An erection – an increase in the penis in the volume with a sharp increase in its elasticity; due to the stretching and filling with blood of the cavernous bodies during sexual arousal, which provides the possibility of sexual intercourse.
Erectile dysfunction – the inability to erection or maintain it at a level sufficient to perform normal sexual intercourse, lasting for at least 6 months. Erectile dysfunction does not always accompany aging and may be absent in extreme old age. With age, the frequency and severity of ejaculations, the degree of sexual tension and the need for ejaculation decrease, and the ability to erection often persists.
While maintaining morning erections and good erections in the process of masturbation, mental factors play a major role in the development of the disorder. With sustained inability to erection under any circumstances suggest an organic cause. Erection disorders can be true and imaginary (dissatisfaction with erection caused by its inconsistency with subjective and often false ideas about it) and combined with ejaculation disorders.
The frequency of occurrence of erectile dysfunction – 52% of men aged 40–70 years. Only 10% of patients seek help from specialists.
- Organic lesions of the nervous system;
- Genital diseases ( prostatitis , urethritis , colliculitis );
- Endocrine disorders (due to direct lesion of the testes, pituitary, adrenal glands, thyroid, erectile dysfunction);
- Penile lesions (malformations, injuries, fibroplastic compaction of the penis – compaction of the tunica albuginea and the septum of the penis with the formation of nodules or plates not welded to the cavernous bodies, hence the deformation of the penis during erection; chronic cavernitis, priapism );
- Diseases of the internal organs ( arterial hypertension, diabetes mellitus , angina pectoris , renal failure );
- Vascular lesions ( Leriche syndrome );
- Medicines (for example, antihypertensives, beta-blockers, antidepressants);
- Alcoholism, drug addiction;
- Psychological factors (stress, overwork).
- Lack of erection with sexual arousal;
- Less commonly, deformity of the penis during erection, making sexual intercourse impossible;
- Neurotic disorders (anxiety, fear), signs of endocrine disorders are possible.
Many patients fail to detect significant changes in the nervous, urogenital and endocrine systems, as well as internal organs.
- Blood and urine tests
- Blood glucose and glucose tolerance test
- Serum lipids
- Tracking Nightly erections
- Endourethral thermometry
- Penial pressure measurement
- Aortography and selective perineal angiography
- Dynamic Cavernography
- Neurological examination
- Psychological Testing
- Examination of the external genital organs
- Rigiscan test
- Color Doppler Ultrasound
- Study of the hormonal status
- Psychological examination
- Penile ultrasound
- Electromyography of the pelvic floor muscles.
When erectile dysfunction in the first place should determine the cause and, if possible, eliminate it, and not only symptomatic treatment.
Symptomatic treatment methods include medications, vacuum devices and / or psychotherapy. The drugs used for erectile dysfunction include yohimbine , phentolamine , apomorphine, trazodone , thioridazine , testosterone, andriol , pantocrinum, eleutherococcus, nitromasin, L-arginine, herbal remedies , etc.
Phentolamine has been proposed as a therapeutic agent for improving the natural erectile response to sexual stimulation in patients with moderately severe erectile dysfunction. According to various researchers, treatment with Phentolamine is effective in 42–69% of cases (A. Zorgniotti , 1994). The long-term administration of phentolamine mesylate has no significant effect on libido, orgasm, and ejaculation.
For the treatment of erectile dysfunction is also used a lot of drugs of natural origin. This is due to the fact that these drugs have significantly fewer side effects compared with chemotherapy, do not cause addiction and withdrawal syndrome. Many of them are not drugs, referring to dietary supplements. Among the registered drugs, tentex forte is the most famous and frequently used in the treatment of erectile dysfunction.
A large number of drugs used in the treatment of disease, suggests that the “gold standard” in drug treatment does not yet exist.
If a man with erectile dysfunction has a low testosterone concentration and normal prostate gland, testosterone treatment can be started. Testosterone (mixture of esters) – intramuscularly every third week. Mesterolone 25 mg orally 3-5 p. / Day . An annual assessment of the size of the prostate gland (using ultrasound). If, for about 8 weeks, recovery of erectile function did not occur, the therapy is stopped and other causes of the disease and methods for its correction are sought.
Sildenafil is an inhibitor of the enzyme phosphodiesterase . This drug is intended to be taken in the form of tablets of 25, 50 and 100 mg, which is taken for 1-2 hours before sexual intercourse. The initial dose is 50 mg. In elderly patients, the initial dose is 25 mg. Excess doses of 100 mg does not cause additional effect. Sexual stimulation is required.
At normal concentrations of testosterone and no effect of sildenafil used alprostadil administered vnutrikavernozno (the penis). First, a test injection is performed in the clinic (to check the effectiveness of the injection and to find the appropriate dose). With the effectiveness of the first injection, this technique is taught to the patient himself and, possibly, his partner. The patient is given written instructions explaining the injection technique and ways to combat prolonged erection (if it occurs). The initial dose in young men is 0.25 ml (5 µg), in elderly patients – 0.5–1 ml (10–20 µg). If necessary, the dose can be increased to 2 ml (40 μg). The solution is injected into the erectile tissue of the penis (in the third closest to the body). The needle is directed from above and several to the side, thus avoiding damage to the urethra. You can use a special injection syringe-pen for difficulties with the use of a conventional needle. Side effects: pain in the penis of every second man, in rare cases, it is strongly pronounced; prolonged erection (4–6 hours) in 5% of patients. Treatment of prolonged erection: physical activity, such as ascending and descending stairs, cool shower, sucking blood from the penis with a needle and syringe (100-200 ml). The introduction of drugs into the penis is rarely used due to the fact that this is a very painful procedure.
Gel alprostadil is administered into the urethra using an applicator penis gently massaged for about 10 minutes. This method of treatment is most suitable for impotence of psychogenic origin or with minor arterial insufficiency of blood supply to the penis.
Treatment with local negative pressure (using a vacuum pump) is the method of choice for men who do not want to use drugs. Erections can be achieved to some extent in 90% of patients. However, not all men prefer these mechanical devices. Side effects – numbness and pain in the penis.
As an extreme measure (with the failure of all other methods of treatment) use penile prostheses.