In 1992, the U.S. National Institutes of Health has decided to change, which was considered offensive to many men, the term "impotence" in a sweet and not as flashy term "erectile dysfunction". But, in spite of the fact that the name has changed, the problem remains and has not lost its relevance. It is known that erectile dysfunction occur in more than half of men aged 40 to 70 years. For example, in the U.S., the number of patients is 10 million (?).
Erectile dysfunction (ED) — the inability to achieve or maintain a penile erection sufficient for sexual intercourse, which is observed for three months or more.
Erection — this increase in volume of the penis and the sharp increase its elasticity due to its filling tissue blood during sexual arousal.
Among the reasons leading to the development of erectile dysfunction are the following:
- alcohol abuse;
- use of certain drugs;
- disturbance of blood supply of the penis (atherosclerosis, hypertension, diabetes, abdominal and pelvic injuries, accompanied by damage to the blood vessels supplying the penis);
- injuries that result in damage to the spinal cord or brain (so-called neurogenic erectile dysfunction).
Not so long ago it was believed that in most cases of ED is psychogenic in nature. That is the main causes of disorders of potency were considered to fear, embarrassment in front of a partner, anxiety, lack of confidence, depression, religious beliefs, and other anxiety disorders and psychotic personality changes.
A special place is occupied by hormonal (endocrine) ED due to lack of male sex hormones, as well as hormonal changes associated with diabetes, thyroid disorders and obesity.
What is shown?
Clinical manifestations of ED laid in the very definition of erectile dysfunction. Severity of symptoms can vary from mild to severe symptoms of sexual dysfunction.
Decrease or disappear spontaneous erections, reduced ability to perform repeated sexual intercourse during the day, reducing the number of full sexual intercourse, ejaculation and orgasm ending, reducing their duration, there is a need for more erotic stimulation, reduced elasticity of penile erection strength becomes insufficient. Such sexual dysfunction lead to a steady decline in mood, prolonged depression, nervousness, irritability, avoidance of sexual intercourse
The survey begins with a thorough survey of the patient, find out his relationship with the partner (s), the circumstances and age of occurrence of violations, the presence of night and morning erections, specify the presence of chronic diseases such as diabetes, coronary heart disease, hypertension, etc.
To determine the extent and causes of disorders of sexual function questionnaires exist in which a man is offered a number of issues. For example:
- How often do you have a spontaneous (not related to sexual activity) erection?
- In the last month, what was the erection during sexual intercourse?
- In the last month, how many attempts to have intercourse you were successful?
- In the last month, how many completed you had sexual intercourse?
- How long have you experience sexual dysfunction?
Genital examination is conducted, performed a series of laboratory tests, monitoring of nocturnal erections, duplex ultrasonography and computed tomography of the penis, intracavernous administration of vasodilators rheography, psychological counseling, endocrinologist, cardiologist, internist, etc.
At home, the patient can perform a test to assess the nocturnal erections, so called. test marks. Onpenis special strengthening strips, are torn by increasing the girth by a certain amount.
Duplex ultrasonography allows simultaneous imaging of blood vessels Penile and to determine the blood flow parameters.
Intracavernous administration of vasodilators to assess the condition of vessels of the penis, eliminate or suspected vascular pathology.
Rheography gives an indication of the state of tone, elasticity of blood vessels and the degree of filling of the penis with blood.
ED treatment is aimed at restoring adequate blood supply and improve oxygenation of tissues of the penis, restoring normal hormonal levels, the restoration of innervation of the penis and removing the patient's psycho-emotional disorders, as well as perform surgical procedures after failure of conservative treatment (falloprotezirovanie).
Penile implant — implanted in the penis rigid and semi-rigid prostheses.
Now widely adopted special preparations drugs: sildenafil citrate, tadalafil, vardenafil.
So far, the method has remained intracavernous administration of vasoactive drugs (alprostadil, papaverine), proposed in 1978, as well as the use of vacuum devices.