A pathology that scares all the representatives of the stronger sex, erectile dysfunction, is most often the result of another disease. It involves the absence or insufficient erection of the penis, which is necessary for a full-fledged sexual intercourse.

In moderate and severe degree, this type of violation is observed in 20% of men. The interest of urologists-andrologists in this problem is due to a decrease in the quality of life of patients, the destruction of families and the psychological problems that the disease leads to.

Glad to see you again on the blog, dear readers. Alexander Burusov is in touch and today we will talk in detail about erectile dysfunction and its diagnosis.

Erectile dysfunction in men involves a violation of blood circulation in the genitals. In particular, there is insufficient filling of the cavernous bodies with blood. This is possible due to arterial insufficiency or excessive outflow of venous blood from the penis.

In this regard, it can be established that risk factors for dysfunction are similar to cardiovascular diseases. These include:

• elderly and senile age,
• overweight,
• depressive states,
• metabolic Syndrome,
• smoking and drug addiction
• diabetes,
• low physical activity.

It is known that this condition can be prevented by getting rid of bad habits.

Classification

Erectile dysfunction (ED) is classified into three groups depending on the risk factors that cause it:

1. Psychogenic ED. It occurs in men with neurosis, dependence on psychotropic drugs, and also in some situations that provoke an episode of dysfunctional disorder.
2. organic erectile dysfunction. Appears in patients with vasculogenic (vascular), neurogenic, hormonal disorders. Also, organic erectile dysfunction is typical for men with structural changes in the penis (Peyronie's disease, traumatic organ damage, micropenis, hypo- and epispadias, sclerosis of the cavernous bodies after inflammation). Hormonal factors include: hypogonadism, hypo- and hyperthyroidism, Itsenko-Cushing's disease, hyperprolactinemia. Organic erectile dysfunction can occur in the presence of Parkinson's disease, tumors of the brain and spinal cord, multiple sclerosis, damage to the discs between the vertebrae, after strokes. Polyneuropathies of various etiologies provoke the appearance of pathology. Most often, it is cardiovascular changes that are the cause of the development of impotence in men. Organic erectile dysfunction can be the result of atherosclerosis, high blood pressure, smoking (spasm of the vessels of the penis), Leriche's syndrome, veno-occlusive disorders, imbalance of fats and sugars in the blood.
3. Drug ED. Poor erection is often observed in people taking antidepressants, antiandrogenic drugs, psychotropic and pressure-reducing drugs. This group also includes men who use drugs.

The causes and treatment of ED are closely related. Therefore, the identification of risk factors and determination of the nature of disorders is important for further tactics of patient management.

Diagnosis of erectile dysfunction

First of all, the very fact of the presence of the disease is clarified. To do this, the doctor carefully interviews the patient, summarizes the symptoms.

Significant assistance is provided by specially designed questionnaires. These questionnaires include the International ED Index and the Male Copulation Quantification Scale.

After erectile dysfunction in men has been established, its nature is determined. For psychogenic ED the following parameters are typical:

• occurs suddenly,
• preserved morning erections,
• having problems with a partner
• pathology appears only in certain circumstances.

organic erectile dysfunction is characterized by:

• gradual development,
• lack of morning erections,
• persistence of violations
• lack of psychological and interpersonal problems.

Clinical diagnosis of erectile dysfunction includes examination for cardiovascular, neurological, hormonal pathologies. Mandatory examination of the patient, including:

• weighing, height measurement,
• assessment of the development of the musculoskeletal system,
• determination of the nature of hair growth,
• analysis of the distribution of subcutaneous fat,
• determination of voice timbre, waist circumference,
• determination of the location of the testicles, their size and consistency.

All of these parameters are needed to identify the hormonal status of a man, which has a direct impact on potency.

Erectile dysfunction in men is confirmed differently in the laboratory. It depends on what pathology the doctor suspects. Can be assigned:

• lipid Profile,
• determination of blood sugar levels,
• blood testosterone test.

Be sure to exclude inflammatory diseases of the prostate, seminal vesicles, testicles and their appendages.

To conduct a differential diagnosis of vascular disorders, use the introduction into the penis vasoactive drugs. The most commonly used is Alprostadil. It is administered at a dosage of 10mcg and the effect is expected.

If after 10 minutes an erection does not occur, suggest the presence of vascular disease. You can confirm the problem by using UZDG arteries. The speed of blood flow after the introduction of pharmaceuticals is noted.

You can complete your survey with: methods:

• vascular angiography,
• cavernosometry and cavernosography,
• determination of evoked potentials,
• EMG of the penis.

All examinations are prescribed by the attending physician. Only he knows in what situation one or another diagnostic method can be applied.

Treatment

The main goal of therapy is to restore erectile dysfunction to a state that allows for normal sexual intercourse. First of all, the treatment of diseases that caused pathological condition(diabetes, atherosclerosis, obesity, etc.). If there are anatomical changes in the vessels, surgical correction is performed.

One of the methods of treatment is the prescription of drugs based on testosterone. It is important to remember that the method is applied only to men with a confirmed deficiency of the hormone in the blood.

After provoking factors have been excluded, lifestyle has been normalized and related conditions have been corrected, they resort to prescribing basic medicines.

In most cases, erectile dysfunction can be cured by taking phosphodiesterase-5 inhibitors. The drugs included in this group include the following drugs:

• sildelafil,
• tadalafil,
• udenafil,
• vardenafil.

