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Erectile Dysfunction
(Impotence)


Impotence (Latin impotentia - weakness), or erectile dysfunction - is a condition in which a man can not achieve an erection or an erection that is not enough for sexual intercourse. Erectile dysfunction affects men of all ages, from adolescence. There is hardly a grown man, buyout ever in my life have suffered sexual failure. In most cases, young men aged 25-30 years, psychogenic erectile dysfunction is the underlying cause, which in most cases successfully solved sexologist, psychologist. Preferable if the course are both partners.
Unfortunately, erectile dysfunction is a common phenomenon is that he devote today scientific conferences and symposia. Its individual species devoted dozens of scholarly monographs.
According to the most approximate estimates, in the U.S. alone suffer from erectile dysfunction about 10 million men. It is estimated that number of German scientists in the united Germany is approaching 5 million. It is obvious that in Russia, men who have erectile dysfunction, not fewer. Chronic stress, typical of a society in a difficult economic period, poor nutrition and thus atherosclerosis, smoking, play a negative role on the state of human genitalia. In both men and women.


Physiology of erection

It is now established that the key in the process of erection and detumescence (Latin DETUMESCO - stop swell) - reducing the size of the genitals with a decrease in sexual arousal due to the outflow of
blood), has the function of smooth muscles of the corpora cavernosa and bearing walls of the arteries and arterioles. In the absence of an erection of the penis is the latest in a reduced state under the influence of the sympathetic nerves. In the presence of sexual stimulation, the pulses transmitted by the parasympathetic nerves presumably, cause the release of neyroendotelialnyh structures in the corpus cavernosum and the so-called noncholinergic neadrenergi-cal neurotransmitter erection. Research in the last five years showed the highest activity of nitric oxide as a neurotransmitter erection. It is shown that under the influence of nitric oxide nitrik-oxide synthase, activates guanylate cyclase and calcium-sensitive potassium channels and Na / K ATPase, causes accumulation of cGMP and relaxation of smooth muscles of the corpora cavernosa and bringing arterioles, which in turn causes a significant increase in arterial blood flow to the cavernous bodies. Increases in diameter, the erectile tissues compress venules and there is a simultaneous significant reduction in venous outflow. Work of the so-called venookklyuzivnogo mechanism facilitates location venules directly under tunica to which they are pressed and expanding cavernous bodies. It is high prevalence of blood flow over the outflow leads to increased intracavernosal pressure to 100 mm Hg or higher and & Development rigid erection. Detumescence occurring as a result of ejaculation or cessation of sexual stimulation begins after activation of the synaptic structures, followed by separation in the cavernous body of neurotransmitters such as norepinephrine, neuropeptide Y, and endothelium, causing constriction of the smooth muscle of the newly cavernous bodies and arterioles, which is the basis of the inverse of an erection . Important integrative role in erectile function is average preoptic area of ​​the cerebral cortex. In this case, the most important neurotransmitters that determine sexual behavior are dopaminopodobnye (stimulation) and serotoninopodobnye (suppression) of substance.




Classification of erectile dysfunction:

In accordance with generally accepted at present classification of erectile dysfunction, impotence, 7 species isolated on etiopathogenic principle.

Psychogenic impotence.
Leading pathogenetic link psychogenic impotence is reduced sensitivity to the effects of the cavernous tissue neurotransmitter erection through direct inhibitory effect of the cerebral cortex or indirect effects of the cortex through the spinal centers and increased levels of peripheral catecholamines. The basis of these phenomena are fatigue, depression, phobias, sexual deviance, religious prejudices, associative stressful factors, etc. In recent years, with the development of an objective diagnosis of erectile dysfunction, psychogenic impotence in its pure form is diagnosed less often.
Neurogenic impotence.
Comes as a result of injury or disease of the brain or spinal cord, and peripheral nerves, which prevent the passage of nerve impulses to the corpora cavernosa. The most common cause of impotence is nerogennoy spinal cord injury (75%). Its other causes may be tumors, cerebrovascular pathology, syringomyelia, multiple sclerosis, herniated disc, etc.
Arteriogenic impotence.
Developmental and pathological dynamics of atherosclerotic coronary and penile vascular roughly correspond to each other, which makes the disease impotence age. Other causes of impotence are arteriogenic trauma, congenital abnormalities, smoking, diabetes, hypertension. With limited blood flow significantly affected the intracellular metabolism of the cavernous tissue and vascular endothelium bearing that forms a vicious circle, and often leads to irreversible dysfunction of cavernous tissue.
Venogennaya impotence
Causes of ill venokklyuzivnoy function is not clear, but it is already known the following: ectopic drainage of the corpora cavernosa through large dorsal subcutaneous veins or enlarged or nozhkovye cavernous veins, cavernous-cancellous shunt failure albuginea due to traumatic rupture, Peyronie's disease, primary or secondary thinning , functional impairment of cavernous erectile tissue as a result of a lack of neurotransmitters, psychogenic inhibition, smoking, and ultrastructural changes.
Hormone impotence
The leading cause of hormonal impotence is diabetes, which leads to serious structural changes in the penile blood vessels and the cavernous tissue.
Known fact that the normal level of testosterone in the blood serum is absolutely necessary for normal erections, questioned because visually-induced erection is not affected in patients with hypogonadism. Therefore, at present it is considered that more important is the degree of uptake of testosterone, rather than its level in the blood serum. However, hormone replacement therapy for the treatment of erectile dysfunction is shown in patients with hypogonadism and in male menopause.
Dysfunction of the cavernous tissue (cavernous failure).
The reasons for failure of the cavernous different. They lead to intra-and extracellular changes in the cavernous bodies, their blood vessels and nerve endings, which prevent normalnomk erektornogo functioning mechanism.
Impotence caused by age-related changes, system
disease and other causes.

