Erectile Dysfunction

Symptoms

Symptoms    
How do they manifest

Early    
- weak (until complete disappearance) nocturnal and morning erection;
- decreased sexual desire (libido);
- increase in time between foreplay and erection;
- "erasing" of the brightness of orgasm, up to the disappearance of its sensation;
- premature ejaculation (ejaculation);
- inability to have repeated sexual intercourse;
- problems associated with the conduct of "habitual" sexual intercourse;
- increased recovery time between erections;
- a decrease in the volume of ejaculate (the amount of sperm released during sexual intercourse)

Late    
- inability to achieve sufficient phallus tension;
- inability to keep the phallus erect;
- extreme degree of erectile dysfunction - complete impotence

Causes

Internal causes of erectile dysfunction
1.    Disorders of the cardiovascular system.
 A variety of diseases of the heart and blood vessels lead to a violation in the intimate sphere (up to 65% of cases) - ischemic disease, heart rhythm disturbance, hypertension , conditions after myocardial infarction. The vessels of the phallus have a high degree of intrinsic vasoconstriction (atherosclerosis). Not surprisingly, some scientists advice beginning a heart check as soon as feasible if there are issues in the intimate sphere since they view potency dysfunction as a sign of cardiac illness. Also important is high cholesterol and smoking, which leads to damage to the walls of blood vessels. In addition, drugs for the treatment of hypertension and heart disease can themselves also cause significant erectile dysfunction.  

2.    The traumatic factor 
 One of the main factors in the development of persistent potency disorders. These are fractures of the pelvic bones, ruptures of the urethra, head trauma, direct damage to the cavernous bodies, conditions after prostate surgery for adenoma and cancer.  

3.    Nerve conduction disorders. 
In addition, there is a group of causes associated with disruption of the internal secretion organs (endocrine causes): diabetes mellitus, leading to damage to peripheral vessels and nerves, disruption of the thyroid gland, obesity . The decrease in testosterone levels is also important, including age-related, due to fatigue, hormonal imbalance. 
The cause of erectile dysfunction may be inflammatory diseases of the genitourinary organs (prostatitis, vesiculitis, urethritis).
External causes of erectile dysfunction
Increased radiation background, work in conditions of high-frequency radiation and environmental factors cannot be the cause of erectile dysfunction. However, erectile dysfunction may occur due to the traumatic effects of these factors.

Psychogenic etiology
The most common cause of erectile dysfunction is fear of failure, self-doubt, especially at a young age. Of great importance are conflicts with a partner, and, conversely, even relations leading to the so-called "habitual" sexual intercourse. Of great importance is acute and chronic stress, professional fatigue, leading to exhaustion of the whole organism. In some cases, this is how hidden psychopathology manifests itself - Schizophrenia , paranoia, depressive states. Alcohol abuse has a big negative impact.
 

Treatment

Oral phosphodiesterase type 5 inhibitors for the treatment of erectile dysfunction
A real revolution in the treatment of potency disorders was made by phosphodiesterase-5 inhibitors, which have an effect on nitric oxide. This substance prevents the decrease in the tone of the veins of the penis and, therefore, improves erection. The name of the miraculous drug "Viagra" was prepared a long time ago and has been waiting in the wings for several years. This capacious and pleasant name translates as "the power of the huge Niagara Falls." The hour came in 1993, when the American company Pfizer accidentally discovered an outstanding side effect of a new blood pressure drug, sildenafil citrate. The drug was very quickly introduced into wide clinical practice and won first place among the many pharmacological agents for the treatment of erectile dysfunction. New generations of PDE-5 inhibitors followed. These drugs increased the clinical effect and minimized side effects. First of all, these are Levitra (vardenafil) and Cialis (tadalafil). The drugs can improve erection in many forms of erectile dysfunction, even with low levels of testosterone in the blood of men.

Psychotherapy
In most forms of erectile dysfunction, psychosexual therapy is of great importance, as well as lifestyle correction, elimination or reduction of adverse life factors. For advice, you should contact a psychotherapist.
Mechanical devices for the treatment of erectile dysfunction
A certain role in the treatment of erectile dysfunction is played by vacuum constrictor therapy (VOC-therapy). The main mechanism of this type of therapy is to create a negative pressure (vacuum) on the cavernous bodies of the penis with the help of special devices. Vacuum devices provide an adequate erection in 60% of cases.
Surgical treatment of erectile dysfunction
When all other treatments for erectile dysfunction have failed, surgery is used:

•    The creation of an anastomosis (anastomosis) between the epigastric artery and the lateral artery of the phallus is performed when this artery is narrowed;

•    Operations on the veins of the penis are done in violation of the veno-occlusive apparatus;

•    Penile prosthetics (implantation of prostheses) is the final step in the treatment of erectile dysfunction when other methods are ineffective. This technique allows you to achieve results (full erection) in 70-80% of cases.

