often, the cause of the disorder can be fear of failure in sex or self-doubt during sexual intercourse with a new partner.

These are the main causes of impotence, which are determined in patients who consult a doctor with this problem.

But there is more pathology development factorsassociated with direct injuries of the penis or circulatory disorders in its structures.

In case of abnormal blood flow in the vessels of the penis, a delay in erection or its manifestation in an incomplete volume is possible. The development of penile angiospasm - circulatory disorders in the tissues of the penis - can also cause the first signs of impotence.

If there are problems in the veins, an erection quickly arises, but lasts very little, which often makes it difficult to finish sexual intercourse. This can happen due to inflammation of the inner vascular wall, which is often observed in men with an autoimmune disease or in a smoker with a long history.

In very rare cases, erectile dysfunction develops, the causes of which lie in abnormalities of the penis, for example, improper placement of the urethra exit or Peyronie’s disease (curvature of the penis due to the growth of fibrous tissue).

Treatment methods

  • PDE5 inhibitors: Viagra, Dynamo, Cialis, Levitra (give only a short-term effect),
  • based on plant substances: ginseng, eurycoma longifolia,
  • making positive changes in lifestyle (for example, quit smoking and exercise more),
  • urethral injection
  • injections into the cavernous body of the penis (papaverine, alprostadil, etc.),
  • penile vacuum devices
  • psychotherapy,
  • massage,
  • penile vascular surgery aimed at reducing venous outflow or increasing arterial blood flow (resection of the dorsal vein, endovascular embolization of the penile veins, revascularization of the cavernous bodies of the penis). It should be noted the extremely low efficiency of vascular operations on the penis. Only in very rare cases, the effect of them lasts longer than one or two years.

If all of the above is not effective, penile prostheses are used. Prosthetics has been used in medicine for several decades. Falloprosthetics in the treatment of erectile is a highly effective method, if other treatment methods have not yielded the desired result. After installing the implant in the penis, sexual function is restored in 95% of the operated men source not specified 1324 days . Falloprostheses have different designs and differ in degree of complexity:

  1. Plastic dentures. They are silicone rods reinforced (for example, twisted metal wire). This design has a “memory" that allows you to give the penis the desired position. To achieve an erection, the penis must be straightened, then, after intercourse, return it to a calm state. Examples of such falloprostheses: AMS Spectra, Coloplast Genesis, Promedon Tube
  2. Inflatable, or hydraulic prostheses. They are hollow silicone tubes containing liquid inside. A pump is brought to the tubes, which during surgery is placed in the scrotum, a reservoir of liquid is placed behind the pubic bone next to the bladder. For the onset of an erection, it is necessary to squeeze the pump several times, the liquid rushes into the rods and an erection occurs, after intercourse, the liquid returns to the reservoir by pressing the button that opens the valve (located next to the pump), which puts the penis in a calm state. This type of falloprosthesis is the most physiological, allows you to fully restore intimate life and gives fewer complications. Such prostheses are called two-, three-component (rods, pump, reservoir). Two-component prostheses are gradually becoming obsolete due to their unnatural appearance and inconvenience in use. Three-component prostheses are currently preferred when performing phalloplasty. The latest generation prostheses - three-component hydraulic - the most reliable and most effective source not specified 1324 days . The operation to install them is complex and painstaking, requires certain skills and abilities from the urologist surgeon. In addition, the cost of such prostheses is very high. which one? . Examples of such falloprostheses: Coloplast Titan OTR, AMS 700 CX, AMS 700 LGX

Diagnosis and treatment of a problem

Effective treatment of impotence in men is possible only by contacting an experienced qualified urologist. Its task is to establish the cause of the problem and determine how to treat erectile dysfunction in a particular case.

In a series of surveys the specialist will establish the degree of functionality of the nerve endings of the penis. For this, the patient checks for a bulbocavernous reflex.

During the procedure, the doctor presses on the head of the penis, which should cause a simultaneous reduction in the anal sphincter. If the test showed a suspicion of diabetes or a nerve injury, the patient is prescribed additional diagnostic procedures, and then impotence is diagnosed, the reasons and treatment of which will be announced by the doctor a little later.

To check all the possible causes of the development of the problem, a comprehensive study of the whole organism after which it will be determined, this case of impotence is treated.