The main causes of erectile dysfunction:

All the causes of erectile dysfunction according vysheprivdenoy klassifiktsii are divided into two groups - organic when there is a disturbance in the body, and the psychological, which are due to the peculiarities of the patient's mind only.

For psychological impotence is characterized by:

Outbreak
Nocturnal spontaneous erections are preserved
The problem of relations
Problems in certain circumstances
For organic impotence is characterized by:

Gradual onset
Nocturnal spontaneous erections are absent
Normal libido and ejaculation
Problems in all circumstances
In practice, the most common combination of these reasons, when a disease or disorder, which leads to erectile dysfunction, psychological factors are imposed that prevent further man always reach full erection. All organic causes of erectile dysfunction are divided into endocrine, medication, local, neurological and vascular.

Endocrine causes. If the male body produces insufficient amounts of the male sex hormone (testosterone), it can lead to erectile dysfunction. Simultaneously may appear symptoms such as an increase in the voice, stopping the growth of facial hair, the deposition of fat in the breasts, hips, buttocks. Usually, this is heavy human body's hormonal areas in which assistance is required endocrinologist.
In another situation, the pituitary gland (a gland in the brain) may occur tumor secretes the hormone prolactin. However, no other violations in the body, except for erectile dysfunction, can not be observed. For the diagnosis of the disease, except for the survey endocrinologist must perform a CT scan of the brain. Treatment in this case is reduced to a long reception of the drug bromocriptine.

Medicinal causes of erectile dysfunction. Some medicines and other drugs with a long reception cause erectile dysfunction. Typically, this is due to the blocking of nerve endings that provide the appearance of an erection. Erection quickly recovered after discontinuation of the drug. Substances, addictive (in particular this applies to drugs) lead to erectile dysfunction indirectly, as a result of the overall impact on the body and the violation of fundamental vital systems. In this case, to restore erections necessary not only to stop using the drug, but also the course of treatment that will restore all disability.

Substances that act on the central nervous system

Alcohol
Chlorpromazine
Amitriptyline
Arrametidin
Barbiturates
Haloperidol
Heroin
Hydroxyzine

Glyutetimid
Guanethidine
Debrizokvin
Doxepin
Isocarboxazid
Imipramine
Cannabis
Cocaine

Mebanazin
Methadone
Morphine
Pargyline
Protriptyline
Lithium salts
Thioridazine
Tranylcypromine

Benzedrine
Phenelzine
Phenoxybenzamine
Ftorfenazin
Hlomipramin

Antihypertensives

Clonidine

Clofibrate

Methyldopa

Reserpine

Alimentary synapses

Inderal

Anticholinergics

Phentolamine

Hormonally active drugs

Antiandrogens

Estrogens

Antihistamines

Diphenhydramine

Suprastin

Miscellanea

Antiparkinsonian funds
Digoxin
Indomethacin

Spironolactone
Thiazide diuretics
Cimetidine

Local factors that lead to erectile dysfunction, are different, but they all lead to the development of sclerosis of the cavernous tissue of the penis. Normally, this tissue resembles a sponge with fine mesh. During erection, each cell (cavern) tightly filled with blood, the penis increases in size and becomes hard. When sclerosis cavernous tissue walls of the cells stick together, and they can no longer fill with blood.
Sclerosis cavernous tissue occurs normally in older men, and therefore they lose the ability to commit a sexual act. Accelerate the development of multiple sclerosis cavernous tissue can such factors as:

injuries of the penis;
frequent practice of overextended sex acts in which a man, wanting to deliver maximum satisfaction to his partner, long delayed ejaculation;
multiple injections (injections) in the penis;
transferred priapism (prolonged spontaneous erection).
Neurological causes of erectile dysfunction. Erectile dysfunction can develop after an injury of the brain or spinal cord, Parkinson's disease, epilepsy, multiple sclerosis, after undergoing surgery on the pelvis, pelvic injury or perineum. In almost all cases, the prognosis for cure causes of the disease is poor.
Vascular causes of erectile dysfunction. The most common group of reasons. During an erection is a significant change of blood flow to the penis - dramatically increases blood flow through the arteries and blocks blood flow to almost the veins. From here there are two groups and vascular causes of erectile disorder - lack of blood flow through the arteries to the penis (arterial insufficiency) and excessive discharge of blood during erection the veins (venous insufficiency).
Arterial insufficiency of the penis can occur with endarteritis, atherosclerosis, aortic aneurysm, trauma, pelvic, perineum, pelvic fractures, and other diseases of the arteries. Venous insufficiency of the penis may occur in diseases of the veins, such as their varicose. It should be said that the causes of vascular disorders of the penis to date are not well understood and install them is not always possible.

Special mention should be diseases such as diabetes and hypertension. In these diseases often develop erectile dysfunction, which is caused by several factors - vascular, neurological, local, medication.

Psychological causes of erectile disfukntsii occupy a special place in the development of this disease. They can independently lead to erectile dysfunction, but more psychological factors superimposed on the organic cause narushniya erection, which greatly complicates the diagnosis and treatment of this condition. Psychological causes of erectile dysfunction may be to anxiety and depression, indifference to the partner, fear of inability to perform sexual intercourse, conflicts between partners, sexual habits discrepancy partners, strong excitement before sexual intercourse, fatigue, and general poor health and the health of men. In favor of the psychological causes of erectile dysfunction say symptoms such as selective erection, preservation of spontaneous erections, erection during masturbation, nocturnal erections (erections when a man says, waking up in the morning). Such patients require assistance of an experienced sex therapist or psychotherapist.