Information of Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (impotence) is the inability to have and maintain an erection firm enough to have sex.

Erectile dysfunction can be a short-term or long-term problem. Do you have when

  • 0You may have an erection, but it doesn’t take long for you to have satisfying or satisfying sex
  • are unable to get an erection at any time
  • can get an erection sometimes, but not every time you want to have sex

Does erectile dysfunction have another name?

Sometimes erectile dysfunction is called impotence, but medical professionals use the term less frequently now, so they won’t interfere with other non-medical word meanings.

Who is more likely to develop erectile dysfunction?

If you are more likely to develop ED

  • have certain psychological or emotional issues
  • take certain medicines
  • are older
  • have certain diseases or conditions
  • have certain health-related factors or behaviors, such as overweightor smoking

How common is erectile dysfunction?

ED is very common. It affects approximately 30 million men in the United States.1

How does erection occur?

Erections are neurovascular events, which means that the nerves and blood vessels (arteries and veins) are involved in the erection process and they must all work properly to develop a hard erection that lasts long enough. The erection begins with sexual stimulation. Sexual stimulation can be tactile (for example, a couple touching the penis or masturbating) or mental (for example, with sexual fantasies, see pornography). Sexual stimulation or excitement causes the nerves that go into the penis to release chemical nitric oxide. Nitric oxide boosts the production of another chemical, cyclic GMP (cGMP), in the corpora cavernosa muscle. CGMP relaxes the cavernous muscle of the trunk, allowing more blood to flow into the penis. Incoming blood fills the body’s cavernosa, causing the penis to expand.

What are the complications of erectile dysfunction?

Complications of erectile dysfunction may include

unable to get pregnant couple
loss of intimacy between you and your partner, resulting in a strained relationship
dissatisfied sex life
depression, anxiety and low self-esteem
Depression, anxiety, and low self-esteem can also contribute to erectile dysfunction, creating a cycle of health problems.

 

Certain psychological or emotional issues

Psychological or emotional factors can worsen erectile dysfunction. Erectile dysfunction can develop if you have one or more of the following:

  • stress: the sexual performance or stress in your life in general
  • fear of sexual weakness
  • low self-esteem
  • anxiety
  • guilt for sexual performance or certain sexual activities
  • depression

What causes erectile dysfunction?

  • The erection is the result of increased blood flow to the penis. Blood circulation is usually stimulated by sexual thoughts or direct contact with the penis.
  • ED can occur due to problems at any stage of the erection process. For example, the arteries of the penis may be too damaged to open properly and allow blood to enter.

ED can be the result of health problems, emotional problems or both. Some known risk factors are:

  • Lack of exercise
  • Be over 50 years old
  • Thick
  • Have High Blood Sugar (Diabetes)
  • Use drugs or drink too much alcohol.
  • Have high blood pressure
  • smoke
  • Have cardiovascular disease
  • Have high cholesterol

Physical Causes of ED

  • The penis cannot catch blood during an erection

Unless the blood stays in the penis, one cannot maintain an erection. This problem can occur at any age.

  • Medications used to treat other health conditions can affect erections.

Patients should discuss their side effects with their treating physician.

  • There is not enough blood flow to the penis..

Many health conditions can reduce blood flow to the penis, such as hardened arteries, heart disease, high blood sugar (diabetes) and smoking.

  • Treatments with carcinoma near the pelvis can affect the functionality of the penis.

Surgery and / or radiation therapy for carcinoma of the lower abdomen or pelvis can cause erectile dysfunction. Treatment for prostate cancer, colon and bladder often leaves men with erectile dysfunction. Survivors of cancer should visit a urologist for sexual health problems.

  • Neural signals from the brain or spinal cord do not reach the penis

Certain diseases, injuries, or operations in the pelvic area can damage the nerve of the penis.

