Erectile function in men. Sexual dysfunction in men - causes and treatment of an unpleasant disease. Choose a pose where your body is upright

Erectile dysfunction (sexual impotence, impotence) is the main fear of all men in the world without exception. The inability to engage in sexual relations deprives a man of more than just the joy of sex. Such a problem devalues ​​a man in a woman’s eyes and causes him serious psychological trauma. We will talk about why sexual impotence develops and whether this disease can be cured in this article.

The essence of the disease

Sexual dysfunction is a pathological condition in which a man has a greatly weakened erection or no erection at all, which makes sexual contact impossible.

In the vast majority of cases, impotence occurs in men at the age of 60, and this is considered a completely normal phenomenon due to the aging of the body and changes in hormonal levels. However, if erectile dysfunction occurs in a young man, this is a serious reason to consult a doctor. True, it is worth understanding that one-time “misfires” happen to absolutely everyone, and therefore isolated cases of erectile dysfunction should not be considered a disease. We can talk about sexual impotence only if an erection cannot be achieved in every 4th case. Let's deal with possible reasons this condition.

Types of erectile dysfunction

It turns out that this disease has several types, which differ in causes, as well as in the approach to treating the disease. So, dysfunction happens:

• psychological (psychogenic);
• organic;
• mixed.

According to statistics, only 20% of cases of sexual impotence develop as a result of psychological problems. The remaining 80% is the result of serious diseases (diabetes, hypertension, autoimmune diseases).

Each type has a number of characteristics. For example, erectile dysfunction caused by psychological problems usually appears suddenly. It can be triggered by severe emotional fatigue and emptiness, problems in partner relationships, or severe stress. At the same time, a man’s morning erection may persist.

As for organic erection problems, they do not develop immediately. A man begins to notice over and over again that it is becoming more and more difficult to maintain a normal erection. And this gives reason to believe that the problem is associated with some kind of disease. Organic erectile dysfunction also includes taking certain medications that negatively affect potency. In this case, the man retains sexual desire (libido), he can ejaculate, but an erection does not occur at the right moment or the penis loses rigidity during intimacy.

It should be said here that if you notice changes in erections that become regular, you should not attribute everything to fatigue and stress. Erection problems in men of reproductive age are not the norm, and therefore do not hesitate to contact a specialist who will conduct the necessary diagnostics and be able to determine the cause of the ailment.

Causes of sexual impotence

Now let’s look at a number of reasons that provoke sexual impotence in men.

1. Endocrine diseases
Very often the reason for the lack of potency is hormonal disbalance, in particular, disruption of the production of testosterone, the most important male sex hormone. This can happen in the case of infections, genetic abnormalities, a tumor or injury. In these cases, it is enough to carry out hormonal therapy, as well as remove a tumor or eliminate the consequences of an injury, so that the man regains potency.

2. Taking medications
Taking certain medications, the side effect of which is a decrease in the production of male sex hormones, can also lead to erectile dysfunction. These may be medications that inhibit the activity of the cerebral cortex, as well as drugs and alcohol.

3. Neurological causes
This should include diseases of the peripheral nerves, as well as pathologies of the brain or spinal cord. For example, sexual impotence can develop as a result of head or spinal cord injury, in case of cerebrovascular accident, sclerosis, epilepsy, autoimmune diseases, as well as injuries to the pelvis and groin area.

4. Psychological reasons
Psychological causes of impotence lie in acute or prolonged stress, depression, neuroses, as well as problems with a sexual partner. Sometimes even ordinary physical fatigue turns into erectile dysfunction. Moreover, for some men, the lack of erection may be explained by fear of failure in bed or fear of intimacy with a new partner.

Other causes of impotence in men include vascular pathologies and injuries to the penis. That is, an erection may not occur or may not appear in full if blood flow to the organ is disrupted. This may be penial vasospasm (poor blood circulation in the vessels of the penis) or inflammation of the inner lining of the blood vessels, which is often found in smokers and people with autoimmune diseases. In rare cases, impotence can be caused by Peyronie's disease, an anatomical change in the opening of the urethra in the genital organ.

