Erections - Increase in the volume of the penis with a sharp increase of its elasticity; due to stretching and filling with blood the corpus cavernosum during sexual arousal that enables sexual intercourse.
Erectile dysfunction - the inability to get an erection or maintain it at a level sufficient to carry out normal sexual intercourse, continuing for at least 6 months. Erectile dysfunction does not always accompany aging and may not be available in old age. With age, the frequency and severity of ejaculations degree of sexual tension and the need for reduced ejaculation, and erectile ability often persists.
When you save a morning erections and a good erection during masturbation major role psychological factors play in the development of the disorder. When sustained inability to have an erection under any circumstances imply the organic cause. Erectile dysfunction can be true and imaginary (erection dissatisfaction caused by its mismatch of the subjective and often misconceptions about it), and combined with disorders ejaculation.
The frequency of occurrence of erectile dysfunction - 52% of men aged 40-70 years. Only 10% of patients seek help from professionals.
Causes
- Organic lesions of the nervous system;
- Genital diseases (prostatitis, urethritis, Kollikulit);
- Endocrine disorders (as a result of direct injury testis, pituitary, adrenals, thyroid, senile erectile dysfunction);
- Lesions of the penis (malformations, trauma, Fibroplastic seal penis - and seal tunica septum of the penis with the formation of nodules or plates are not welded to the corpora cavernosa, hence the deformation of the penis during an erection; chronic cavities priapism);
- Diseases of internal organs (arterial hypertension, diabetes diabetes, angina, kidney failure);
- Vascular lesions (Leriche syndrome);
- Drugs (e.g., antihypertensives, beta blockers, antidepressants);
- Alcoholism, drug addiction;
- Psychological factors (stress, fatigue).
Manifestations of erectile dysfunction
- Lack of erection during sexual arousal;
- Less common deformity of the penis during erection, intercourse making it impossible;
- There are neurotic disorders (anxiety, fear), signs of endocrine disorders.
Many patients are unable to detect significant changes in the nervous, urogenital and endocrine systems, as well as internal organs.
survey
- Blood and urine tests
- blood glucose and glucose tolerance test
- Serum lipids
- Tracking nocturnal erections
- endouretralnye thermometry
- Measurement of pressure Penial
- Reofallografiya
- Aortography and selective angiography of the crotch
- dynamic kavernografiya
- neurological research
- psychological testing
- Examination of the external genitalia
- Rigiscan-test
- Rigidometriya
- Color Doppler ultrasound
- A study of hormonal status
- psychological examination
- cavernosography
- Ultrasound of the penis
- rheotachygraphy pelvic floor muscles.
Treatment of erectile dysfunction
When erectile dysfunction should first identify the cause and eliminate it if possible, not be carried out only symptomatic treatment.
symptomatic therapies include drugs, vacuum devices and / or therapy. For drugs used for erectile dysfunction include yohimbine, phentolamine, apomorphine, trazodone, thioridazine, testosterone, andriol, Pantocrinum, Eleutherococcus, nitromaz, L-arginine, herbal and other.
Phentolamine has been suggested as a therapeutic agent for the improvement of the natural erectile response to sexual stimulation in patients with moderate erectile dysfunction. According to various researchers, phentolamine treatment is effective in 42-69% of cases (A. Zorgniotti, 1994). Admission phentolamine mesylate long course has no significant effect on the libido, orgasm, 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 than chemotherapy drugs do not cause addiction and withdrawal symptoms. Many of them are not medications, treating biologically active additives. Among the drugs for the best known and frequently used in the treatment of erectile dysfunction is Tentex forte.
A large number of drugs used in the treatment of diseases, suggests that the "gold standard" in the drug treatment does not exist yet.
In the presence of men with erectile dysfunction low testosterone concentration and normal-sized prostate gland can start testosterone treatment. Testosterone (mixture of esters) - intramuscularly every third week. Mesterolone 25 mg orally 3-5 p. / Day. Annually assess the size of the prostate gland (using ultrasound). If a period of about 8 weeks of recovery of erectile function has not occurred, treatment was stopped, and begin to look for other causes of the disease and methods of its correction.
Sildenafil - a phosphodiesterase inhibitor of the enzyme. This drug is intended for administration in the form of tablets of 25, 50 and 100 mg, which take 1-2 hours. before sexual intercourse. The initial dose is 50 mg. Elderly patients the initial dose is 25 mg. Exceeding 100 mg dose causes no additional effect. Requires sexual stimulation.
At normal concentrations of testosterone and no effect on the use of sildenafil, alprostadil administered vnutrikavernozno (the penis). First, in the clinic conducted a test injection (injection to test the efficacy and choose an adequate dose). When the efficiency of the first injection, the technique taught by the patient and possibly his partner. The patient is given written instructions that explain injection techniques and how to deal with a prolonged erection (if it occurs). Initial dose in young males is 0.25 ml (5 g) in elderly patients - 0.5-1 ml (10-20 mg). If necessary, the dose may be increased to 2 ml (40 mg). The solution is introduced into the erectile tissue of the penis (in the near to the body of his third). The needle is directed from above and somewhat to the side, thereby avoiding damage to the urethra. You can use a special injection pen syringe when there are difficulties with using conventional needles. Side effects: pain in the penis every second man, in rare cases, it is strongly expressed; prolonged erection (4-6 hours) in 5% of patients. Treatment prolonged erections: physical load such ups and downs on the stairs, cool shower, suctioning of blood from the penis using a needle and syringe (100-200 ml). The introduction of the penis drug 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 psychogenic origin or minor arterial insufficiency of blood supply to the penis.
Treatment of local negative pressure (using a vacuum pump) - selection method for men who do not want to use drugs. Erections to some extent can be achieved in 90% of patients. However, these mechanical devices prefer not to all men. Side effects - a sense of numbness and pain in the penis
As an extreme measure (with failure of all other treatments) is used penile prostheses.