They are produced under various brands. The most popular are Cialis, Viagra, Vizarsin, Dynamico etc. Means differ in dosing regimen and pharmacokinetic characteristics (half-life, time of onset of effect, duration of erection). As a rule, all funds must be taken some time before the planned sexual intercourse.

However, medicines for daily use have already been released. They do not cause unwanted erections during the day. The action occurs only after an impulse is given from the brain.

The second line of ways in which ED can be treated are intracavernous injections of drugs. Solutions of alprostadil, phentolamine, papaverine are used.

The dosage is selected strictly individually. After the introduction of the drug, an erection occurs within 5-10 minutes.

It is important to remember that injections into the cavernous bodies can be performed no more than 2 times a week with an already selected dosage.

chief side effect such treatment is a prolonged unwanted erection. If the condition persists for 4 hours or more, you should contact a medical institution.

If all of the above methods of treating ED were ineffective, decide on prosthetic penis.

From the point of view of official medicine, erectile dysfunction is the inability to achieve and maintain a full erection for sexual intercourse lasting for three months. This situation requires treatment (penile rehabilitation). The remaining cases are classified as short-term situational sexual disorders.

Erectile dysfunction is commonly referred to as impotence. The problem manifests itself in several ways:

• Too (less than a minute);
• Unstable erection (the member falls during the introduction or immediately after it);
• Member does not rise at all.

According to statistics, the first serious signs of impotence in men appear on the threshold - from 45 to 55 years, depending on the lifestyle and sexual constitution. Here we are talking not so much about physical erectile dysfunction, but about the reluctance to have sex due to increased fatigue, weakening of the body due to chronic diseases. The reason is a decrease in testosterone levels., which is responsible not only for libido, but also for the state of cardio-vascular system, muscle endurance, mood. At the age of 40-50, 40% of men complain of impotence, at 50-60 - at least half, after 60 - more than 70%.

Risk factors for early andropause and impotence:

1. Hypodynamia (reduced physical activity).
2. Obesity (as a result of malnutrition and physical inactivity).
3. Smoking and drugs.
4. Alcoholism (relationship).
5. Avitaminosis.
6. Metabolic syndrome (the body does not respond to insulin, which leads to an increase in visceral fat).

For self-examination, you can take the AMS online test, which helps to assess the severity of androgen deficiency. Follow the link to take the test.

How often do you have erection problems during intercourse?

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08.06.2019

Types and causes of impotence in men

The erection mechanism is disturbed due to organic causes (in other words, various diseases and anatomical defects) and psychological problems. In most cases, impotence is combined.

Psychogenic impotence

Psychogenic impotence is officially called "insufficiency of the genital reaction, not associated with organic pathologies." It is caused by situational factors (external circumstances) and neurotic deviations (phobias, dependence on drugs, alcohol).

Psychotherapist Grigory Ovtsov will tell about the psychological side of erectile dysfunction

Situational causes of psychogenic impotence:

• Fear of another sexual failure after several "failed" sexual acts;
• Chronic stress: problems at work, loans, dissatisfaction with relationships with a partner;
• Depression: loss of interest in life, accompanied by physical weakness, apathy.

This type of erectile dysfunction is corrected with the help of consultations with a psychologist, medications, and physiotherapy.

organic impotence

An erection occurs as a result of the well-coordinated work of neurogenic (transmission of nerve impulses), vascular and hormonal mechanisms: a man sees or represents a sexual object, impulses are transmitted, blood flow to the penis is accelerated, an erection occurs due to compression of the efferent veins of the penis. Arousal is possible only with normal libido(here we talk about) , which is provided by the appropriate level of testosterone (hormonal factor). Depending on which link failed, There are three types of organic impotence:

1. . Causes: arterial hypertension, diabetes mellitus, atherosclerosis, cardiovascular pathologies, surgical interventions in the pelvic area, radiation,.
2. Neurogenic impotence. Diabetes mellitus (not only disrupts metabolism, but also causes dysfunction of nerve endings (it is also provoked by kidney disease)), parkinsonism, pathologies of the brain and spinal cord, alcoholism.
3. Hormonal impotence. It is caused by a congenital or acquired lack of androgens.

At a young age, vascular impotence mainly occurs due to smoking(some start at school) and alcohol. Vessels and nerves resist nicotine and alcohol intoxication for a long time, but eventually give up. Sedentary young people also endanger their sexual function.. They develop stagnant processes in the pelvic area, congestive prostatitis, hemorrhoids.

Young people who achieve impressive fitness in the gym by taking anabolic steroids also run the risk of earning temporary impotence. After the course, a withdrawal syndrome will develop - there is no longer external testosterone, and its synthesis has not yet been restored. If you get carried away too much, then the testicles will atrophy altogether.

In young men, neurogenic impotence sometimes occurs due to frequent masturbation which takes the form of a severe addiction. Intense onanism leads to depletion of the spinal genital centers, the sensitivity of the receptors of the head decreases (about that), atony of the prostate may develop (flabbiness of the muscles due to frequent contractions, when the fibers simply do not have time to recover).

Organic impotence can also be penile - caused by structural pathologies of the penis: curvature due to trauma, scarring, sclerosis (replacement of normal connective tissue) due to cavernitis (inflammation of the cavernous bodies).

Another type of impotence is iatrogenic or drug-induced. It is provoked by taking antidepressants, antihypertensive drugs, antiandrogens.

