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Erectile Dysfunction: Causes and Treatment
“Erectile dysfunction is defined as the inability to maintain an erection sufficient for sexual intercourse. It is a disorder that affects millions of men worldwide in different ways and for different reasons.”
what is this
Erectile dysfunction is a medical term used to define the inability to erect an erection with sufficient hardness and/or sufficient duration to satisfy both partners during sexual intercourse. It is important to understand that it can also occur when desire and passion (ejaculation) are present.
Erectile dysfunction (ED) affects about two-thirds of men over the age of 50, representing 10 to 20 million Brazilians.
Most men, at some point in their lives, have experienced erectile dysfunction, usually due to fatigue, stress or alcohol abuse. Occasional failure should not be overrated. However, if the problem persists, consult a urologist.
Erectile dysfunction is one of the many aspects of male sexual function. In the sexual response cycle, there are four main stages of human desire, erection, passion and relaxation. Each one can vary.
The causes of ED are divided into organic, psychogenic and mixed, with combined factors can be found. For example, organic problems such as diabetes, cancer, arteriosclerosis and neurological injury can often lead to psychological complications. It can also be secondary and appear as the first manifestation of various disorders such as hypertension, diabetes, cardiovascular disease and renal failure.
ED of psychological origin can manifest in various ways, or delayed ejaculation, painful ejaculation and even impotence. Loss of libido (sexual desire), lack of arousal and fear (fear) of sex, can all be due to anxiety, depression or guilt. A person has unpleasant experiences, such as loss of erection for intercourse or premature ejaculation, tends to the next relationship, remembers these “failures” and becomes anxious. This provides a new flaw, creating a vicious circle.
Organic causes are divided according to etiology. Vasculogenics are more prevalent, especially flow changes, arteriosclerosis and trauma (resulting in blood vessel injury). Venous flow abnormalities are less common. Neurogenic causes include diabetic neuropathy, multiple sclerosis, alcohol abuse, trauma, spinal cord injury, and nerve damage through radical prostatectomy (surgery to remove the prostate). The causes are hormonal hipoandrogenismo primary or secondary (disorders of male hormones).
ED can also be caused by the use and abuse of drugs such as marijuana, alcohol, heroin, cocaine, barbiturates, antidepressants.
DE has several risk factors such as advanced age, diabetes, hypertension, peripheral vascular disease; Neurological diseases, endocrine disorders, spinal cord injuries, radical pelvic surgery, radiation therapy, alcoholism, smoking, use of marijuana and / or cocaine; use of antihypertensives, tranquilizers and psychotropic substances; Relationship problems with partner, stress, anxiety and fear of failure, depression, obsessive-compulsive personality, sexual deviance.
The goals of the initial evaluation of the patient are to determine the possible cause of the ED and to identify organic or psychological factors that may influence appropriate treatment.
A detailed medical interview is the most important component in evaluating patients with this problem. History should identify the duration, progression, and severity of ED and associated factors.
Once you identify a patient’s sexual performance problem, the next step is to differentiate it from other sexual problems such as loss of libido and ejaculation disorders.
Physical examination is the assessment of the patient’s health, with special attention to the cardiovascular, neurological and genital organs, due to their contribution to erection. A neurological evaluation should include their perception of the patient’s anxiety or depression. Genital herpes is evaluated to detect localized lesions.
There are some basic laboratory tests that can be used to identify disorders that may result in ED.
In case of psychogenic DE, psychotherapy is indicated. Several factors should be evaluated by a urologist and, if possible, a psychologist or psychiatrist. Factors such as physical, psychological, mental, conflicting relationship with the partner and sexual inappropriateness should be addressed in the couple.
Penile injections are the first efficient and objective, with little or no side effects, significantly improving erections, even in severe OF and organic. It was the main complication, painful erection. It also had the disadvantage of limiting the time limit of erection and the frequency of application (3 times per week). This method is abandoned due to the advancement of technology.
Due to the advance of treatment, some oral medications are available in the market. They are:
– Viagra (Sildenafil) from Pfizer: Works on the penis by relaxing muscles and increasing blood flow to the region. Effective in partial impotence, penile stimulation and erection within 40 to 60 minutes of taking the drug. Its effect can last up to six hours. Side reactions such as headache, nasal congestion, facial flushing and dyspepsia. Heart patients, especially in the treatment of nitrates (Sustrate, Monocordil, Isordil, Nitradisc, Nitroderm TTS, Isocord, Isorbide, Nitroglycerin) cannot take this drug.
– maximum (apomorphine), from Abbott Laboratories, acts on the central nervous system, facilitating the transmission of sexual stimuli from the brain to the penis. Sublingual erection occurs 10-20 minutes after oral administration. Headache, nausea, dizziness, fainting and flushing may occur, but can be used by heart patients.
– Cialis (Tadalafil), manufactured by Eli Lilly, acts directly on the penis by inhibiting the phosphodiesterase enzyme. Erection occurs within 30 minutes and lasts up to 36 hours. Headache, gastric intolerance, nasal congestion, back pain, muscle pain, dizziness and flushing may occur. As with Viagra, nitrates cannot be used for heart disease.
– Levitra (vardenafil), from Bayer and Glaxo, acts directly and selectively on the male genitalia by inhibiting the phosphodiesterase enzyme, with fewer side effects (headache, flushing and runny nose). Erection occurs within 15 minutes and lasts up to 8 hours. As Viagra and Cialis, the use of nitrates can not be used in heart disease. The main advantage is the most affordable price and being sold in single packs.
Although drug treatment is indicated, some patients are unable to fit and require treatment with mechanical devices such as vacuum erection devices or penile implants that are inflatable or malleable. In certain cases, others may need surgery to repair the blood vessels that supply blood to the male genitalia.
Because erectile dysfunction can have many causes, there are many treatments that work through different mechanisms, with specific contraindications, a urologist should be consulted.
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