Erectile dysfunction symptoms treatment. Erectile dysfunction: causes and treatment. Stimulation of an erection by the nervous system

Male sexual dysfunction- the problem of one of the four main components of male sexuality, it deprives a man of interest and / or the opportunity to have sexual relations. Sexual function is disrupted by a number of factors, including drugs.

Libido- sexual desire is a cognitive component of sexual function. A decrease in libido is manifested by a lack of sexual interest or a decrease in the frequency and intensity of sexual thoughts, both spontaneous and arising in response to erotic stimulation. Libido is determined by testosterone levels as well as diet, health, and medications. Conditions primarily associated with decreased libido include hypogonadism, uremia, and depression. Drugs that sometimes reduce libido include mild androgen receptor antagonists such as spironolactone or cimetidine, and virtually all drugs that act on the central nervous system, such as selective serotonin reuptake inhibitors, tricyclics, and antipsychotics. Decreased libido due to the use of selective serotonin reuptake inhibitors, tricyclics may be partially restored with the addition of bupropion or trazodone.

Erection arises as a result of a complex of neurophysiological processes. The superior cortical pathway and the connecting sacral parasympathetic reflex arc connect to stimulate an erection. The nerve impulse travels through the pudendal nerves, which cross the posterolateral surface of the prostate. Terminating in the penis, these non-adrenergic/non-cholinergic nerves activate the synthesis of nitric oxide, which relaxes the smooth muscles of the cavernous bodies of the penis, which increases their blood supply and volume.

The latter cause compression of the veins that perforate the tunica albuginea of ​​the cavernous bodies, causing venoocclusion. Increasing blood flow and veno-occlusion contribute not only to an increase, but also to an increase in the hardness of the cavernous bodies of the penis, creating and maintaining an erection.

Ejaculation and orgasm. Ejaculation is controlled by the sympathetic nervous system. Adrenergic stimulation leads to a contraction of the smooth muscle elements of the epididymis, vas deferens, prostate and reflex jerky contraction of the striated muscles of the pelvic floor. At the same time, the bladder neck is closed, which prevents the retrograde ejection of sperm into the lumen of the bladder. Selective serotonin reuptake inhibitors can reduce or inhibit ejaculation.

Orgasm- This is a voluptuous sensation that appears in the brain mainly at the same time as ejaculation. Hypo- and anorgasmia may occur due to a decrease in the sensitivity of the penis and its glans, more often as a result of neuropathy.

Insufficiency of ejaculation reduces or leads to a complete absence of sperm volume. One of the reasons for this may be retrograde ejaculation - the ejection of sperm into the lumen of the bladder against the background of blocking the adrenoreceptors of its neck. It can be the result of surgery on the prostate and bladder neck. Diabetic neuropathy may be a possible cause. Disturbance of sympathetic stimulation during surgery or when taking drugs also reduces ejaculatory volume.

premature ejaculation- ejaculation that appears before the desire of a man or his partner. It is usually caused by sexual inexperience, anxiety, and other physiological factors rather than disease. This is successfully treated with psychotherapy and selective serotonin reuptake inhibitors.

Persistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual activity. " Erectile dysfunction in men" defines the nature of sexual disorders more precisely than the old term "impotence". Most erectile dysfunctions, in addition to psychogenic factors, are associated with vascular, neurological and hormonal disorders. Their cause may be the use of a number of drugs. Diagnosis should include screening for major vascular, metabolic and endocrine diseases, determination of testosterone levels. Treatment includes oral phosphodiesterase 5 inhibitors, intraurethral or intracavernous prostaglandins, vacuum constrictor devices, and endopalloplasty.

The term impotence replaces the term erectile dysfunction in men.

In the United States, 10 to 20 million men over the age of 18 suffer from erectile dysfunction, about 50% of men aged 40 to 70, and the incidence increases with age.

Causes of erectile dysfunction (impotence, male sexual dysfunction)

Primary impotence is extremely rare and always due to anatomical abnormalities of the external genitalia. The most common secondary erectile dysfunction in men. In 80%, secondary impotence is of an organic nature. Often, in men with organic impotence diseases, it leads to secondary psychogenic disorders, which forms a combined problem. Psychogenic causes may be related to anxiety, stress, or mood swings. Impotence can be situational, including the place of intercourse, time, or a particular sexual partner.

The main organic causes of erectile dysfunction are vascular and neurological disorders caused by and. Other important causes of erectile dysfunction include complications and consequences of prostate surgery, hormonal disorders, certain medications, and diseases of the penis.

The most common cause of vascular impotence is the arteries of the penis, often secondary to. Atherosclerosis with stenosis of the lumen of the arterial vessels and restriction of relaxation of the smooth muscles of the cavernous bodies reduces the amount of blood that can fill the cavernous bodies of the penis. The insufficiency of the veno-occlusive mechanism can also be the cause of ED, more precisely the failure to maintain filling for as long as desired. Venous leaks make it difficult for blood to remain in the penis for the duration of an erection, so an erection, if it occurs, cannot be sustained. Priapism, more commonly in sickle cell disease, can permanently damage the cavernous bodies and vessels of the penis and lead to severe impotence. Cerebral, focal brain lesions, disseminated, neuropathy, spinal cord injury are the main neurological causes of impotence.

Some endocrinopathies associated with testosterone deficiency can reduce libido and lead to ED. However, erectile function is rarely restored with normalization of testosterone concentration in the blood. Some drugs can cause ED. Alcohol can cause temporary ED. In men undergoing transurethral resection of the prostate, 15-40% experience erection problems due to damage to the pelvic nerves. Erectile dysfunction in men is most likely after a more extensive resection of the prostate. Prolonged compression of the perineum can cause temporary ED.

Diagnosis of erectile dysfunction (male sexual dysfunction)

The examination should include an assessment of complaints and anamnesis, including information about taking medications, alcohol, smoking, concomitant diabetes mellitus, arterial hypertension and atherosclerosis; symptoms of vascular, hormonal, neurological and psychogenic disorders. It is extremely important to diagnose depression, which may be hidden. An obsessive depressive state and age-related senile depression can significantly aggravate impotence. It is necessary to specify satisfaction from sexual relations, sexual dysfunctions of the partner.