Infections that cause impotence

Impotence is caused not by the infections themselves, but by the diseases provoked by them:

• Prostatitis;
• Vesiculitis (inflammation of the seminal vesicles behind the prostate);
• Inflammation of the seminal tubercle (due to it, painful early ejaculation is possible);
• , pyelonephritis.

The above pathologies can be caused by hidden sexual infections, as well as their own opportunistic microflora (E. coli, staphylococcus aureus from chronic foci of inflammation (tonsillitis) or from the skin). The most common cause of slowly developing impotence is prostatitis, provoked by chlamydia or E. coli.

Signs of impotence

The first signs of impotence in the form of an unstable erection are usually attributed to stress, depression, and alcohol intake. Such dysfunction can indeed be situational, but if it is repeated regularly, then we are already talking about a violation.

More a serious sign of impotence - the absence of night and morning spontaneous erections, the inability to call it during masturbation. Symptoms gradually increase, the man loses his desire to have sex, he becomes withdrawn, irritable.

Immunologist Georgy Alexandrovich Ermakov more about how erectile dysfunction manifests itself

Signs of impotence in men over 50

In men over 50, impotence often occurs against the background of urination disorders (delay or, conversely, increased frequency) associated with prostate enlargement (age-related hyperplasia).

Due to the decrease in testosterone levels, sexual desire decreases. I don’t want sex as such, which is why there is no arousal and erection.

Diagnosis of erectile dysfunction

In the event of impotence, they first turn to a urologist-andrologist. He prescribes an initial set of tests: blood (including hormones, cholesterol and sugar), urine (general and biochemical analysis), digital examination of the prostate and ultrasound (duplex scanning) of the pelvic organs.

Impotence due to disorders of nerve conduction is dealt with by a neuropathologist (neurologist). If the analysis showed a hormonal imbalance, then the patient is referred to an endocrinologist.

Treatment of erectile dysfunction

Restoring a normal genital response usually involves a whole a set of measures: medicines, lifestyle correction, if necessary, surgical intervention(change in the vascular bed, ligation of the veins of the small pelvis, removal of varicocele, adenoma).

Can impotence be cured?

First-line drugs in the treatment of impotence are PDE-5 inhibitors (sildenafil, tadalafil). For the treatment of vascular erectile dysfunction, they are taken in courses. A single pill helps to cope with most cases of psychogenic impotence.

The best remedies for impotence:

• "" - 1538 rubles. for 2 tablets;
• "" - 795 rubles. per tablet;
• "" - 3576 rubles. for 28 tablets.

Generics are much cheaper than the original, but many complain of significant side effects after taking them. According to men on thematic forums about impotence, best option– PDE-5 inhibitors from the Russian company Severnaya Zvezda:"" (335 rubles for 20 tablets), "" (752 rubles for 30 tablets).

Comparison of popular generics (click on image to enlarge)

For men taking drugs for high blood pressure, PDE-5 is prescribed together with Tamsulosin to avoid its critical decrease (orthostatic hypotension).

If there is no effect from oral drugs, then intracavernous injections of vasodilators (prostaglandin E1) are used. The injections are first put by the doctor in the treatment room, then the patient learns to do them on his own.

For the treatment of impotence in men after 50 years, the same drugs are used, but taking into account existing chronic diseases. There will be more contraindications. For elderly patients, PDE-5 inhibitors are often prescribed in conjunction with androgens, alpha-lipoic acid (Thioctacid), which improves the condition of nerve fibers. Particular attention is paid to the condition of the prostate.

Physiotherapy

Vacuum erectors are used as an alternative to medical treatment of impotence. - expansion of the vessels of the penis by exposing the organ to negative pressure in a special flask. The task is to achieve an erection and fix it with the help of a penis worn on the base. This type of therapy is more suitable for older men with reduced sexual activity.

More about LOD-therapy doctor urologist-sexologist Kurinov Artyom Nikolaevich

In the absence of effect from PDE-5 inhibitors, mild impotence can be treated with shock wave therapy (SWT). During the procedure, the cavernous bodies are exposed to acoustic waves. It is assumed that in this way it is possible to stimulate the synthesis of nitric oxide, which dilates blood vessels.

Surgery

Radical surgical treatment of impotence involves the implantation of implants into the cavernous bodies (penile implantation). This method is used when all the previous ones are ineffective.

Scheme of installing a hydraulic penile prosthesis with irreversible impotence

An erection occurs without fail when you press the valve in the scrotum. Ejaculation and orgasm remain the same.

At home

Several methods can be used to correct a mild degree of erectile dysfunction and as adjuncts to the main treatment at home:

• LOD-therapy with the help of vacuum pumps;
• Course intake of dietary supplements with Eurycoma longifolia, tribulus, burning flour, amino acids;
• The use of local stimulants: lubricants with aphrodisiacs, gels, ointments, sprays;
• cock massage and inguinal region(possible with the use of heparin ointment);
• to strengthen the pubic-coccygeal muscle and enhance the sensitivity of receptors;
• Rectal suppositories for the treatment of prostate diseases ("Prostatilen", "Propolis DN").

Prostatilen is a drug of animal origin used in diseases of the prostate gland. Price from 318 rubles.

There are also folk methods treatment of impotence, including rubbing the penis with heparin, taking tincture on the beaver stream, decoction of dead bees, natural drone homogenate.