In a medical institution, a specialist urologist prescribes treatment, depending on the reason for the development of impotence.

If the cause is a disease of the endocrine system, the urologist prescribes a course of hormonal drugs to the patient.

If the causes of impotence lie in the influence of medications, you need to choose those drugs that will not violate erectile function in men.

Video: "Treatment of Erectile Dysfunction"

Another thing is how to cure impotence, related to psychological problems. Such cases require a special approach:

  • ensuring patient relaxation,
  • conditions in which he can feel as relaxed as possible,
  • creating trust between the patient and his sexual partner.

An erectile dysfunction developed on the background of psychological problems, the treatment of which is rather difficult, may include sessions with a psychologist or sex therapist.

Can impotence associated with abnormal penis development be cured? Of course, this is real thanks to the surgical treatment of the problem.

Psychological factor

Psychological (psychogenic), organic and mixed erectile dysfunction are distinguished.If earlier, various psychological problems were considered the main reason for its occurrence, now this opinion has changed. It has been shown that erectile dysfunction in 80% of cases is organic in nature and occurs as a complication of various somatic diseases. Most men tend to attribute failure in bed to stress, problems at work or in the family, fatigue, and lack of attraction. In fact, erectile dysfunction has a purely psychological (psychogenic) nature in only 10-20% of cases. Quite often there is a mixed type of ED. It is undoubtedly true that all varieties of this pathology require close attention and medical and psychological assistance.

Signs of psychogenic erectile dysfunction are:

  • sudden onset of the disease
  • relationship problems
  • presence of spontaneous nocturnal erections
  • erection problems are episodic
  • restoration of normal erection after elimination of an external problem

If erectile dysfunction is caused by organic causes, it is usually accompanied by the following symptoms:

  • gradual onset of the disease
  • lack of spontaneous nocturnal erections
  • normal libido and ejaculation
  • systemic erectile dysfunction

For most people, sexual relations are a very delicate topic, therefore, men suffering from erectile dysfunction, seek to explain the problem by external factors, often even try to hide it. Despite the fact that in 95% of cases, erectile dysfunction can be treated medically, only 10% of men who have difficulty with potency seek medical attention.

Reasons for not visiting a doctor:

  • embarrassment and modesty,
  • the expectation of self-healing,
  • lack of desire for an active sex life, respectively, problems with an erection for a patient are not too important,
  • the patient considers the problem too serious and thinks that nothing can help him.

There are a number of behavioral signs that suggest that a man has difficulty with potency, even if he himself is trying to pretend that everything is in order:

  • a man avoids sexual intercourse in various ways (he comes home late, refers to fatigue, headache, etc.),
  • never initiates sexual intercourse,
  • ignores allusions or direct sentences.

His sexual partner can help overcome the psychological barrier to a man, however, only a doctor can determine effective methods of treatment. In order to make a visit to the doctor easier, there are free hotlines and online consultations where qualified specialists anonymously answer questions regarding erectile dysfunction and methods of its treatment.

Conclusion

How to cure erectile dysfunction effectively in each individual case can only be determined by an experienced urologist after conducting a series of examinations and talking with the patient. If a man has problems with an erection, ejaculation or the onset of an orgasm, he should not self-medicate and listen to the advice of friends about this. Only a trip to the doctor will make it clear to the man how to get rid of impotence in his particular case.

How to treat erectile dysfunction (methods)

Modern methods of treating erectile dysfunction in men have reached very high heights. Almost in most cases, the patient can be helped. First of all, it is necessary to conduct a thorough diagnosis and, taking into account individual characteristics, determine the optimal treatment method suitable for you.

If you have psychogenic erectile dysfunction and the reason is a psychological state or a nervous breakdown, then consultations with a specialized specialist can help in the treatment, and if the matter is different, then treatment is used from medication to surgery. Some try to use folk remedies to treat erectile dysfunction. Today, several methods are used to treat erectile dysfunction.

  1. Sex Therapy and Psychotherapy. It can also be a massage or banal positive changes in life. In addition to psychogenic erectile dysfunction, such treatment is sometimes used in organic cases.
  2. Taking pills to increase an erection, which include drugs such as Viagra or Levitra (the best adjuvants in the treatment of problems such as erectile dysfunction). This is the so-called first therapy. It can be used from the very beginning in the treatment of all types of dysfunction.