Penis injuries

In rare cases, sexual dysfunction develops as a result of trauma to the penis. For example, this situation leads to:

• Injury. This closed organ damage can be obtained in a fight, falling from a height, and even while doing physical exercise. As a rule, the inability to achieve an erection in this case is accompanied by problems with urination, pain during movement, swelling and the appearance of a hematoma. Treatment in this case consists of taking analgesics and applying compresses. If necessary, the doctor performs surgery.
• Fractures. Heavy blows, as well as sharp bends of the penis during sexual intercourse can lead to its fracture. In this case, rupture of the cavernous bodies occurs, which leads to the inability to achieve an erection. In this case, the man feels a painful shock, observes swelling and the formation of an extensive hematoma. Medical care in this case can vary from applying compresses to surgery.
• Subcutaneous hemorrhage. This problem usually appears in the case of prolonged sexual contact or non-standard forms of intimacy. In this situation, the blood vessels are damaged, resulting in swelling, hematoma and aching pain. This problem can usually be solved with cold compresses.
• Burn. Such damage to the genital organ can be caused by flammable liquids, chemicals and even ultraviolet radiation. In this case, the symptoms will depend on the degree of the burn (swelling or serious damage to the skin). The possibility of restoring an erection depends on the degree of damage.

Circumcision

Circumcision refers to a common operation in which the foreskin of men or boys is removed. Circumcision may be performed for medical reasons or for religious or social reasons. However, in the absence of flesh covering the head of the penis, irritation of its receptors may occur (through contact with underwear or when walking).

In addition, circumcision can lead to infection in the reproductive system, causing the development of impotence. By the way, doctors associate persistent erectile dysfunction after 40 years with circumcision.

Symptoms of erectile dysfunction

Symptoms of sexual impotence can be divided into several types. It could be:

• Violation of libido (sexual desire). This is the most common symptom and is usually associated with stress, feeling unwell or tired, as well as relationship breakdown or hormonal imbalances. In this case, the man loses sexual interest, and he simply avoids physical intimacy.
• Erectile dysfunction. Lethargy, incomplete erection, as well as its complete disappearance and the inability to complete sexual intercourse, hints at the development of vascular and other diseases.
• Violation of orgasm and ejaculation. This condition, medically called anorgasmia, is quite rare. Orgasms in this case may be too short or absent completely. This is due to psychological problems.

Diagnosis of the disease

First of all, the doctor interviews the patient to understand in which direction to carry out the diagnosis. To check the functioning of the nerves of the penis, an innervation procedure (pressure on the head of the penis) is performed. The result in this case should be an instant contraction of the anal muscles. If testing of innervation suggests a disturbance in the functioning of the nerves or the development of diabetes, the patient is referred for additional studies.

In addition, the doctor conducts a visual examination and palpation of the penis to identify possible bruises and fractures. The patient must submit general analysis blood, blood tests to determine sugar, cholesterol and testosterone levels. He is being measured arterial pressure, and if necessary, an ultrasound scan of the thyroid and adrenal glands is performed.

Treatment of erectile dysfunction

Therapy for an existing disease depends on the cause that caused it. If sexual impotence has developed as a result of hormonal disorders, you cannot do without taking hormonal medications or using gels with hormonal components. When impotence is caused by neurological causes, treatment of the underlying disease is required, after getting rid of which the erection will return. Eliminating psychological problems requires a special approach. Here it is important to achieve a trusting relationship between partners, as well as to help the patient cope with existing psychological difficulties. When erection is negatively affected by the anatomical features of the structure of the penis, the problem is solved surgically.

Drug treatment

A specialist can prescribe medications that stimulate blood flow to the penis and thereby improve erection. The most popular medications in this group are Vigara, Levitra and Sealis. True, it is recommended to use them only after a doctor’s prescription, since each of the medications has a number of serious side effects.

Intracavernosal administration of drugs

This therapy involves administering injections into the corpus cavernosum of the penis that dilate the blood vessels. The injection is performed immediately before sexual intercourse, but no more than one procedure is allowed per week. This method has few side effects and is characterized by inconvenience of use, but for people with serious illnesses this is practically the only way to have sexual intercourse.