An important (and in some cases key) point in the treatment of impotence is power correction. Basic Rules:

1. Exclude fast food, including convenience foods.
2. Don't drink beer.
3. In no case do not exclude natural vegetable and animal fats (butter, cheeses, eggs, sour cream), because without them testosterone will not be synthesized.
4. 2/3 of the diet should be vegetables, fruits, cereals, leafy greens. It is a source of antioxidants that improve vascular elasticity and prevent cell destruction.

Dried fruits, honey, nuts are useful.

How a woman can help a man with impotence

If a man has become impotent, and his woman is interested in continuing intimate relationships with him, then she is capable of much. It is women who raise these topics on the forums, develop entire treatment programs no worse than doctors, and in most cases achieve success. To help her husband, they write him down to specialists, persuade him to be examined and monitor the implementation of all points of the prescribed therapy. The main condition is mutual trust. If it is not there, then the man will close in on himself, and the woman will first be angry, then move away.

Even worse is the situation when a man suffers from impotence and it does not bother him, but a woman suffers. He does not want to put implants, drink Viagra and any similar proposals cause aggression. In this case, the only option for a sexually active woman would be to leave this man in order to avoid the development of severe psychosomatic disorders in her.

Prices for treatment and which clinics to contact

Impotence treatment programs are offered by many clinics, especially in big cities. For example:

• Clinic of Andrology (Moscow, 2nd Syromyatnichesky Lane): consultation with an andrologist - 1,500 rubles, selection of drugs - 500 rubles, drug therapy - from 10,000 rubles.
• Clinic "IAKI" (Moscow): consultation - 3250 rubles, course treatment with the help of the apparatus "Androgin" - 7500 rubles. for 5 procedures.
• "SM-clinic" (Moscow): consultation - 1500 rubles, treatment of impotence without the cost of medicines - 17600 rubles.

With a complete list of clinics where you can undergo treatment for impotence, see https://docland.ru/russia/urologija-i-nefrologija/impotentsija.

How to avoid impotence

If there are no congenital health problems, then it is not difficult to avoid impotence. Enough follow a few rules:

1. Do not smoke anything: no cigarettes, no hookah, no vaping.
2. Do not abuse alcohol, exclude beer.
3. Eat rationally.
4. Check with a urologist once a year.
5. Ejaculate 1-2 times a week (no matter how this is achieved).
6. Do not sit in front of the monitor, periodically perform Kegel exercises, squat. Exercise 3-4 times a week.

Particular attention should be paid to their potency in the case of constant use of certain medications. If erectile function worsens, it is necessary to inform the doctor, who should adjust the therapy.

FAQ

Can coffee cause impotence?

No. A couple of cups of ground brewed coffee, on the contrary, will only improve potency. This is a kind of charging for blood vessels. Impotence is more likely to cause beer.

How to have sex with impotence?

In serious cases (if not worth it at all), place the penis in a vacuum pump (an erection will appear quickly in it), then fix the erection ring on the base of the penis (preferably a soft adjustable lasso), remove the pump. You can additionally lubricate the head with an aphrodisiac, for example, Persian Shah cream. If erectile dysfunction is of moderate severity, then, with the permission of the doctor, PDE-5 inhibitors can be taken in the “on demand” mode. Alternatively, some use rigid condoms.

Conclusion

Erectile dysfunction of varying degrees occurs from time to time in any man. In such cases, do not be nervous and break down on loved ones. You need to pull yourself together, objectively assess your condition and sign up for a consultation with an andrologist. It is better to apply to state institutions, where specialists are mostly impartial and do not make unnecessary appointments.

Diseases of the genitourinary system in men are often the cause. In most cases, we are talking about chronic inflammatory processes, but doctors often diagnose functional disorders. If the pathology affects the activity of the reproductive system, the quality of life of the patient is significantly reduced. Patients complain of the impossibility of conception and sexual weakness due to a weakened erection. Such a pathology in young men is increasingly due to negative psychological factors, but physiological disorders should not be ruled out.

Impotence in most cases is diagnosed in men older than 40 years. The disorder of the sexual sphere is often associated with chronic diseases of the genitourinary system that affect the condition of the prostate gland and blood vessels of the pelvic organs. Modern medical technologies make it possible to solve this problem with the help of medicines, surgical interventions and special implants. Unfortunately, in some cases, even the most effective treatment does not restore the function of the genital organs.

More about pathology

Erectile dysfunction (impotence) is a violation of the function of the penis in men, manifested by insufficient blood supply to the organ. At the same time, erectile dysfunction leads to sexual weakness, because with impotence, the penis is not hard enough to perform intercourse. In most cases, erectile dysfunction is not an independent disease - it is a common complication of pathologies nervous system, endocrine organs, heart and blood vessels. Also, erectile dysfunction can be exclusively psychogenic in nature, therefore, during the diagnosis, doctors always evaluate the actual possibility of blood supply to the organ.

Erection is a complex physiological process associated with the nervous system, blood vessels, muscles and humoral factors. Violation of any component of the regulation of the penis can cause impotence. It is assumed that psychological ailments more often lead to a disorder of the sexual sphere in young men, while inflammatory processes and structural disorders are usually detected in older patients. Modern methods of examination allow you to quickly determine real reason erectile dysfunction.