Such drugs increase blood flow to the penis and keep it there. However, when taking such drugs, there may be side effects. As a result, there are some recommendations and limitations. The most harmless side effect may be temporary color blindness.

People with a weak cardiovascular system are advised to limit the use of such medications.. A large number of cases of counterfeiting of these tablets are also known. Needless to say, you need to take them only after consulting a doctor. Injection therapy. It is used when treatment with pills for erectile dysfunction does not give the desired result. Also when they are contraindicated. This method of treatment involves the injection of hormonal drugs into the penis itself. In this case, special vasodilator drugs are used that increase blood flow to the organ. This achieves a normal erection. This is a very effective method and the patient can learn to make these injections when necessary, as well as adjust the duration of the erection. The doctor will teach you to do these injections absolutely painlessly.

At the same time, the degree of sexuality of the partner does not affect the occurrence of an erection. This method is effective in 70-80% of cases. In this case, the drugs are not addictive and with regular use for more than a year, they can improve their own erections.

Contraindications for this method can be transferred diseases of the penis or its cavernous bodies. As well as inflammation of the tissues of the penis. The use of vacuum ereters or as they are also called pumps for erectile dysfunction (special devices). There are many different models and their modifications. This method is used in the treatment of organic erectile dysfunction. True, in some cases, and psychogenic forms. Its advantages are that in the absence of side effects and prescriptions it is a non-aggressive method and gives 90% of the result.

The essence of this method is that the penis is placed in a cylinder in which a vacuum is created using a pump. Blood rushes to the penis and is held there with the help of special rings, the so-called rings for erectile dysfunction. This device can also be used by healthy people to massage or supplement their own erections, enlarge or straighten the penis, as well as prevent premature ejaculation.

  • Exercises Helping Eliminate Erectile Dysfunction. The method consists in restoring the muscles of the lower pelvis and learning to work them with the force with which it is necessary. This is a biofeedback method. He trains the muscles of the perineum, making them work when we need to. Used for injuries or prolonged inactivity of muscles as a result of any injuries.
  • The most radical, but also the most effective method of treatment is falloprosthetics. It is used when other methods are powerless, and dysfunction is caused by irreversible causes. With the help of surgical intervention, prosthetics of the penis occur.

    An erection occurs after compression of a special pump located in the scrotum. With this operation, you can achieve the maximum effect. The operation of falloprosthetics itself is quite complicated and must be carried out by high-level specialists. the only way to avoid postoperative complications.

    When treating erectile dysfunction with alternative methods or in some independent ways at home, most often use decoctions from different roots and plants. Ginger is very popular. Tea, various tinctures and even baths are made on its basis. From the root of ginseng and celery make tinctures. They also recommend eating honey with nuts. You can make a decoction of clover, spearmint, nettle and St. John's wort.

    All these ways help raise the overall tone of the body, realize his inner strength and relieve nervous or psychological stress. This can be the cause of psychogenic dysfunctions and some organic cases. For more serious reasons, and even more so for serious diseases such as diabetes, they will not help and you will need to immediately consult a doctor.

    Find out how you can treat varicocele without surgery at home.

    Prevention

    For to prevent the appearance and development of erectile dysfunction, it is necessary first of all to lead a healthy lifestyle.

    You need to eat right and exercise when possible. It is also best not to smoke and minimize alcohol consumption. And it’s better to exclude it altogether. Naturally, in no case should you use drugs.

    Regarding reception medicines, you must strictly follow the prescription and dosages prescribed by your doctor. Especially, this applies to drugs of the psychotropic group and medications that affect the nervous and hormonal systems.

    For pelvic surgery, injuries in this area, hypertension or diabetes, you need to consult a urologist.

    Also in the prevention of erectile dysfunction, a vacuum erector can be used. Folk techniques advise eating more ginger, walnuts and honey. Decoctions of herbs will help tone the entire body.

    Thus, today almost all cases of erectile dysfunction are treatable. There are many methods and an experienced doctor is able to find you a personalized method of treatment.

    It is also necessary to remember that this an illness can be a symptom of another, more serious disease. The main thing is not to delay, and at the first symptoms to undergo a diagnosis in a specialized center. Your health is in your hands.

    And this video talks about why erectile dysfunction may appear.