Examination and diagnosis of impotence should be aimed at identifying genital and extragenital signs of hormonal, neurological and vascular disorders. The genitals are examined for abnormalities, signs, fibrotic changes, and La Peyronie's plaques. A decrease in the tone of the anal sphincter, disturbances in perineal sensitivity, changes in the bulbo-cavernous reflex can help in the diagnosis of neurological diseases, and disturbances in peripheral pulsations in the confirmation of vascular disorders.

Psychogenic causes of male sexual dysfunction should be suspected in younger, otherwise healthy men with sudden onset of erectile dysfunction, especially if the onset is associated with a specific adverse emotional event, or if impotence occurs in a specific situation. Possible reports of erectile dysfunction with sudden improvement may also confirm its psychogenic nature. Men with psychogenic impotence usually have normal nocturnal and morning erections, which is usually not the case with organic forms.

Laboratory studies should also include the determination of testosterone levels when it is reduced - the determination of FSH and LH. The detection of latent diabetes mellitus, dyslipidemia, hyperprolactinemia, thyroid diseases, Cushing's syndrome is undoubtedly necessary if indicated.

Penile-brachial index. If the systolic in the penis diverges from the systolic in the arm, then this indicates a weakening of the blood flow in the penis, but the test is rarely used in clinical practice.

Treatment of erectile dysfunction in men

The underlying organic disorders require appropriate treatment. Medications that were used before the development of erectile dysfunction should be discontinued or suspended. Depression needs treatment. Restoration of self-confidence and training is essential for all patients. In subsequent therapy, non-invasive methods should be used first. Men who have an erection but are unable to keep it can use a constrictive ring. As soon as an erection has appeared, a metal or elastic ring or a leather cord with a clasp is placed around the base of the penis, preventing venous outflow. If a man is unable to develop an erection, a vacuum device promotes blood flow to the penis, after which the cord or ring is placed at the base of the penis, which keeps the erection. Hematoma of the penis, cooling of the tip of the penis, lack of spontaneity reduce the effectiveness of the method. A constrictive ring and vacuum devices may also be helpful for patients who do not respond well to medical therapy.

Today, the method of choice in the drug therapy of erectile dysfunction, is the use of oral PDE 5 inhibitors. They prolong the effect of cyclic GMF, promote the release of ions from the smooth muscle cells of the cavernous bodies of the penis, creating their long-term and persistent relaxation, which ensures an adequate long-lasting erection. Taking a PDE 5 inhibitor tablet 1-2 hours before sexual intercourse contributes to the emergence and maintenance of a high-quality and long-lasting erection, provided there is adequate sexual stimulation. The effectiveness of these drugs is almost the same. The duration of action of sildenafil and vardenafil a is 4-5 hours, tadalafil a is 36 hours. All PDE 5 inhibitors cause persistent coronary vasodilation and potentiate the hypotensive effects of other nitrates, including those used to treat cardiovascular diseases. Therefore, organic nitrates are absolutely contraindicated within 24 hours after taking a PDE 5 inhibitor. Other side effects include hot flashes, blue vision, headache, bone and muscle pain, and indigestion. The choice of drug is determined by its effectiveness in each individual patient, provided that there are minimal undesirable side effects. Vardenafil should not be used with c-blockers. Sildenafil may be used with caution with doxazosin. Studies have shown that long-term systematic use of PDE5 inhibitors, regardless of sexual activity for 6-12 months, can lead to the restoration of erectile function in 80% of patients.

With insufficient effectiveness of PDE 5 inhibitors, it is possible to use alprostadil, in the treatment of erectile dysfunction. Intraurethral administration or intracavernous injection of prostaglandin E1 causes an uncontrolled erection lasting an average of 60 minutes. The effectiveness of endourethral administration is less than intracavernous injections, and undesirable side effects of such treatment are discomfort in the urethra in a man and vagina in a woman due to the contact effect of the endourethral drug. Taking into account the individual sensitivity of each patient, the dose of alprostadil administered intracavernously should be strictly titrated by the joint efforts of the patient and the attending physician in order to avoid the occurrence of priapism. However, even with strict dosing, the risk of developing priapism is about 1%. The second undesirable effect is pain at the site of intracavernous injections. The dissatisfaction of patients with such treatment of erectile dysfunction in men is most often due to the "artificial", uncontrolled nature of an erection that is in no way associated with sexual arousal, an erection that does not stop with the achievement of orgasm and ejaculation. Combination therapy with PDE5 inhibitors and aprostadil may be useful in patients with severe ED when PDE5 inhibitors alone are ineffective.

Underlying ED in men organic disorders require appropriate treatment. Medicines that have caused erectile dysfunction in men should not be used and replaced with those that do not have this side effect. Psychogenic components and especially depression require treatment. All patients need to restore confidence during intercourse, if necessary with the involvement of a sexual partner. In addition to drug treatment of erectile dysfunction, it is possible to use vacuum constrictor therapy using special devices. They are flasks of a special design with an aspirator that creates a negative pressure in the flask. When the penis is placed in the lumen of such a bulb and a vacuum is created in it, an erection occurs, which can be maintained with the help of special constrictive rings that are displaced at the height of the erection to the base of the penis. Such erectile dysfunction treatment in men, possibly patients who do not properly respond to PDE5 inhibitors. The vacuum device can increase blood flow to the cavernous bodies of the penis, and the constrictive ring can prevent venous outflow. The artificial nature of the erection, discomfort and even hematomas of the penis are undesirable side effects of this method. Today, this method is used to a greater extent not to modulate erections, but to improve blood circulation in the cavernous bodies, which restores the function of the cavernous tissue, enhances and prolongs the effects of drug therapy with PDE5 inhibitors.

For patients who do not respond to drug therapy, surgical treatment of erectile dysfunction is indicated. With veno-occlusive insufficiency, it includes ligation of the superficial penile veins, and with damage to the cavernous tissue, endophalloprosthetics - implantation of a penial prosthesis. These may be relatively rigid silicone or plastic rods implanted into the lumen of the corpora cavernosa, or controlled hydraulic devices that inflate to create rigidity and empty as needed. In addition to irreversibility, such operations are accompanied by the risk of general anesthesia, the possibility of infection, perforation of the glans penis, etc. Therefore, the indications for them are the most severe and irreversible forms of erectile dysfunction.