Scientists managed to develop an effective treatment for impotence only in the second half of the 20th century, when new drugs were discovered that affect the state of blood vessels. Up to this point, erectile dysfunction could be comparable in severity to disability, since sick men could not maintain full-fledged relationships with women. In the 21st century, methods for correcting the disease have improved significantly: doctors have studied new diseases that affect erection and have created more reliable methods for restoring penis function.

The work of the body is normal

The male penis is the main organ of the reproductive system. This soft tissue anatomical structure combines the functions of the urinary and reproductive systems. During intercourse, the cavernous bodies are filled with blood, resulting in an increase and straightening of the organ. Located at the bottom of the penis spongy body through which the urethra passes. The urethra of the penis is necessary for the excretion of urine and ejaculation during intercourse.

Several anatomical components are involved in the process of penis enlargement (erection), including the nervous system, smooth muscles, blood vessels, and endocrine factors. Electrical impulses coming from the human brain contribute to the release of regulatory substances that affect the vascular tone of the penis. As the cavernous bodies are filled with arterial blood, the intensity of venous outflow decreases, as a result of which an erection is maintained for a long time. After ejaculation, the parasympathetic components of the nervous system restore the venous outflow of blood and eliminate the erection.

The main stimulus for the blood supply to the penis is nitric oxide, which is produced by endothelial cells. This regulatory substance sets off a chain reaction of molecular changes leading to smooth muscle relaxation and blood vessel dilation. In this regard, most of the drugs needed to restore an erection enhance the action of nitric oxide or stimulate the release of this chemical compound. Such treatment does not help patients with severe structural pathologies associated with vessels, muscles and other components.

Physical reasons

In most cases, erectile dysfunction is a polyetiological condition. The primary disease may be organic or functional in nature, but often the pathology is aggravated by psychological factors. If the cause of impotence is not immediately detected by symptoms and special examinations, it is necessary to assess the state of several systems at once that can provide Negative influence on the male reproductive organs.

The main organic causes of the disease

1. Pathologies of the cardiovascular system, causing insufficient blood supply to the penis. This may be a myocardial infarction, inflammation of the vessels, or. Anomalies in the structure of the vessels of the pelvic cavity should also be taken into account.
2. Violation of the nervous system. Impotence can be simultaneously caused by a disorder of the central and peripheral nervous systems, since the activity of the penis is controlled by various structures. Usually we are talking about a stroke, spinal cord injury or.
3. Pathologies of the respiratory system, including chronic obstructive pulmonary disease and breath holding during sleep.
4. Systemic disorders that simultaneously disrupt the work of several components of regulation. In this case, the cause of impotence may be a metabolic disorder or soft tissue disease.
5. Diseases of the regulatory systems of the body. Thus, dysfunction of the thyroid gland, which controls the work of most organs and systems, can lead to impotence.
6. Injuries resulting from surgery. Patients undergoing pelvic surgery are at risk.

The organic etiology of erectile dysfunction is not always eliminated with the help of medications. Irreversible violation of the functions of the penis in this case is most often due to the pathology of the nervous system.

OUR DOCTORS

Psychogenic etiology

Sexual activity in many aspects relies on the reflexes of the nervous system, which a person practically does not control consciously, but one should not forget about the influence of higher brain structures on the functioning of the genital organs. Even in the absence of any structural disorders that impede the blood supply to the penis, a man may suffer from periodic or permanent impotence.

Possible reasons

1. Clinical depression is a pathology of higher nervous activity, manifested by a persistent decrease in mood. Episodes of a large often affect the performance of organs and libido.
2. characterized by fear and social discomfort. Presumably, anxiety can disturb the balance of activity of the sympathetic and parasympathetic components of the nervous system.
3. Post-traumatic mental disorder. The cause of such a disease can be physical violence, death loved one or some other tragic event. The disorder is manifested by anxiety, depression and psychosomatic symptoms.

Do not forget that many drugs in psychiatric practice have a negative impact on potency and libido in men. First of all, these are antidepressants, neuroleptics and some anxiolytics. If erectile dysfunction occurs during the treatment of a mental disorder, the patient should first consult with the attending physician.

Risk factors

The etiological factors listed above do not always determine the development of the disease. It is necessary to take into account additional forms of predisposition to erectile dysfunction associated with a man's lifestyle, heredity and other aspects.

Possible risk factors:

• taking certain medicines. (Erectile dysfunction in some cases occurs when taking antihypertensive drugs, 5-alpha reductase inhibitors and gastric therapy);
• chromosomal and genetic disorders affecting the development of the genitourinary system;
• and chronic cardiovascular pathologies;
• and inactive lifestyle;
• smoking and frequent consumption of alcoholic beverages.
• low stress resistance, difficult working conditions;
• taking hormonal drugs;
• spinal and pelvic injuries.

Accounting for risk factors helps to create conditions for the prevention of impotence. Older men need to monitor the state of the cardiovascular system and regularly undergo urological examinations.

Additional symptoms

Since impotence is usually a complication of the primary disease, it is necessary to consider a holistic symptomatic picture. Additional signs indicating the root cause of erectile dysfunction are most often associated with the work of the genitourinary system.

Possible symptoms:

• lack of sexual arousal (violation of libido);
• soreness of the perineum, penis, or pubic area;
• discomfort during urination or ejaculation;
• , constant weakness;
• , false urge to defecate;
• the occurrence of phobias;
• everyday anxiety, discomfort when dealing with women.