  • Diabetes can cause minor vessel disease or damage to the nerve of the penis.
  • Obesity
  • Parkinson’s disease
  • Multiple sclerosis
  • Sleep problems
  • Surgery or injuries that affect the pelvis or spinal cord.
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • Some prescription drugs
  • A Heart problem

Emotional Causes of  ED

Normal sex needs the mind and body to work together. Emotional problems or relationships can cause or worsen erectile dysfunction.

Some emotional problems that can cause erectile dysfunction are:

  • Concerned about sexual performance
  • Depression
  • Stress due to social, cultural or religious conflicts.
  • anxiety
  • Stress at home or work
  • Conflict Relationship

How Erections Work

  • During an erection, the spongy tissue relaxes and enters the bloodstream. The blood pressure in the chambers causes the penis to become firm, causing an erection. When a man has an orgasm, the second set of nerve signals reaches the penis and causes the muscle tissue in the penis to become infected and the blood returns to the human circulation and the erection decreases.
  • During sexual arousal, the nerves release chemicals that increase blood flow to the penis. The blood enters two erection chambers in the penis, made of sponge muscle tissue (corpora cavernosa). The cavernosa chambers of the company are not hollow.
  • When you are not sexually excited, your penis is soft and extreme. Men may notice that penis size varies with heat, cold or anxiety; This is normal and reflects the balance of blood entering and leaving the penis.

What are the symptoms of erectile dysfunction?

  • With Erectile Dysfunction (ED), it is difficult to get or maintain an erection firm enough to have sex. When an emergency becomes a routine and annoying problem, your health professional or urologist can help.
  • Erectile dysfunction can be an important warning sign for cardiovascular disease, indicating that blockages are forming in the human vascular system. Some studies have shown that men with erectile dysfunction are at increased risk of heart attack, stroke or circulatory problems. ED also causes:
  • Angry about the man and his partner.
  • Low self-esteem
  • Depression
  • If erectile dysfunction affects one’s well-being or relationships, it should be treated. The purpose of treatment is to repair or improve erectile function, assist circulatory health, and improve the quality of life of a person.

Diagnosis

  • Clinical evaluation

Assessment should include a history of medications (including prescriptions and herbs) and alcohol consumption, pelvic surgery and trauma, smoking, diabetes, hypertension and atherosclerosis, as well as vascular, hormonal, and neurological symptoms. and psychological disorders. Sexual satisfaction should be explored, including assessment of couple interaction and couple sexual dysfunction (eg, atrophic vaginitis, dyspareunia, depression).

  • Testosterone level

It is essential to detect depression, which is not always obvious. Beck’s Depression Scale or, in older men, the Yesavage Geriatric Depression Scale (see table General Depression Scale (short form)) is easy to administer and may be useful.

  • Detection of depression

The test focuses on genital and extragenital signs of hormonal, neurological and vascular disorders. The genitals are examined for abnormalities, signs of hypogonadism, and fibrous plaques or bands (Peironi’s disease). Poor rectal tone, decreased perineal sensation, or abnormal bulbocavernous reflexes may indicate neurological dysfunction. A decrease in peripheral impulses suggests vascular dysfunction.

Psychological cause should be suspected in young and healthy men with sudden onset of Erectile Dysfunction (ED), especially if the onset is related to a specific emotional event or if the dysfunction occurs only in certain contexts. The history of ED with spontaneous improvement also suggests psychological origin (psychogenic ED). Men with psychogenic erectile dysfunction usually have nocturnal erections and normal wakefulness erections, unlike men with organic erectile dysfunction.

What doctors treat erectile dysfunction?

The type of specialist doctor treating erectile dysfunction will depend on the cause of the problem. Depending on your family’s medical history, as well as your own medical history and your current medical condition, your doctor may treat you with oral medications (Viagra®, Levitra®, Cialis®).

If these options fail, you may be referred to a urologist who may assist you with other non-surgical options, such as vacuum or injection devices or surgical treatment options. If necessary, your doctor may also refer you to a psychologist specializing in sexual dysfunction.