For a long time, doctors have debunked the myths that difficulties with potency occur exclusively in older men. Today, urologists are increasingly faced with the problem of identifying the causes and the need to find new ways to restore erectile dysfunction in young patients. The proposed methods of treatment, subject to timely diagnosis, can significantly improve the quality of a man's sexual life.

general information

Erectile dysfunction is a recurring condition characterized by a violation of the quality of an erection, the inability to maintain it for a certain time and achieve the degree necessary to complete a full sexual act. The term was first introduced in 1992. The American National Institutes of Health suggested using it instead of the word "impotence" as a more extended concept.

Erectile dysfunction is a true health barometer. According to experts, in the male population of our country, potency disorders are diagnosed several times more often than in other developed countries. Common causes of such a pathology in Russia are: smoking, drinking large quantities of alcoholic beverages, a high degree of injury.

Like many diseases, erectile dysfunction is accompanied by a number of symptoms. However, unlike other ailments, this problem is really treatable. For many representatives of the stronger sex, the decrease in potency is proportional to the loss of male power.

Prevalence

According to ongoing research, erectile dysfunction is a fairly common pathology. According to statistics, 30% of men between the ages of 18 and approximately 59 years of age have difficulties of this nature.

The global situation is somewhat different. Currently, more than 150 million men over 40 suffer from erectile dysfunction in varying degrees. According to experts, by 2025 this figure may increase by more than 2 times. Such a negative trend is very easily explained by a sharp increase in risk factors for the formation of this pathology (diabetes mellitus, cardiovascular diseases).

The mechanism of erection

The male genital organ has the so-called cavernous bodies, the filling of which with blood leads to swelling and, accordingly, tension. An analogy can be drawn with a vessel with two tubes. One way blood comes in, the other way out. During an immediate erection, there is a strong influx of blood, and its outflow completely stops. The CNS is responsible for regulating this "operation". The nervous system is often compared to the main computer, failures in which provoke erectile dysfunction.

Of course, there is also the endocrine system, the hormones of which completely regulate sexual behavior. If their production is disturbed, men also note that there is no erection.

Classification

1. Temporary This pathology is typical for certain periods of a man's life. The reasons for its development, as a rule, lie in recent stress, an unhealthy lifestyle, and the abuse of alcoholic beverages.
2. Increasing impotence. The continued onset of symptoms may be due to a chronic condition (eg, heart failure, atherosclerosis, or hypertension). In this case, it is recommended to immediately seek medical help. The thing is that high-quality therapy is required not only to restore sexual functions, but also to get rid of the primary disease.
3. One-time violations. If there are isolated cases, that is, under other circumstances, such problems are absent, most likely, mild erectile dysfunction occurs due to psychogenic or emotional reasons. In this case, it is recommended to exclude everything that has a direct impact on the psyche.

Depending on the primary factors that provoked the appearance of this kind of problem, erectile dysfunction may differ in functional or psychogenic nature. Each option has its own specific features:

• For example, erectile dysfunction due to various psychological factors most often appears suddenly. The cause of this problem, as a rule, lies in stress, nervous overwork. It is important to note that in this case, the so-called morning erection and the ability of the penis to change size as a result of sexual stimulation are not lost.
• Erectile dysfunction in men associated with functional disorders manifests itself consistently. With the next sexual intercourse, it becomes increasingly difficult to maintain a normal erection. All this indicates the presence of a background disease that should be cured. In addition, organic problems can be caused by taking certain groups of drugs that sharply reduce potency. As a result, libido and the ability of a man to ejaculate are preserved while nocturnal erections either completely disappear or are unstable.

The main reasons for the decrease in potency

Until recently, many thought that erectile dysfunction is a problem that occurs in the stronger sex exclusively with age, and its development cannot be prevented. However, this assumption has not yet been scientifically confirmed. The relationship between age and the disease itself is due only to the fact that over time, the risk of developing somatic ailments increases. Accordingly, the likelihood of problems with potency increases. It is quite normal if, subject to a healthy lifestyle and the absence of bad habits, a man’s sexual activity persists at 50 and even at 70 years old.

All the main factors provoking the development of this pathology can be divided into four groups.

1. Endocrine (caused by impaired functioning of the endocrine glands responsible for the production of testosterone). This may be the result of various kinds of genetic diseases, mechanical injuries, tumors. According to experts, erectile dysfunction in this case is successfully treated.
2. Neurological (associated with a number of pathologies of peripheral nerves, spinal cord or brain).
3. Medication (appear due to the intake of certain drugs that block the production of sex hormones).
4. Psychological. In this case, problems with potency arise as a result of frequent stressful situations, depression, neuroses, failures in bed.

Common causes of this pathology also include problems with blood vessels. Due to a consistent violation of blood flow to the genitals, or there is no erection at all, or it is very weak.

Symptoms

Taking into account the fact that erectile dysfunction is characterized by changes in a man's sexual life, its traditional signs are as follows:

• decreased libido (sex drive);
• unstable ejaculation (premature / late ejaculation);
• directly violation of the erection itself;
• lack of orgasm.

The most common symptom of this pathology is considered to be a decrease in sexual desire due to constant stress, fatigue. The reluctance of physical intimacy can also be dictated by discord in relationships, quarrels and conflicts on a domestic basis.

Diagnostics

As a rule, the doctor learns that the patient has lost an erection during the initial consultation. Like any other disease, impotence is much easier to treat at the initial stage of its appearance. It is important not only to confirm this diagnosis, but to identify the cause of its development in order to choose the most competent course of therapy.

At the first stages, diagnosis involves the collection of a somatic / psychological history. The doctor must determine which of the mechanisms responsible for a normal erection is broken. Before the immediate course of treatment, the patient is usually recommended to take a series of tests (for example, blood for hormones), as well as check the functioning of the cardiovascular system. In addition, the following diagnostic measures may be required:

• Keeping a diary of night / morning erections.
• Ultrasound of blood flow in the penis.
• Study of the work of the central nervous system.
• Psychotherapist's consultation.
• X-ray examination of the vessels of the penis.