Management of suppositories

There is another way to ensure an erection before sexual intercourse. To do this, half an hour before the intended intimacy, a suppository is inserted into the urethra, which ensures a high-quality erection. There is also inconvenience of use, which is complemented by the high cost of the drug.

Erectile dysfunction, or impotence (from the Latin impotens - impotent) is an integral part of the problem of sexual dysfunction, the continued inability to achieve and maintain an erection at the level necessary to ensure full sexual intercourse.

Erection (from Latin erectio - straighten) is a neurovascular process that is directly related to the amount of blood pressure inside the cavernous (cavernous) bodies of the penis. During sexual stimulation, they are biologically released from nerve endings. active substances(mainly nitric oxide), which relax the smooth muscles of the cavernous bodies of the penis, as well as the muscles of the arteries. This leads to vasodilation, increased blood flow in the penis, expansion and filling of the cavernous spaces with blood. At the same time, the veins that perforate the tunica albuginea of ​​the corpora cavernosa of the penis narrow, and passive venous outflow becomes difficult.

The most effective exercise Squats are considered to strengthen an erection; it is recommended to perform 50–100 squats per day.

Filling of the cavernous bodies of the penis with blood and veno-occlusion lead to an erection. During sexual intercourse, this state of the vessels is maintained, the inflow and outflow of blood stops, and intracavernous pressure increases. There is an increase in the volume of the penis and further strengthening of the erection.

Problems with erections over a long period (3-6 months) are grounds to suspect erectile dysfunction.

According to WHO, about 160 million men in the world suffer from erectile dysfunction. Every tenth man over 21 years of age suffers from erectile dysfunction, about 50% of men over 40 years of age experience various difficulties associated with erectile dysfunction, every third man over 60 years of age is unable to perform sexual intercourse.

Forms

According to the etiological factor, the following types of erectile dysfunction are distinguished:

• psychogenic;
• organic;
• mixed.

Among psychogenic erectile dysfunctions, primary and secondary forms are also distinguished:

• the primary (congenital) form is rare and is characterized by a complete absence of normal sexual function throughout life;
• Secondary erectile dysfunction is characterized by a gradual decline in the previously existing ability to have erections.

Causes of erectile dysfunction and risk factors

The causes of erectile dysfunction are divided depending on the pathophysiological mechanisms underlying its occurrence.

When treating the organic form, eliminating the disease that led to erectile dysfunction is of paramount importance.

Organic causes are associated with disruptions in the functioning of internal organs or systems. These include:

• vascular. Insufficient blood pressure in the vessels of the arterial bed leads to an inadequate supply of blood to the cavernous bodies, and contraction of smooth muscles opens up the paths of passive venous outflow. Weakening or absence of erections may be a manifestation of arterial hypertension, obliterating endarteritis, hyperlipidemia, atherosclerosis, arterial damage caused by irradiation of the pelvic area, as well as heart failure, coronary heart disease and myocardial infarction;
• neurological. Diseases of the parasympathetic pelvic visceral nerves and pathologies of the nerve pathways can lead to impaired redistribution of blood flow, insufficient pressure in the cavernous bodies, and impaired ability to have erections. Potency is affected by neurological disorders in Alzheimer's disease, Parkinson's disease, polyneuropathy, multiple sclerosis, hemorrhagic or ischemic stroke, damage to the spinal cord, pelvis and perineum, degeneration of intervertebral discs, cerebral insufficiency, etc.;
• endocrine. Causes of impotence of endocrine origin include increased levels of prolactin, endogenous estrogens and decreased levels of androgens, diseases associated with dysfunction of the pituitary gland and adrenal glands;
• Iatrogenic. They are explained by the side effects of a number of drugs (neuroleptics, tranquilizers, antihypertensives, anticonvulsants, cytostatics, antidepressants, antihistamines I generation, corticosteroids, etc.) on sexual function;
• toxic. Caused by the toxic effects of alcohol, drugs, nicotine.