It is important for a specialist to immediately exclude the psychosomatic nature of the symptoms and detect a specific disease that affects the functioning of the penis. In many patients, during the examination, a healthy blood filling of the penis is revealed even in the presence of chronic diseases of the urogenital area, so not all signs can be taken into account.

Diagnostics

The main examinations aimed at finding the cause of impotence are carried out by urologists and andrologists. During the initial appointment, the specialist will clarify the patient's complaints, study the anamnestic information and conduct a physical examination. Palpation of the prostate gland sometimes helps to detect the pathology of the organ already at this stage. Also, clear signs of cardiovascular and neurological disorders are detected during the examination. For diagnosis and selection effective treatment the specialist will need the results of instrumental and.

Necessary diagnostic procedures

1. Duplex scanning of the penis. This ultrasound technology allows you to assess the condition of the blood vessels and cavernous tissue of the organ.
2. Bulbocavernous reflex electromyography - detection of neurological disorders that cause erectile dysfunction.
3. An intracavernous test with a caverject is a high-precision instrumental study that involves the introduction of erection stimulants into the penis, followed by visualization of the organ using. This method allows to exclude the psychogenic nature of impotence and to detect structural pathologies.
4. and - laboratory tests to diagnose pathologies of various organs and systems.
5. Additional methods of visual examination for the search for organic disorders. It can be computed or magnetic resonance imaging. With the help of or MRI, doctors obtain three-dimensional images of anatomical structures.

If there are additional indications, psychologists are also involved in the examination.

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Prescribed drugs

1. PDE5 inhibitors that enhance the action of nitric oxide and improve blood supply to the cavernous bodies of the penis. This is the most common group of medicines, which include Viagra and Cialis.
2. Herbal medicines. According to some studies, ginseng has a beneficial effect on the functions of the male genital organs.
3. Injectable preparations that relax smooth muscles. These are papaverine and alprostadil.
4. Hormone replacement therapy for low testosterone.

Many drugs have only a temporary effect, so the main task is to eliminate the root cause of impotence. Also, patients need to consider the side effects of certain medications that affect the state of the cardiovascular system.

Other correction methods

The modern approach to the treatment of impotence is not limited to drugs. Depending on the identified etiology of the disease, the doctor may prescribe the patient a surgical intervention aimed at eliminating the anatomical defect or implanting an artificial material. Vascular operations rarely lead to the restoration of erection, however, with organic damage to the arteries and veins, such treatment may be the only way out.

Modern methods of correction

1. The use of vacuum devices for blood supply to the penis. This method of treatment leads only to a temporary improvement in erection, so pumps must be used immediately before sexual intercourse.
2. Plastic and inflatable prostheses that give the penis a certain shape. During intercourse, the patient can independently straighten the penis, which will make it possible to insert the penis into the vagina.
3. Resection of blood vessels, restoration of patency of the cavernous bodies and other methods of surgical intervention.

Also, additional methods of treating impotence can be attributed. Relief of depression and anxiety with the help of psychotropic drugs allows you to eliminate the frequent root cause of the disease, and subsequent psychological correction has a beneficial effect on social interactions patient.

Forecast and prevention

In most cases, the prognosis is favorable. New methods of treatment can eliminate the root cause of impotence in 60% of men. At the same time, cardiovascular and neurological factors that affect the functioning of the penis can lead to more severe disorders. Psychogenic erectile dysfunction is best treated.

Prevention methods:

• examination by a urologist or andrologist at least once a year;
• regular examination of the cardiovascular, nervous and endocrine systems, if indicated;
• lifestyle improvement: weight loss, regular physical activity, refusal of fatty foods, alcohol and cigarettes;
• treatment of inflammatory diseases of the genitourinary system;
• psychotherapeutic treatment of anxiety, depression and other emotional disorders;
• regular sex life.

Thus, impotence is a polyetiological condition. Erectile dysfunction in young men is accompanied by a significant deterioration in the quality of life, however, modern methods of therapy can quickly and reliably eliminate the root cause of the pathology.

The World Health Organization gives the following definition of sexual health: “Sexual health is a complex of somatic, emotional, intellectual and social aspects of a person’s sexual existence that positively enriches a person, increases a person’s sociability and his ability to love.” Prevention and treatment of sexual disorders have great importance not only in the medical, but also in the social aspect.

Erectile dysfunction (ED)- inability to achieve and / or maintain an erection sufficient for a full sexual intercourse. The diagnosis is established if it lasts more than 3-4 months.

For many years this condition was called impotence, however, proposed in Lately the term "erectile dysfunction" more fully reflects the essence of the disease and less injures the patient's psyche.

Epidemiology. ED increases with age: at 40-50 years old, it is detected in 40% of men, at 50-60 years old - in almost half of the examined, and in the older age group, more than 70% of men suffer from this disorder.

Etiology and pathogenesis. IN last years ideas about the physiology of erection, its disorders and their treatment have changed significantly. According to modern concepts, sexual stimulation activates the parasympathetic nervous system. The release of neurotransmitters, in particular nitric oxide (NO, endothelial relaxing factor), from the vascular endothelium of the cavernous bodies leads to the accumulation of cyclic guanosine monophosphate (cGMP) in the cavernous tissue and relaxation of the smooth muscle cells of the walls of the afferent arteries and cavernous bodies. Filling the cavernous bodies with arterial blood causes compression of the venules and blockage of the outflow of blood from the penis (veno-occlusive mechanism), an erection occurs (the tumescence phase). Vascular smooth muscle cells metabolize cGMP by phosphodiesterase type 5 (PDE-5). During relaxation (the detumescence phase), smooth muscle cells contract, blood flow through the arteries decreases, and venous outflow increases.