Timely diagnosis is the key to successful treatment of such a pathology as erectile dysfunction.

Treatment: pills, vacuum therapy, psychotherapist's help

With this disease, first of all, the doctor must determine the main causes that led to its development, and try to eliminate them. Exclusively symptomatic therapy, as a rule, is ineffective. Below are the most common treatments:

Are there other options for treating impotence? In some cases, doctors decide to have surgery. As a rule, an operation is prescribed when there are clear signs that the blood supply to the penis is impaired. An alternative surgical method is the implantation of a special prosthesis - penile prosthesis.

Help of traditional medicine

With such a diagnosis as mild erectile dysfunction, treatment often involves the use of traditional medicine recipes.

All of the above recipes of traditional medicine allow you to overcome the problem as soon as possible. It is important to note that such therapy should only be used after consultation with a specialist. Moreover, folk recipes should not be taken as an alternative to medical or surgical treatment.

Preventive measures

Of course, it is better to prevent the development of erectile dysfunction than to subsequently wonder how to treat impotence. Below we list the most effective tips for the prevention of this pathology.

1. First of all, it is recommended to completely reconsider your usual lifestyle. Doctors advise to pay more attention to physical activity, eat right, give up all bad habits.
2. After receiving a mechanical injury to the organs of the pelvic area, it is necessary to consult a urologist.
3. Regular physical activity is extremely important. The thing is that an erection occurs if the blood flow to the penis increases. To achieve a positive result, it is enough to walk daily, for example, from work.
4. Not always special drugs for the treatment of erectile dysfunction are effective. During therapy, it is very important to follow the principles of a balanced diet. The diet is also recommended to diversify with fresh vegetables (include carrots, celery, tomatoes), dairy products, garlic and onions.
5. Doctors advise to have a regular sex life. The body, receiving a daily dose of pleasure hormones, constantly produces intimacy.

Conclusion

In this article, we talked in as much detail as possible about what constitutes such a pathology as erectile dysfunction. Patient reviews clearly prove that this ailment is not a sentence; it is really possible to overcome it through medications or surgery. Be healthy!

erectile dysfunction- a concept denoting the inability of a representative of the stronger sex to have a stable erection necessary for a full sexual intercourse.

Erectile dysfunction is more typical for older men, however, in the modern world, erection problems are quite often observed in young men. A variety of reasons can provoke the occurrence of such problems. If erectile dysfunction occurs periodically, then you should not worry about this. However, with constant problems, a man can experience very strong discomfort. The consequence of such problems is a constant stay in a state of stress, the deterioration of personal relationships and a serious decrease in self-esteem. Therefore, the treatment of erectile dysfunction must be carried out without delay. But any methods and drugs should be prescribed only by a specialist. Modern treatment of erectile dysfunction allows you to return to a full sexual life in most cases.

The reasons

Experts identify several varieties of causes that lead to erectile dysfunction in men. Erection problems can be a consequence of the fact that there are psychological problems in a man's life. As a rule, difficulties of this kind are observed in young people. A guy who has recently begun to lead a sexual life may experience violations that are the result of childhood trauma. Also, the reasons may be the fear of seeming inexperienced, doing something wrong, getting infected sexually transmitted diseases etc. This kind of problem in experienced men is overcome without consequences, but young people can suffer from violations, not knowing what to do in this case. It is very important in such a situation to get support from a partner who, with the right approach, will help to cope with the difficulties that have arisen.

Sometimes erectile dysfunction is a consequence of a deficiency in the body. This phenomenon is more typical for men of middle and mature age. The lack of this hormone contributes to the inhibition of reactions that are responsible for a normal erection. Another hormonal reason is too active production of the hormone in the male body. The fact is that prolactin is an antagonist to testosterone.

In men with damage to the walls of blood vessels, erectile dysfunction occurs due to vascular causes. The erection is reduced due to a violation of the filling of the blood of the penis. In most cases, a man suffers from a number of serious diseases -, atherosclerosis , ailments of the cardiovascular system .

The neurogenic factor becomes the cause of ED in people who have undergone diseases and injuries of the central nervous system and peripheral nerves. In this case, nerve impulses do not always pass into the cavernous bodies. Most often, erectile dysfunction is observed as a consequence of spinal cord injuries.

erectile dysfunction sometimes observed after taking certain medicines that were used to treat other diseases. In most cases, erectile dysfunction in men disappears after a certain period of time after the withdrawal of such drugs. But if the medications that provoked such disorders cannot be canceled, then the symptoms of ED will continue to be present.

In addition to these factors, other reasons leading to problems with should be remembered. These are persistent smoking and frequent drinking, malnutrition, unfavorable psychogenic environment leading to stress, etc. If a man constantly consumes a lot of fatty foods, this will inevitably lead to an increase in the concentration of female hormones. Metabolic syndrome is a phenomenon in which fat accumulates in the abdomen, the level rises, blood pressure rises and insulin resistance develops. This syndrome usually leads to regular erectile dysfunction. Therefore, the prevention of erectile dysfunction should always include the rejection of bad habits and correction of the diet.

It should be noted that erection can be adversely affected by sexually transmitted diseases, as well as exposure to high temperatures. Therefore, to abuse trips to the bath is also not worth it.

Diagnosis, which is carried out by a doctor, must necessarily be aimed at determining the causes of erectile dysfunction. Only by eliminating these factors, you can get the desired effect in the treatment process. Therefore, treatment with folk remedies at home is not worth practicing.

Not only the causes of erectile dysfunction described above are determined, but also a number of other factors that somehow influence the manifestations of ED. According to medical statistics, a weak erection or its absence is observed in about 60% of men who are 75 years old. Age-related causes of weak erection eventually begin to be noted by most men. There is a very weak erection of the penis, in order for an erection to occur, more time is needed, more active and prolonged stimulation is needed. However, ED in men is not an inevitable sign of aging. Most often, this is a consequence of a number of diseases that develop in old age, as well as the result of taking certain medications.