    Causes and types of erectile dysfunction

    Doctors divide the causes of impotence into three groups: organic (associated with a physical obstacle to the natural occurrence and maintaining an erection), psychogenic (in which no physiological disturbances are observed in a person, and problems in sex are explained by stress, chronic fatigue or psychological trauma), and also mixed (when both of these factors contribute to the development of the disease).

    In men with depression, the likelihood of developing erectile dysfunction ranges from 25–90%. Most often we are talking about men of young or middle age. The main role in the treatment of such patients is assigned to a psychotherapist.

    The most common causes of impotence are organic - they are often associated with age-related changes in the walls of blood vessels.

    The fact is that the mechanism of the appearance of an erection can be partially compared to filling the bathtub with hot water: when you close the drain with a stopper and open the tap, the tank is gradually filled, and to empty it, you need to shut off the water supply and remove the stopper. With vascular damage (for example, cholesterol plaques), the process of filling the cavernous bodies of the penis - a kind of analogue of the bath - slows down, sometimes so much so that an erection does not occur at all. Also, in some cases, the problem with sex is explained by a “leaking plug” - a pathology of the veins, in which the blood too quickly, before completing sexual intercourse, leaves the penis. If the cause of erectile dysfunction is a violation of the hormonal background, then the whole mechanism of excitement goes downhill: a man may completely cease to be interested in sex.

    Erectile dysfunction can be a problem not only in the intimate sphere, but also an alarming symptom, urging you to check the health of the vessels as soon as possible. The fact is that coronary heart disease and type 2 diabetes in the initial stages can be almost asymptomatic, gradually leading to deadly disturbances in the body. Therefore, it is so important not to postpone the visit to the "male doctor": it can save you from a heart attack, stroke and hyperglycemic coma.

    Signs of the disease

    Do I need to sound the alarm in the event of a single "fiasco"? No - doctors consider a pathological situation in which problems with an erection occur no less than in a quarter of cases of sexual contact. However, there are a number of signs that should become an occasion for consultation with a specialist:

    • lack of morning erection,
    • the inability to cause an erection during masturbation,
    • slowing the rate of occurrence of an erection upon excitation or its complete absence,
    • rapid ejaculation.

    With erectile dysfunction of an organic nature, these symptoms increase gradually, often accompanied by a fading of a man's interest in sex. If the disease is based on psychological problems, there may not be any signs of disturbances outside of sexual intercourse (morning erection persists, and difficulties in sexual intercourse are not observed constantly, but only from case to case).

    Be that as it may, only the doctor can establish the true cause of erectile dysfunction - for this, after the initial consultation, he will prescribe laboratory tests and special types of examinations (ultrasound of the vessels, testing of the innervation of the penis, etc.). If the patient is diagnosed with chronic somatic diseases (diabetes mellitus or hypertension), then an important element in the diagnosis and treatment will be a visit to a specialist - a cardiologist or endocrinologist.

    Forms

    According to the etiological factor, the following types of erectile dysfunction are distinguished:

    Among psychogenic erectile dysfunctions, primary and secondary forms are also distinguished:

    • the primary (congenital) form is rare and is characterized by a complete absence of normal sexual function throughout life,
    • secondary erectile dysfunction is characterized by the gradual extinction of previously existing ability to erection.

    Diagnosis of erectile dysfunction

    Diagnosis of erectile dysfunction begins with a collection of a general history identifying etiological factors and an assessment of sexual activity. A number of questionnaires have been developed to identify the pathophysiological basis of impotence.

    A physical examination often reveals signs of vascular, neurological or hormonal disorders, confirming the pathophysiological hypothesis based on the anamnesis: the presence of signs of hypogonadism, fibrotic changes, gynecomastia, phimosis, detection of La Peyronie plaques, disturbances in perineal sensitivity, decreased tone of the anal sphincter, atrophy , changes in peripheral pulsations.

    Diagnostics should include screening for major vascular, metabolic and endocrine diseases, determining testosterone levels.