ED may be due to insufficient vasodilation due to cGMP deficiency, insufficient vascular responsiveness to cGMP, insufficient compression of the penile veins due to connective tissue overgrowth, or a combination of these causes. It is believed that ED in 80% of cases occurs due to various organic causes and in 20% of cases due to psychological factors, but their combination is very common.

Psychogenic ED can be based on depression and anxiety. The causes of the most common organic ED are vascular, neurogenic, hormonal disorders, drug exposure, anomalies, injuries or diseases of the penis, renal failure, hemodialysis. Most often, the occurrence of ED is associated with cardiovascular diseases (arterial hypertension, atherosclerosis) and diabetes mellitus. In somatic patients, drug therapy may contribute to the development of ED. According to a number of authors, every fourth case of ED is somehow associated with taking medications. The most compromised in this regard are antihypertensive drugs, in particular thiazide diuretics and non-selective beta-blockers. The main risk factors for ED are age, smoking, and being overweight.

The causes of ED can be: anomalies (congenital curvature, hypospadias, epispadias), injuries and diseases of the penis (Peyronie's disease, sclerotic changes due to cavernitis or priapism).

The pathogenesis of ED is multifaceted. Distinguish organic, psychogenic And mixed causes of erectile dysfunction (Table 17.1).

Table 17.1. The main etiological and pathogenetic factors in the development of erectile dysfunction

Symptoms and clinical course. Studying the patient's complaints and history, you can find out the possible causes of ED. Attention should be paid to the patient's age, the presence of concomitant endocrine, vascular diseases, mental disorders and neurogenic disorders. The data of the general and sexological anamnesis are analyzed, as well as the state of the copulative function in the past and at the present time. It is necessary to obtain information about the nature of the relationship with the sexual partner, previous consultations, therapeutic measures and their effectiveness. It should be clarified whether the patient suffers only from ED or if it is combined with other types of sexual disorders (reduced libido, ejaculation and orgasm disorders). In order to objectify the patient's complaints, a number of questionnaire systems have been proposed. Most common international index of erectile function(The International Index of Erectile Function).

On examination, pay attention to the severity of the development of secondary sexual characteristics, the anatomical state of the genital organs. Given the high prevalence of diseases of the cardiovascular system and metabolic syndrome, the scope of the examination should be sufficient to conclude that sexual activity is acceptable and that there are no contraindications to ED therapy.

Erections are divided into adequate, spontaneous and masturbatory. Adequate erections are those that occur during sexual contact. Spontaneous are not associated with sexual intercourse and are reflex. They usually occur during sleep and disappear after waking up (night and morning penile tumescence). The nature of erectile dysfunction is determined by the type of ED. A feature of psychogenic ED is the weakening of erection during sexual intimacy (problems in relations with a partner) while maintaining night and masturbation. Organic ED, including vasculogenic genesis, develops gradually, usually against the background of some disease affecting it. It slowly progresses until the complete disappearance of adequate erections. At the same time, spontaneous and masturbatory erections weaken or are absent. Sexual desire (libido) is preserved in most cases. ED is one of the manifestations of Leriche's syndrome - atherosclerosis of the aorto-iliac vascular segment.

Neurogenic ED develops as a result of diseases of the nervous system. Cortical and spinal disorders may not affect spontaneous and masturbatory erections, which persist reflexively. Peripheral neuroreceptor lesions are characterized by the preservation of libido, the absence of adequate and spontaneous erections.

Diagnostics. Laboratory diagnostics includes the study of the level of blood sex hormones (testosterone, prolactin, gonadotropic hormones), as well as the level of PSA in men over 50 years of age.

For the study of nocturnal penile tumescence, the postage stamp test and the Snap-Gage test are performed, and the Ridgi-Scan device is also used.

By doing postage stamp test the patient wraps the penis around the circumference with a strip of postage stamps, with the last stamp on top pasted over the subject, sealing the ring. The test is carried out sequentially over three nights. If during this time no rupture of the rings is noticed, the test is considered negative, which means that the patient suffers from organic ED. And, conversely, if the ring was broken, the test is positive, and most likely psychogenic erectile dysfunction.

In order to improve the results of the postage stamp test, a special Snap Gage Device, which is a strip of synthetic material and three plastic strips, located in parallel. Each strip is torn with a radial force corresponding to a certain intracavernous pressure (from 90 to 180 mm Hg. Art.). Of course, the Snap Gage test is more accurate than the postage stamp test, but it is also not able to provide information about partial rigidity, the number of erections and their duration.

Currently, nocturnal penile tumescences are monitored using Ridgi-Scan device- a portable portable meter, which is fixed on the thigh (Fig. 17.1). The meter has two loop ends, one of which is placed at the root of the penis, and the second - at its top. With a qualified interpretation, taking into account the data of the anamnesis and objective examination, the accuracy of the test becomes especially high.

Doppler ultrasound occupies one of the leading places in the diagnosis of organ circulation in ED. In the process of its implementation, the location and patency of the arteries of the penis are established, blood pressure is measured in them, and calculated indicators are determined that reflect the state of the arterial hemodynamics of the organ. The patient is examined in the supine position in a calm atmosphere in order to adapt him to the diagnostic situation and stabilize the central hemodynamic parameters. After ultrasound and assessment of the functional parameters of blood flow, prostaglandin E1 or papaverine hydrochloride is administered intracavernously to patients to perform the pharmacological load. As pharmacological erection develops, bilateral Doppler parameters of blood flow in the vessels of the penis are recorded and evaluated using color Doppler mapping, power Doppler study and pulsed Dopplerography.