Efficiacy

According to a review of all randomized controlled trials of the American Urological Association (AAA) for essential dysfunction, 36% to 76% of patients receiving the drug were able to “have sex.” “During treatment. For tadalafil, four randomized controlled trials found that between 11% and 47% of patients” were capable of coitus “. Similar efficacy was observed with vardenafil, although studies were less. Meta-analysis published in 2013 has clearly demonstrated greater placebo efficacy for all PDE5 inhibitors. And direct comparison has suggested that tadalafil exceeds sildenafil in valid measures of erectile dysfunction, including the international erectile function index and sexual intercourse profile-2 and -3.

Cons indications

Patients at high cardiovascular risk should not be treated for erectile dysfunction until their heart condition has stabilized. These conditions include unstable or refractory angina, myocardial infarction or stroke for the past 2 weeks, uncontrolled hypertension, Functional Heart Classification New York Heart-III (NYHA), congestive heart failure, cardiac arrest and arrhythmia and arrhythmias hypertrophic obstructive cardiomyopathy. Severe valve disease This class of drugs is also contraindicated in patients using nitroglycerin or nitrate-containing compounds.

Although vardenafil does not appear to give a significant QT prolongation, it is thought to be avoided in patients with congenital QT prolongation abnormalities and in patients using class I antiarrhythmics such as quinidine and procainamide. It is also best to avoid the use of vardenafil with class III antiarrhythmics, such as amiodarone or sotalol.

Because of the risk of hypotension, caution should be exercised in patients using alpha-blockers for prostate hyperplasia and patients using other antihypertensive and alpha-blocking agents who should not be co-administered with PDE5 inhibitors. In patients receiving 50 mg or more of sildenafil and using alpha-blockers, administration of sildenafil should be avoided at least 4 hours after the alpha-blocker dose. In patients taking 25 mg sildenafil, the use of any alpha-blocker is considered safe.

Dose adjustment is recommended in patients with hepatic impairment and concomitant administration of drugs metabolised with cytochrome p450 enzymes. There is an informed risk of non-arterial anterior ischemic optic neuropathy (NAION) with the use of PDE5 inhibitors. Although the association is controversial, it is reasonable to consider alternative treatments for erectile dysfunction in patients with NAION or at risk of suffering from it.

 

Treatment

The 2018 American Urological Association guidelines for the treatment of erectile dysfunction recommend a complete story and lifestyle and lifestyle changes, followed by a shared approach to decision-making regarding existing medical services. treatments (Figure 1)

Figure 1: American Urological Association guidelines for the treatment of patient with erectile dysfunction.

Risk factors

As you get older, erections can take longer to develop and may not be as firm. You may need direct contact with the penis to get and maintain an erection

Several risk factors can contribute to erectile dysfunction, including:

  • Smoking, which restricts blood flow to the veins and arteries, can over time cause chronic health problems that lead to erectile dysfunction.
  • Certain medical treatments, such as prostate surgery or cancer radiation.
  • Being overweight, especially if you are overweight
  • Medications, including antidepressants, antihistamines, and medicines to treat high blood pressure, pain or prostate problems.
  • Injury, especially if it damages the nerves or arteries that control the erection
  • Psychological conditions such as stress, anxiety, or depression.
  • Drugs and alcohol use, especially if you are a long-term addict or heavy drinker

Complications

Complications arising from erectile dysfunction may include:

  • The inability to get your partner pregnant
  • Unsatisfactory sex life
  • A few problems
  • Stress or anxiety
  • Shame or low self-esteem

Prevention

The best way to prevent erectile dysfunction is to make healthy lifestyle decisions and to control existing health conditions. For example:

  • Practice regularly.
  • Work with your doctor to control diabetes, heart disease or other chronic health conditions.
  • Consult your doctor for regular checkups and medical checkups.
  • Stop smoking, restrict or avoid alcohol and do not use any illegal drugs.
  • Take steps to reduce stress.
  • Get help with anxiety, depression or other mental health problems.