Erectile dysfunction (impotence)

The term impotence in urological practice has been replaced by erectile dysfunction for moral and ethical reasons and as a term that fully reflects the condition of a man with an erectile component.

This is a disease (condition) in which erectile dysfunction occurs in men, leading to the absence or deterioration of sexual activity, making it inadequate and leading to psycho-emotional disorders and a decrease in the quality of life. The question of erectile dysfunction arises when there is an inability to achieve or maintain an erection sufficient for intercourse. As a diagnosis, this disease is considered when the described violations are observed in more than half of the attempts at sexual intercourse within six months and under the condition of regular sexual activity.

Risk factors for this pathology are cardiovascular diseases, diabetes mellitus, arterial hypertension, high blood cholesterol levels, radiation and chemotherapy, overweight, a sedentary lifestyle, smoking, the use of drugs and certain drugs and substances, somatic diseases and persons whose work is associated with high physical and psycho-emotional stress. Men with erectile dysfunction, experiencing their condition, are prone to depression, irritability, withdrawal and anger.

A man's erection depends on a number of mental, neurogenic, hormonal, vascular and anatomical factors. Accordingly, drawing a conclusion from the above, the causes of this disease may be the following: 1) Mental disorders and diseases: Among the causes of psychogenic erectile dysfunction, there are strict upbringing, religious beliefs, fear of sex life, sexual perversions (perversions), depression, fear of aging, physical shortcomings, a certain sexual preference of a partner, a conflict with a partner, a negative first sexual experience in a man, an expectation of failure in contact with a partner, mental illness and some other conditions.

2) Neurogenic erectile dysfunction occurs as a result of damage to the central nervous system (brain and spinal cord) and or peripheral nerve structures. Tumors, epilepsy, strokes, Parkinson's disease, Alzheimer's disease, multiple sclerosis, vascular diseases of the brain can lead to erectile dysfunction due to suppression of libido (libido) or excessive inhibition of spinal erection centers or nerve conduction disturbances in the lesion that is involved in the emergence and maintenance of an erection necessary for the implementation of a full sexual intercourse. With lesions of the structures of the spine and spinal cord, such as osteochondrosis and herniated disc, tumors, multiple sclerosis, the innervation of the penis can be disrupted, which also leads to erectile dysfunction.

3) Endocrine diseases are the most widespread and often detected in patients with erectile dysfunction. Patients with diabetes mellitus are most often treated. The cause of erectile dysfunction in this case is not so much the underlying endocrine disease as vascular problems and damage to peripheral nerves. Tumors of the hypothalamus and pituitary gland can also lead to a decrease in libido, a change in the level of hormones that are responsible for an erection. In a certain percentage of cases of thyroid gland disease, directly and indirectly affect a man's ability to have sexual intercourse. Recently, a view on the problem of male aging has become relevant, because with age, many physiological functions in a man fade away, and many of this group of patients want and have the opportunity to live a full sexual life. One of the first terms that appeared to describe age-related changes in men is the term in male menopause, which is currently used quite widely as a description of a complex of symptoms that develop in men after 45-50 years and are manifested not only by a decrease in sexual desire, erection, etc. h. and morning and dissatisfaction in sexual life, but also depression, decreased attention and memory, increased nervousness, fatigue, decreased muscle strength, hot flashes and sweating, sleep disturbances and other symptoms. But men do not have a clear age period for a decrease in the production of sex hormones, in contrast to women. Therefore, the use of the term male climax (from Latin вclimaxв means a step, a ladder) is not correct, because in men, this condition has a blurred and gradual beginning, lasting for years, and in women, it has a sharp and spasmodic course. Therefore, the term male menopause should be considered as age-related androgen deficiency. In the absence of contraindications, it is possible to prescribe testosterone replacement therapy to such patients to restore sexual function, erection and improve the quality of life.

Arterial pathology is most often caused by stenosis or atherosclerotic lesions of the arterial wall, as a result of which blood perfusion through the corpora cavernosa of the penis decreases with the development of erectile failure. Patients with arterial insufficiency most often note an incomplete erection and difficulty maintaining it. With pathological venous outflow, patients also note weakness and the rapidity of the disappearance of an erection shortly after its onset.

5) Sometimes drugs that are recommended to a patient for another disease can lead to erectile failure. Most often it occurs in patients taking sleeping pills, sedatives, antidepressants, hormones and anabolic steroids, blood pressure lowering drugs (diuretics, beta-blockers, ACE and Ca-channel inhibitors) and other drugs. Therefore, such patients need to correct the appointment by canceling or replacing drugs together with a therapist or cardiologist (if, for example, erectile dysfunction caused by taking antihypertensive drugs).

A detailed sexual history of the patient, as well as a thorough laboratory and visual examination, play an important role in the differential diagnosis of sexual dysfunctions. Given that there are many reasons for erectile dysfunction, patients are prescribed without fail:

• general analysis of blood and urine,
• fasting glucose,
• creatinine,
• urea,
• testosterone ,
• prolactin and other hormones as needed.

These tests are carried out at the initial stages of the examination, further diagnosis and treatment by a urologist depends on the general condition of the patient, the desire to be treated and the patient's financial capabilities.