Rice. 17.1. Ridgi-Scan device

for monitoring night penitentiaries

tumescence

The diagnosis of the veno-occlusive function of the penis is currently carried out by two methods: using dynamic cavernous-isometry and cavernosography. Dynamic infusion cavernosography, performed in two projections, allows you to evaluate the venous discharge of blood from the cavernous bodies with vascular contrast. Pharmacocavernosometry- the main method to assess the degree of violation of the elasticity of the sinusoidal system and its closing ability. It is considered the closest approximation to the physiological mechanism of erection. It can be used to recreate an artificial erection by perfusion of the solution into the cavernous bodies after a preliminary intracavernous injection of a vasoactive drug. To diagnose neurogenic ED, perform electromyography.

Radioisotope phalloscintigraphy allows you to evaluate the qualitative and quantitative indicators of regional hemodynamics in the cavernous bodies of the penis. Selective pharmacoangiography internal genital and cavernous arteries makes it possible to make a clear visualization of the arteries of the penis.

Treatment. Before proceeding with the treatment of erectile dysfunction, it is necessary to establish the disease that contributed to its development (endocrine diseases, circulatory disorders, neurogenic and mental disorders, etc.) and conduct its adequate therapy.

Treatment of patients with ED includes pharmacotherapy, the use of vacuum-constrictor devices, intracavernous injections of vasoactive substances, and surgical treatment. Currently, the main and most effective drugs for the treatment of ED are inhibitors of phosphodiesterase type 5 (PDE-5). All other drugs, which include adrenoblockers (yohimbine), dopamine receptor antagonists, serotonin uptake blockers, antipsychotics, androgens, adaptogens (extracts and tinctures of ginseng, eleutherococcus, zamaniha, etc.), are significantly inferior to them in effectiveness.

PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) are classified as first line treatment ED. By blocking the breakdown of cGMP in the cavernous body, they enhance the relaxing effect of nitric oxide, which makes this group of drugs highly effective in both organic and psychogenic ED. These drugs should not be taken together with nitrates, since the combined effect on the NO/cGMP system leads to a potentiation of the hypotensive effect.

To treatments for ED second line include intracavernous or intraurethral injections of vasoactive drugs (alprostadil, papaverine hydrochloride, prostaglandin E1). They are indicated in case of ineffectiveness or presence side effects oral therapy, as well as the preferences of the patient who wants to get a more reliable, faster and more predictable erection. Contraindications are gross anatomical defects

Rice. 17.2. Bendable penile prostheses with memory effect (a) and their implantation (b)

Rice. 17.3. Two- (a) and three-component (c) hydraulic penile prostheses and their implantation (b, d)

of the penis or cavernous bodies, diseases predisposing to the development of priapism (sickle cell anemia, myeloid leukemia), mental disorders.

In the treatment of ED, vacuum erectors continue to be used, which create local negative pressure to increase blood flow to the penis. However, their effectiveness is low, and with the advent of PDE-5 inhibitors, the frequency of their use has significantly decreased.

Surgical treatment is third line therapy for ED and is used when conservative treatment is ineffective. Vascular revascularization operations are indicated for patients with arterial occlusive diseases, but require careful selection of patients. The best results can be expected in young men with isolated arterial disorders due to trauma. Various types of anastomoses are performed between the inferior epigastric artery and the dorsal vein of the penis.

Operations consisting in ligation of the veins draining the cavernous bodies are performed in order to prevent excessive outflow of venous blood from them.

The final step in the treatment of ED is phalloprosthesis. It is indicated primarily for patients who have undergone radical prostatectomy or other operations on the pelvic organs, as well as patients who have had irreversible changes in the cavernous tissue. This method treatment consists in the fact that special longitudinal semi-rigid or multicomponent synthetic structures are implanted into the cavernous bodies, corresponding to the volume of the cavernous bodies. The simplest of them - rigid plastic prostheses - leave the penis permanently in a state in which sexual intercourse is possible, which is very inconvenient in everyday life. Somewhat better in this regard are bendable phalloprostheses with a memory effect (Fig. 17.2). More perfect and convenient for the patient are multi-component phalloprostheses with hydraulic regulation (Fig. 17.3), which allow changing the volume of the penis - making it rigid or transferring it to a relaxed state.

Forecast favorable in most cases. Modern methods of treating ED (drug therapy, intracavernous injections, surgical treatment) in most cases can achieve sexual rehabilitation of patients and improve their quality of life.

Control questions

1. What are the main causes of ED, and how often does it occur?

2. How is ED diagnosed?

3. What are the current treatments for ED?

Clinical task

A 53-year-old patient complained of a significant weakening of erection, the absence of spontaneous and masturbatory erections. The sex drive is preserved. The above symptoms began to be noted about 2 years ago with a tendency to worsen. Recently, the patient is also concerned about constant thirst, dry mouth and blurred vision. Didn't go to the doctor. An objective examination of the condition is satisfactory. The external genital organs are developed correctly, hair is male-type. In laboratory tests, hyperglycemia up to 12 mmol / l draws attention.