It is chronic diseases that are the factor that inevitably leads to erectile dysfunction. This condition may be accompanied by diseases of the vessels, lungs, liver, diseases of the nervous system, diabetes mellitus. Why erectile dysfunction occurs, and what to do in such a situation, the doctor can say after a thorough examination. But only the correct treatment of the underlying disease can save a man from problems with erection.

Another important factor is trauma, as well as surgery. Both the first and second can cause damage to the nerves that control the erection process. This leads to injuries of the pelvis, spinal cord. How to treat such manifestations depends on the severity of injuries and the characteristics of ED.

There is also an opinion that regular cycling can be the cause of erectile dysfunction. If you ride a bike often and for very long periods, then sitting compresses blood vessels and nerves. As a result, there is numbness in the genitals, and for some time a person will notice manifestations of erectile dysfunction.

Symptoms

The male penis consists of two cylindrical spongy structures. When sexual arousal occurs, the blood flow increases significantly due to the occurrence of nerve impulses, the blood fills the spongy cylinders, and an erection of the penis occurs. A normal erection in men is characterized by hardening and straightening of the penis.

If sexual arousal continues further, then more blood flows to the penis than flows out, and thus the sexual erection is maintained. After a decrease in excitation or after ejaculation, excess blood leaves the spongy bodies, and after an erection, the penis returns to its normal state again.

If there is too fast an erection that a man cannot maintain at the level necessary for sexual intercourse, then we can talk about symptoms of erectile dysfunction. True, such a state is determined if the erection time is too short, at least in one case out of four.

If an erection disappears only in rare cases, then this can be considered the norm. It should also be taken into account that the state when there is no erection during sexual arousal, or there are violations of it, may indicate other dangerous diseases that develop in the human body.

Diagnostics

A man should definitely visit a doctor and undergo a consultation if erectile dysfunction ceases to be a temporary problem. Often the representatives of the stronger sex tend to believe that problems in the intimate life of such a plan are their own business. However, going to the doctor in most cases can successfully treat ED. If the course of treatment prescribed by the doctor does not have the desired effect, then it is necessary to undergo a consultation again. Self-treatment or making adjustments to the therapy regimen prescribed by a specialist can only worsen the condition.

In order to establish the correct diagnosis and understand the causes of erectile dysfunction, the doctor will definitely ask the patient questions about when and under what circumstances erection problems appeared, whether there are other health complaints, what medications he takes. It is necessary to discuss with the doctor the psychological problems and emotional experiences that the patient had recently.

If a specialist has a suspicion that erection problems are the result of an organic problem, then the patient is assigned to conduct laboratory blood tests. The specialist can also stop or change the drugs that the patient is currently taking to determine their effect on erection.

In addition, to determine the cause of ED, in some cases, ultrasound is used, which makes it possible to determine information about the blood flow to the penis. Such an examination is carried out after drugs are injected into the penis that allow recording changes in blood flow.

To determine the presence of nerve damage, an examination is practiced, as well as determining the sensitivity of the skin in the genital area.

Another diagnostic technique in this case is cavernosometry and cavernosography. To carry out such a procedure, a dye is injected into the vessels of the penis. Its presence allows you to clearly determine the violation of blood flow. All manipulations are carried out under the local.

Sometimes the doctor prescribes a night erection test. To do this, before a night's sleep, a special tape is wrapped around the penis, with which you can confirm the presence of a nocturnal erection.

Erectile dysfunction is usually divided into three types. Primary Erectile dysfunction is defined if a man does not achieve an erection at all. Secondary ED is diagnosed if such disorders occur periodically. Selective Erectile dysfunction is a condition in which a man can achieve an erection under some circumstances, and under others he does not achieve it at all.

Treatment

Every man should be clearly aware of the fact that treatment erectile dysfunction, as a rule, gives positive results and allows you to live a full sexual life again. There are different methods of treatment that the doctor chooses depending on the reasons that led to such disorders. In modern medicine, they are used as medications for the treatment ED and surgical methods.

When applied invasive therapy drugs may be injected into the urethra. Also, drugs are injected directly into the penis. In addition, there is the possibility of penile prosthetics, as well as vascular surgery.

If there are indications, so-called phalloprostheses are installed for patients, which do not affect the sensitivity of the penis. The quality of orgasm and prosthetic ejaculation remains consistently satisfactory.

However, in the modern approach to the treatment of erectile dysfunction, not only drug treatment is important, but also non-invasive therapy . In this case, we are talking about, first of all, to exclude those risk factors that lead to the manifestation of such problems. Also to non-invasive treatment refers to psychotherapy, the use of drugs (tablets). Special vacuum devices are also used. Recently, in modern medicine, many new methods have appeared that can effectively influence potency. This is, first of all, a number of new drugs, the effect of which has been confirmed in practice.

The doctors

Medications

Prevention

To provide effective preventive measures to prevent erectile dysfunction , it is necessary, first of all, to prevent the occurrence of serious chronic diseases leading to problems with erection and to a deterioration in the state of the body as a whole.

It is important to eat right to prevent high cholesterol levels and the appearance of extra pounds. A man must constantly monitor blood pressure. If a HELL increased, then you must definitely go for a consultation with the doctor and undergo the course of treatment that he will prescribe.

Bad habits must be eradicated or at least reduced to a minimum. This applies to both smoking and drinking alcohol. The intake of any narcotic substances has a very bad effect on potency, so they should not have a place in a man's life.

A man of any age should move as much as possible and engage in the sport that he likes. It is equally important to pay attention to the psychological burden: avoid serious stress, emotional overload, conflicts. If you are concerned about the state of the psyche, a man should not hesitate to seek help from a psychologist.

Another important point for the prevention of erectile dysfunction is the regularity of sexual activity. Neither prolonged abstinence nor excess sexual contact in this case will not bring benefits.

List of sources

• Tiktinsky O.L., Mikhailichenko V.V. Andrology. - St. Petersburg: MediaPress, 1999.
• Mazo E.B., Gamidov S.I. Erectile dysfunction. Moscow: Veche, 2004.
• McVary K. Erectile dysfunction: Diagnosis and treatment.- M.: Practice; 2004.
• Shakhov B.E., Krupin V.N. Diagnosis of erectile dysfunction. Nizhny Novgorod: NizhGMYA, 2009.

