Erection and problems with it
Erection – is increasing of the penis’s volume with the high increasing of its elasticity caused by stretching and filling the cavernous bodies with a blood during sexual excitement, that provides the possibility to have sexual intercource.
Erectile disorder (dysfunction) – is inability to have erection and maintain it at the level sufficient to carry out stable sexual act. Problems with erection doesn’t always accompany aging of the man and may be absent in the old age. With the years the frequency and intensity of ajaculations, the level of sexual tension and necessity in ajaculations are decreased, but the ability to have stable erection often are kept. If morning erections are saved as well as good erection is watched during masturbation – then the man have really stable psychological condition as it plays a great role in development of sexual disorders. With sustained inability to have erection under any circumstances organic cause is suggested as main reason in appearence of erectile disorders. The frequency of ed appearence is about 10% of the men population, but it’s necessary to remember that a lot of them hide their condition from others.
Etiology of erectile dysfunction:
- the organic damages of nervous system
- diseases of genitals with damages of their receptor apparatus (prostatitus, urethritis)
- endocrine disorders (primary hypogonadism as result of destruction of testicles), secondary hypogonadizm (as result of pituitary, adrenal gland, thyroid gland), senile ed)
- lesion of penis (malformations such as hypoplasia, short frenulum, trauma etc…)
- vascular lesions
- antihypertensives, B-blockers, antidepressants
- alcohol, smoking, drugs
Clinical picture:
- patients complain about absence of erection during sexual stimulation.
- there are no any deformation of penis during erection, necessary for possibility of sexual intercourse
Depending on the etiology there may be:
- neurotic disorders (anxiety, phobic reactions).
- signs of endocrine disorders
- hair on the body like female type
- gynecomastia
- cryptorchidism and testicular’s atrophy
- complaints typical for men (irritability, tearfulness, hypochondriacal conditions, headaches, etc…)
- arteriosclerosis of aortic’s and arteries of lower extremities bifurcation): claudication, the absence of pulsation of femoral arteries
- neuropathies – combination of symmetrical peripheral paralysis of foot with the lack of achilles reflexes, dissociated disorders of sensitivity of posteroexternal surface of the femur, tibia, outer edge of the foot and impaired erections, caused by defeat of the first and second segments of the sacral spinal cord.
Diagnosis:
- for a lot of patients that’s difficult to detect significant changes of nervous, urogenical and endocrine systems as well as internal organs
- the stable and adequate erection is violated much earlier and greater, while the spontaneous erection is saved
- the spinal dysfunction of erection – violations the both adequate and spontaneous erections, that were caused at the same time and are progressing gradually
- endocrine dysfunction of erection – is characterized by pronounced decrease of sexual attraction to woman.
- during examination of the patient that’s necessary to pay attention to any signs of chronic using of alcohol, drug or much smoking, make an inspection of genitals, to assess the neurological status, exclude the vascular pathology and endocrine dysfunction
Laboratorial and special examenations:
- the general analysis of the blood and urine
- glucose of blood and test of tolerancy to glucose
- testosterone in the plasma of blood and urine (total and associated)
- tracking of the noctural erections
- aortography and selective angiography
- dynamic contrast radiography of cavern
Treatment
- psychotherapy
- in the initial stages of moderate local vascular insufficiency it’s possible to achieve a result of functional stabilization by massage’s application
- if the spinalcord forms of disease – then physiotherapy may be used (mud rectal swabs, segmental massage, acupuncture), training the tricks of mechanical stimulation of erogenous zones in the optimal rhythm and finding the most comfortable positions for sexual intercourse, and in some cases – using of removable dentures.
Surgical treatment
- when forms of vascular erectile dysfunction – the various techniques of angiosurgery are used (directed at strengthening of arterial inflow or venous outflow restriction), or implantation of internal prostheses
- if the spinal cord forms of disease during the acute stage the surgical operation may be requied
Drug therapy
- if the patient has spinal erectile dysfunction with depletion of erectional center the treatment should be organized in 2 stages:
Drug therapy
- if the patient has spinal’s erectile dysfunction with depletion of the center of erection – treatment is organized in 2 stages: sedative drugs (bromides, preparations of valerian, motherwort, etc…) with the following stimulational therapy, intensity of which are being gradually increased.
- at low concentrations of androgens – that’s necessary to use enanthate of testosterone – 200 mg a week for 3-4 months.
- for erection’s stimulation – injection no more than 3 times a week. If erection caused by the injection lasts more than 6 hours, urgent medical assistance is necessary.
Side effects:
- hypo and hypercoagulable state, sickle cell anemia, structural violations of the penis, allergy to drugs.
- testosterone may cause a delay of water and sodium in the body
- testosterone accelerates the growth of prostate’s cancer, so for elderly patients drug is prescribed under the constant control of its state by experts
- long-term use of excessive doses of sex hormones may cause suppression of pituitary’s function and following testicular’s atrophy
Synonyms
- impotence
- disorder of sexual arousal in men
Modern, safety and highly effective method of treatment:
- Viagra pills, effect of which lasts about 4-6 hours – the most popular ed drug
- Cilalis pills, effect lasts 36 hours – is very popular due to long effect
- Levitra pills, effect lasts for about 6 hours – has more strong effect then abovementioned drugs