    For an objective assessment of the state of physiological mechanisms that control the process of erection, a number of methods are used:

    • assessment of the state of the vascular system - determination of the level of blood flow in the pelvic arteries using vascular dopplerography of the arteries of the penis, plethysmography and radioisotope studies,
    • assessment of neurological status - determination of the threshold of sensitivity of the penis to vibration using a biotheziometer (helps detect early manifestations of peripheral sensory neuropathy), perineal muscle electromyography, examination of refractory sacral nerves, registration of brain potentials with irritation of the external genital organs (helps to determine erectile dysfunction of neurogenic origin). If during a screening test the patient has a neurological pathology, electroencephalography, computed tomography of the brain or myelography are performed,
    • endocrine system assessment - measuring plasma concentrations of testosterone, prolactin, luteinizing hormone,
    • assessment of the mental state of the patient - identification of psychological, causal connection (situational impotence), mental disorders (anxiety, depression, shame, guilt).

    Erection problems over an extended period (3-6 months) are grounds for suggesting erectile dysfunction.

    For differential diagnosis of forms of erectile dysfunction, the procedure for evaluating nightly erections (ONE) using a plethysmographic sensor is used. Differentiation is based on the fact that patients with psychogenic erectile dysfunction have normal erections in their sleep, while patients with organic erectile dysfunction have nocturnal erections.

    Erectile Dysfunction Treatment

    The goal of treatment is to achieve satisfactory erections with minimal side effects.

    In the treatment of the psychogenic form of erectile dysfunction, an important role is played by psychotherapy. It should be aimed at eliminating the causes that led to sexual maladaptation, resolving intrapersonal and interpersonal problems, and forming adequate ideas about intimate relationships. Used techniques of marital therapy, training partners in effective interaction, methods of cognitive-behavioral therapy.

    In the treatment of the organic form, the elimination of the disease, which led to erectile dysfunction, is of paramount importance. If impotence has endocrine causes, hormone replacement therapy is prescribed.

    Widely used pharmacological agents that enhance and prolong erection. First-line drugs are oral type 5 PDE inhibitors. PDE 5 is an enzyme contained in cavernous tissue. Blocking his work leads to relaxation of the smooth muscles of the corpora cavernosa and the appearance of an erection in response to sexual stimulation.

    It is proved that the psychological causes of erectile dysfunction are organic diseases.

    It is also possible the injection of drugs directly into the cavernous body. In this case, a very thin needle is used, with which the patient can independently make an injection of a vasodilator drug selected by the doctor. Unilateral injection is sufficient for bilateral penile enlargement due to cross blood flow. 15 minutes after this, an erection occurs, which lasts up to two hours. The method has disadvantages - inconvenience of use and rare side effects, such as priapism and fibrosis of the penis (2%).

    Another method that increases blood flow to the penis is vacuum constrictor therapy. In this case, the use of a vacuum device enhances blood flow into the cavernous bodies of the penis, and the constrictive ring prevents venous outflow.

    Massage and self-massage of the pelvic and pubic bones are effective, since it has a beneficial effect on vascular tone in the genital area.

    Regular exercise is also recommended, for an erectile dysfunction a sedentary lifestyle and chronic blood stasis in the pelvic area are typical, exercises are prescribed to stimulate and strengthen the muscles surrounding the penis and scrotum. Squats are considered the most effective exercise to strengthen an erection; it is recommended to perform 50-100 squats per day. This helps to normalize blood circulation in the pelvic area. An equally effective method is tension and relaxation of the perineal muscles. Such an exercise is convenient in that it can be performed in any position an arbitrary number of times. Positive results in the fight against insufficient erection gives walking.

    The weakening or absence of erections can be a manifestation of arterial hypertension, obliterating endarteritis, hyperlipidemia, atherosclerosis.

    If non-invasive methods have been found to be ineffective, surgery is indicated:

    • endofaloprosthetics - the installation of prostheses in the cavernous bodies of the penis, is carried out with damage to the cavernous tissue,
    • penile microsurgical revascularization - the creation of an anastomosis between the dorsal artery of the penis and iliac vessels, is carried out with vascular forms of erectile dysfunction,
    • venous surgery techniques - spongiolysis, endovascular resection, embolization or ligation of veins, ligation of the legs of the penis, are used for lesions of the veno-occlusive mechanism.

    Complications

    The consequence of erectile dysfunction is an unsatisfactory sexual life, which leads to further disorders:

    • stress, anxiety, neurasthenia, depression,
    • lower self-esteem,
    • problems in relationships with a sexual partner,
    • infertility.

    Watch the video: Causes and Treatment of Erectile Dysfunction Video Brigham and Womens Hospital (February 2020).

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