Erectile dysfunction (the previously used term “impotence” is now considered incorrect and is practically not used in the medical community) is a very delicate male problem, which, unfortunately, is becoming more common every year. If earlier men over 40-45 years of age encountered sexual dysfunction, now the disease has become “younger”, and young men often turn to doctors, often under the age of 35.

This is connected, of course, primarily with the way of life of people, especially in megacities. Constant stress, disruption of sleep and wakefulness, poor ecology, unhealthy diet, smoking and other bad habits adversely affect the health of the whole organism, including the reproductive system. However, there are actually many more reasons that cause sexual dysfunction. With timely identification of the problem and proper treatment, potency can be fully restored.

Causes of erectile dysfunction

Depending on the causes, there are 3 forms of potency disorders.

Psychogenic form

Most often, this type of erectile dysfunction is diagnosed in men at a young age. In this case, there are no organic disorders in the structure of the genital organs and the hormonal system, libido is preserved or reduced, spontaneous erection is not disturbed, when an erection occurs, a man, as a rule, completes sexual intercourse. Main reasons:

• chronic fatigue, stress, depression, neurosis, including those caused by conflicts between sexual partners;
• the use of alcohol, narcotic and psychotropic substances.

organic form

Most men think that erectile dysfunction is a problem that comes with age, but it really isn't. With age, the number of chronic diseases increases, metabolic and other processes may be disturbed, which entails violations in the genital area. Most "age-related" diseases are treated with medication, and many drugs also have a negative effect on potency. That is why men who lead a healthy lifestyle from a young age and maintain good health for longer, face problems in the intimate sphere much later.

The causes of this pathology can be divided into several large groups:

1. Violation of the blood supply to the penis. This may be due to angiopathy that has developed as a complication or.
2. Decrease in the level of sex hormones as a result of endocrine disorders. The main reasons: dysfunction of the hypothalamic-pituitary system, congenital underdevelopment of the gonads, taking medications that reduce testosterone production, sometimes sports nutrition gives this effect.
3. Diseases of the nervous system: violation of the innervation of the genital organs as a result of injuries and infringement of the spinal cord, tumors or displacement of the vertebrae, myelitis, etc.
4. Diseases of the reproductive system. In recent decades, the number of cases of detection of sexually transmitted diseases has increased, often their consequences play an important role in the occurrence of erectile dysfunction. In addition, surgery on the genital organs, injuries of the penis and its curvature (often congenital), cavernitis can lead to this pathology.

mixed form

Sometimes a violation of potency is the result of a combination of organic and psychogenic factors. Identification of problems with the potency of an organic nature is a huge stress for a man, as a result of which the disease is aggravated by psychological trauma.

Briefly about the symptoms

Usually a man himself pays attention to the appearance of problems in the intimate sphere. The organic form of potency disorder develops gradually. To achieve an erection, an increasingly longer time is required, in the end, a situation is possible when, if a man desires sexual intercourse, he cannot achieve a normal erection at all. It is also possible to weaken it during intercourse, as a result of which it becomes impossible to complete it. Orgasmic disturbance is also possible.

It should be noted that almost every man encounters such situations, for various reasons, at least once in his life, and this is not a reason to sound the alarm. It is good to think about your health and consult a doctor when in 25% of cases a normal completed sexual intercourse becomes impossible.

Unlike the organic, psychogenic form of erectile dysfunction most often occurs in young men, sexual intercourse, which was preceded by a traumatic situation, suddenly becomes impossible. At the same time, memories of this event cause a man even more psychotrauma.

Treatment of erectile dysfunction

A doctor should deal with this delicate problem, the sooner a man turns to specialists, the more likely he is to fully restore normal sexual function or slow down the progression of the disease. In order to prescribe the correct complex treatment, the doctor, first of all, must find out the cause of problems in the intimate sphere.

If the problem is psychogenic in nature, then the treatment is carried out in conjunction with a psychotherapist. In any case, a man needs to change his lifestyle. You should completely abandon bad habits, with a sedentary lifestyle, you need to increase physical activity, avoid stressful and conflict situations. The doctor may recommend taking vitamins, dietary supplements, antidepressants, etc.

The problem of organic origin can be treated somewhat worse, it all depends on how pronounced the disease is, the consequence of which, in fact, is a violation of potency. For each disease, be it obesity, atherosclerosis, hypertension, infectious diseases, hormonal disorders, etc., appropriate therapy is selected.

Symptomatic treatment

In most cases, the problem can be solved if you see a doctor in a timely manner.

Medications

In the 90s, a drug for the treatment of erectile dysfunction appeared on the pharmaceutical market, which simply “blew up” the medical community and broke all imaginable and unimaginable records in the first year of sales. Many have already guessed that we are talking about Viagra. The active ingredient in this drug, sildenafil, was originally studied as a drug for the treatment of hypertension. However, significant results were not achieved in this area, but the side effect in the form of a persistent long-term erection, noted in men, was noticed by doctors. As a result, the drug almost completely changed its profile, began to be successfully sold all over the world, thus making millions of men happy.

The mechanism of action is simple, the drug increases blood flow to the pelvic organs, resulting in a normal erection under the influence of sexual arousal.

Today, in a pharmacy, you can find about a dozen drugs with a similar effect: Zidena, Levitra, Dynamico, Cialis, etc. They are sold mostly without a prescription, however, self-medication, and even more so to abuse these drugs, is still not worth it, because they have there are significant side effects and contraindications. Therefore, the appointment of the drug should consult a doctor.

Taking these drugs is the easiest and most affordable way to correct violations in the intimate sphere. Other non-surgical methods can be called quite specific, but they also “work”.

Intracavernous injections

In some cases, an effective method of achieving an erection is to perform injections into the cavernous bodies of the penis. The doctor selects vasodilators, most often it is the usual Papaverine, which the patient must independently inject himself before sexual intercourse. As a result of the injection, vasodilation occurs, blood flow to the penis increases, and an erection occurs. However, not every man will be able to independently perform such a procedure, and if asepsis rules are violated, a number of unpleasant complications can be obtained, and it is not recommended to resort to this method more than once a week.