•    Shock wave therapy (SWT), magnetic laser therapy (MLT), ozone therapy and prostate massage have no proven clinical efficacy in the treatment of erectile dysfunction and the reasons for their use are purely commercial.

Diet and physical activity
A balanced diet and physical activity play an important role in the prevention of development and in the treatment of erectile dysfunction.
Physical exercises are aimed at improving blood circulation in the pelvic organs in a man (especially in people with a sedentary lifestyle), improving blood flow to the penis and testicles, where testosterone is produced, which is necessary for a full erection.
The exercises are the simplest: walking - at least 6 thousand steps a day, squats (at least 50 times a day).  Some exercises from yoga practice are also used: Janu Shirshasana, Paschimotanasana, Uttanasana, Baddha Konasana, Dhanurasana.

Massage
For treatment and prevention, massage of the pelvic and pubic areas is quite effective. Massage perfectly activates the vascular tone of the male genital organs.

Folk remedies
Various herbal preparations are interesting in terms of mild stimulation and accumulation of their own testosterone. 
 

Tests Required for Diagnosis

Diagnosis of erectile dysfunction in men should begin with a general medical history. At the first stage, they try to identify possible etiological factors, determine the individual characteristics of sexual life. Separately, sexual behavior should be singled out during the so-called "habitual" sexual intercourse.  A thorough examination reveals the nature of hair growth, penile defects, and the size of the testicles. Of great importance is a rectal examination, which allows to judge the size, consistency and shape of the prostate. 
Patients with erectile dysfunction should determine the hormonal background (free and bound testosterone, prolactin, estradiol, gonadotropin), determine the level of sugar in the blood, glycated hemoglobin, blood lipid profile. The results of these analyzes will help to identify a certain type of pathogenesis of dysfunction. 
Pharmacological test: the reaction of the tissues of the penis to the introduction of papaverine, prostaglandins and other medications into the cavernous bodies is investigated.
Ultrasound :
•    TRUS (transrectal ultrasound of the prostate) through the rectum allows you to accurately determine the size and structure of the prostate gland, diagnose prostatitis, benign and malignant tumors of the prostate. All these factors directly or indirectly affect erection.

•    Dopplerography of the vessels of the phallus can assess blood flow, the degree of narrowing of the main arteries and veins during erection. It is a significant prognostic factor in erectile dysfunction. 

•    Ultrasound of the thyroid gland reveals a violation of the structure and size of this important gland, which has a great influence on the overall balance of hormonal levels.

•    Nuclear magnetic resonance imaging of the penis helps to determine the decrease in blood flow in the fibrous-sclerotic areas of the penis;

Useful info

Pathogenesis:
In the pathogenesis of erectile dysfunction, pathologies of the endothelial tissue play a leading role, which ultimately leads to impaired blood supply to the cavernous bodies of the phallus. A huge role is played by vascular atrophy, leading to sclerosis, the replacement of healthy cells of the cavernous bodies with coarse connective tissue. Therefore, the severity of erectile dysfunction depends on the combination of various causes and the degree of their impact on the cavernous bodies.
Classification and stages of development of erectile dysfunction:
I. Psychodependent :
1. Common form:
•    General disturbance of susceptibility;
•    Initial lack of libido;
•    Age-related decrease in sexuality;
•    General violation of libido;
•    Chronic disorder;
2. Situational:
a) In relation to a sexual partner:
•    violation of libido to a certain partner;
•    lack of libido to the preferences of the object;
•    suppression of libido in connection with a conflict relationship with a partner;
b) Doubt in their abilities:
•    Dysfunctional disorders (rapid ejaculation);
•    Expectation of failure (doubt about the onset of an erection, the ability to maintain an erection);
c) Chronic stress:
•    Pathological mood (loss of a spouse, relative, dismissal from work).
II. Erectile dysfunction associated with organic lesions: 
•    Vascular;
•    Neurogenic;
•    Anatomical;
•    Hormonal;
•    Medicinal.
III. Polyetiological erectile dysfunction.
Complications:
•    Complete inability to achieve at least some tension of the penis (impotence);
•    Chronic stress;
•    Decrease in self-esteem;
•    Violation of social adaptation;
•    Family problems;
•    Infertility;
•    Serious mental disorders, up to suicide.