An analogue of this method is the introduction of special suppositories into the urethra. This option, of course, is easier to perform, but it also requires certain skills, and the drugs are not cheap.

Vacuum pumps

Special vacuum-constrictor devices have been developed, with the help of which it is possible to bring the penis into a state of erection. The device consists of a cylinder and a pump (manual or automatic), which pumps air out of it, creating a vacuum. The penis is placed in this cylinder, and the vacuum created causes blood flow to it. A silicone ring is put on its base, which prevents the backflow of blood, an erection caused by a vacuum pump lasts an average of about 30 minutes. This method is quite easy to use, does not have many of the side effects of drugs, but also has some disadvantages and contraindications.

Surgical treatment

Modern medicine has come a long way in recent decades, therefore, in the vast majority of cases, it is possible to cope with the problem without resorting to surgical intervention. The main thing is to be patient and strictly follow the doctor's prescriptions. If medication and other methods of treatment still do not bring the desired result, or a man is diagnosed with a disease that is useless to treat with conventional methods, then the doctor may recommend surgical treatment.

Vascular surgeons can perform shunting of vessels that bring blood to the cavernous bodies of the penis, or, conversely, ligation of a vein to reduce the outflow of blood from them. However, as practice shows, the effectiveness of such operations is not high.

In recent years, the operation of penile prosthetics has become more and more common and in demand. Special prostheses are installed in the cavernous bodies of the penis; several types of such devices have been developed and successfully used today.

More available are semi-rigid and plastic prostheses, which are silicone rods implanted in the cavernous bodies of the penis. The first option is the cheapest, but at the same time it can cause inconvenience to a man (the penis is constantly in a state of erection, which causes discomfort in everyday life). Plastic prostheses are more convenient than semi-rigid ones, since they are made from materials that have a "memory effect", which allows the penis to maintain any given position.

Erectile dysfunction is a condition where a man cannot keep his penis erect for sexual intercourse. They talk about impotence when such a problem lasts for more than three months.

In today's world, about one in five men suffer from weak erections. Among them, more than half of the people do not visit a doctor and do not undergo therapy or self-medicate, only exacerbating the situation. This state of affairs is due to the fact that many consider the disease incurable or perceive it as a normal physiological sign of aging.

The main risk factor for this pathology is age, on average after 60 years. However, young men can also have poor or no erections, especially if they have:

• Diabetes;
• Bad habits;
• Overweight;
• Atherosclerosis;
• Mental overstrain;
• Physical inactivity.

To understand why there is a bad erection, you should understand the mechanisms of excitation of the male body. The penis of a man contains a spongy body and two cavernous. At the same time, the spongy body is located under the cavernous ones and is braided by them in the likeness of a grid. The blood supply of each of the bodies is separate, they have their own arteries and venous network. An erection in a man occurs due to the fact that there are cavities (or lacunae in other words) in the bodies that can be filled with blood. In order for an erection to appear, several properly functioning systems are required:

• Central nervous system;
• Nerve endings (peripheral);
• Vessels;
• Musculature (smooth);
• Cavernous bodies.0

At the time of sexual arousal, the central nervous system sends signals to the peripheral. As a result, the nerve endings affect the tone of the vessels, relaxing them, due to which the cavernous bodies are filled with blood. Since these bodies increase, their walls block the lumen of the venous vessels, due to which the outflow of blood does not occur. A weak erection in men appears in situations where one of the mechanisms of excitation or several at once is affected. From the degree of pathology, one can speak either of poor arousal, or of complete impotence.

The clinical picture of impotence can develop both gradually (progressing) and simultaneously, depending on the cause that caused the pathology. Among the main signs of the disease are:

• Rapid (premature) ejaculation, provided that the penis is not fully excited;
• An erection occurs with the participation of a conscious factor, and not by itself;
• , wet dreams;
• Increases the duration of time at which an erection occurs;
• Insufficiency of excitation (the penis is not completely hard);
• Periodic problems with the appearance of an erection for a month or more (or a weak erection appears at least every fourth time when trying to have sexual intercourse or is absent at all).

In addition to symptoms related directly to erectile function, a clinical picture of the underlying disease that caused damage to the reproductive system may appear. For example, heart problems with atherosclerosis or thirst with rapid weight loss in diabetes. The classification developed for this disease is based on why a weak erection occurs. Distinguish 7 main types diseases.

Psychogenic

Psychogenic erectile dysfunction is characterized by the fact that the cavernous bodies lose their susceptibility to various chemicals that promote erection. This arises due to the fact that the central nervous system, for some reason, depresses the periphery. The causes of this condition can be stressful situations and mental disorders in the form of depression, neuroses and other similar diseases. Impotence can be caused by a man's conscious prejudices or fears. However, due to the high level of diagnostics in recent years, it is rare to meet psychogenic impotence without the participation of at least one more mechanism of disturbance.

Vasculogenic

Depending on the type of vessels that are affected, vasculogenic erectile dysfunction is divided into arterial and venous. In most cases, the arterial type of impotence is based on atherosclerotic lesions of the arterial bed. It is this factor that affects the fact that the age category of those suffering from this disease is mainly the elderly. The main causes that are accompanied by atherosclerosis:

• Hypertonic disease;
• Diabetes;
• Smoking.

In addition to atherosclerotic lesions, insufficient arterial inflow may occur due to congenital malformations or developmental anomalies, or due to trauma. Arteriogenic impotence is dangerous due to the appearance of a vicious circle, which is characterized by a violation of the trophism of the cavernous bodies due to insufficient blood flow, which only progresses in the future. When the cause of a weak erection is a lesion of the venous bed, a classification is distinguished according to the pathogenetic type. Venogenic impotence happens:

• Primary. This includes any congenital malformations of the venous system in the area of ​​the cavernous bodies, for example, pathological drainage or vasodilation.
• Secondary. The mechanism for the development of impotence is to reduce the elasticity of the vessel wall, which is why it does not compress during an erection. This condition may occur due to fibrotic changes in the venous bed in the area of ​​the cavernous bodies, sclerotic lesions in conjunction with the action of psychogenic factors.
• Corporovenous. The pathogenesis of the lesion is the thinning of the tunica albuginea due to injuries due to any specific diseases (Peyronie).

Hormonal

Erection problems in men can occur due to insufficient amounts of the sex hormone. Its small amount is congenital, most often due to hereditary or genetic diseases. Insufficiency may also be acquired. The mechanism of development of erectile dysfunction in this case is characterized by the absence or a significant decrease in sexual arousal (of a mental nature). Because of this, the substances involved in the process of erection are not produced, and subsequently the metabolism of the tissue of the cavernous bodies worsens and their degeneration occurs. The ability to cure such a condition depends on the degree of secondary venous insufficiency, which is formed in this case.

neurogenic

Unlike psychogenic dysfunction, neurogenic dysfunction appears due to diseases of the nervous system of an organic or functional nature. Due to damage to the nerves, the impulse does not reach the penis, which is why impotence occurs. More than half of the cases of neurogenic dysfunction result from traumatic spinal cord injury. Unfortunately, this condition is almost always irreversible. Also, etiological factors can be oncological lesions of the brain, multiple sclerosis, herniated disc lesions, or some kind of cerebrovascular pathology.

Medical

There are many drugs, taking which a man worsens erectile function. These include:

• Medicines to improve heart function (diuretics, cardiac glycosides, beta-receptor blockers, drugs that reduce blood pressure);
• Mental medications (antidepressants and tranquilizers, drugs containing lithium, as well as a group of drugs that depress MAO);
• Hormonal agents (female sex hormones or male inhibitors, corticosteroids);
• Weight loss drugs;
• NSAIDs;
• Cytostatics.

Treatment of erectile dysfunction of this type is to refuse to take the above medications. However, in most cases, their use is dictated by objective reasons, so you should carefully follow the doctor's instructions during treatment with these drugs.

Cavernous

The essence of this type of impotence is to reduce the elastic properties of the tissue of the cavernous bodies. Such a condition can appear due to many reasons, in particular vascular changes, the presence of bad habits, diabetes, various poisonings. The smooth muscles of the cavernous body atrophy, which makes it impossible to fill it with blood during an erection.

Inflammatory

Often, erectile dysfunction of this type is associated with sexually transmitted diseases. Moreover, the mechanism of damage includes not only the direct inflammation of a particular organ, but also the psychological oppression of a man. In particular, the depressive factor affects the erection in the chronic course of diseases. Most cases of erectile dysfunction are the result of the combined action of various factors, which is why another type of impotence is distinguished - mixed.

What to do with a weak erection?

First of all, a man should visit a doctor and conduct a complete examination of the body to identify the causes of impotence, in accordance with which pathology treatment will be prescribed. The survey includes:

1. Blood study. Diabetes mellitus is detected or ruled out. The level of cholesterol and lipids is determined, which makes it possible to suspect atherosclerosis. Also, with the help of some markers, a violation of the liver, which utilizes female sex hormones, is determined.
2. Hormonal studies. The basis is the determination of the level of male and female sex hormones, as well as their ratio.
3. Urine study. Allows you to detect diabetes mellitus and most inflammatory pathologies.
4. prostaglandin tests. With their help, the state of the vessels in the region of the cavernous bodies is determined.
5. Doppler. It allows you to judge the blood supply and, in general, the blood flow in the arteries and veins of the penis.
6. Biotensiometry. With the help of this study, the degree of disorders of nerve conduction is studied. With the help of special vibrating devices, an erection is caused by determining the threshold of excitability.
7. Pollution diagnosis. With the help of a special apparatus, the frequency and strength of erections that occur spontaneously at night are noted.
8. Neurological examination. It is carried out to confirm or exclude diseases of the brain or periphery.
9. Cavernosography. With the use of a contrast agent, an x-ray of the penis is taken in an excited state. The method is of particular importance in Peyronie's disease.

After conducting an examination and identifying the causes, the doctor decides what to do with poor erection, determines how reversible the process is and prescribes treatment.

Treatment of erectile dysfunction in men

There are many ways to treat erectile dysfunction, depending on the cause that caused it. First of all, you need to cure the underlying pathology. And directly to improve erection can be used:

• Taking drugs that increase potency (there are a huge number of them on the market, but such drugs cannot be drunk together with nitrates);
• Hormonal treatment (used for insufficiency of the male hormone testosterone);
• Vacuum therapy (treatment consists in using a special pump, with which air is removed from the cavernous bodies, which promotes blood flow due to the pressure difference);
• Psychotherapy (treatment of weak erection may include sessions with a psychologist (often with a partner), if impotence is not caused by an organic lesion of any system);
• Injections of drugs directly into the penis (the effect is better than with systemic administration, but everyone can inject it);
• Introduction to the urethra of suppositories (expensive, but effective treatment based on the use of vasoactive agents).

All drugs and methods for the treatment of erectile dysfunction (other than psychotherapy) are symptomatic and eliminate dysfunction only for the duration of the substance. In cases where their use is contraindicated or does not bring effect, surgical interventions can be performed. At this stage in the development of surgery, penile arthroplasty is considered the best remedy for erectile dysfunction. During the operation, special prostheses are placed in the organ, which can be either primitive (that is, the penis constantly remains erect) or more modern. The latter involve the use of special containers where fluid is injected to achieve an erection. Such an operation is expensive and irreversible.

Treatment of weak erectile dysfunction with folk remedies

In addition to traditional therapy, traditional medicine is also widely used. However, self-medication for erectile dysfunction should be done very carefully so as not to aggravate the condition to complete impotence. It is best to consult with your doctor first. For the treatment of erectile dysfunction at home, use:

• Herbal preparations (many means are used for their preparation, for example, figs, nettles, celery, mordovnik, echinacea and others);
• Alcohol tinctures (a remedy such as spurge is very popular);
• Decoctions and infusions (substances such as sage, hawthorn, juniper are used here).

There are a lot of folk medicines for erectile dysfunction. The main rules for their use: strict adherence to prescriptions and prior consultation with your doctor.