The consequence of erectile dysfunction is an unsatisfactory sex life, which leads to further disorders.

Psychogenic causes are associated with central suppression of the erection mechanism. These include increased anxiety, lack of sexual arousal, neuroses, mental illnesses (depression, schizophrenia). It has been proven that the psychological causes of erectile dysfunction are based on organic diseases. Most patients suffering from erectile dysfunction exhibit a combination of psychogenic and organic components.

An independent risk factor for erectile dysfunction is aging. The leading causes of erectile dysfunction during aging are an age-dependent decrease in testosterone levels, vascular pathologies and chronic infectious diseases urogenital area. Sexual disorders progressively increase with aging: in the age group of 50–60 years, the number of patients is 10%, and after 80 years – already 80%.

Symptoms

Symptoms of erectile dysfunction include:

• insufficient quality of morning erections or their absence;
• inability to insert the penis due to insufficient tension;
• premature ejaculation;
• increasing the time interval between sexual stimulation and erection;
• incomplete erections or complete absence of erections during stimulation;
• inability to introject and maintain an erection until ejaculation;
• reduction in ejaculate volume;
• increasing the recovery period between erections.

Psychogenic and organic erectile dysfunctions have their own characteristics.

Psychogenic erectile dysfunction begins suddenly. Characterized by the presence of problems in relationships, the presence of spontaneous erections at night. As a rule, problems with erection are episodic. Once the external problem is resolved, normal erection is usually restored.

Massage and self-massage of the pelvic area and pubic bone are effective, as it has a beneficial effect on vascular tone in the genital area.

Erectile dysfunction of organic origin is accompanied by systematic erectile dysfunction. This form of the disease begins gradually and is rarely accompanied by spontaneous nocturnal erections.

Diagnosis of erectile dysfunction

Diagnosis of erectile dysfunction begins with collecting a general history, identifying etiological factors, and assessing sexual life. A number of questionnaires have been developed to identify the pathophysiological basis of impotence.

Physical examination often reveals signs of vascular, neurological or hormonal disorders, confirming a pathophysiological hypothesis based on anamnesis: the presence of signs of hypogonadism, fibrotic changes, gynecomastia, phimosis, detection of La Peyronie's plaques, disturbances of perineal sensitivity, decreased tone of the anal sphincter, muscle atrophy lower limbs, changes in peripheral pulsations.

Diagnosis should include screening for major vascular, metabolic and endocrine diseases, and determination of testosterone levels.

Source: umedp.ru

To objectively assess the state of the physiological mechanisms that control the erection process, a number of techniques are used:

• assessment of the state of the vascular system– determination of the level of blood flow in the pelvic arteries using vascular Dopplerography of the arteries of the penis, plethysmography and radioisotope studies;
• assessment of neurological status– determination of the sensitivity threshold of the penis to vibration using a biothesiometer (helps to detect early manifestations of peripheral sensory neuropathy), electromyography of the perineal muscles, study of the refractoriness of the sacral nerves, registration of brain potentials during irritation of the external genitalia (helps to determine erectile dysfunction of neurogenic origin). If screening tests reveal a neurological pathology in a patient, electroencephalography, computed tomography of the brain, or myelography are performed;
• endocrine system assessment– measurement of plasma concentrations of testosterone, prolactin, luteinizing hormone;
• assessment of the patient's mental state– identification of psychological, causal relationships (situational impotence), mental disorders (anxiety, depression, feelings of shame, guilt).

Problems with erections over a long period (3-6 months) are grounds to suspect erectile dysfunction.

For differential diagnosis of forms of erectile dysfunction, a procedure for assessing nocturnal erections (NEE) using a plethysmographic sensor is used. The differentiation is based on the fact that patients with psychogenic erectile dysfunction have normal erections during sleep, while patients with organic erectile dysfunction have defective nighttime erections.

Treatment of erectile dysfunction

The goal of treatment is to achieve satisfactory erections with minimal side effects.

Psychotherapy plays an important role in the treatment of the psychogenic form of erectile dysfunction. It should be aimed at eliminating the causes that led to sexual maladjustment, resolving intrapersonal and interpersonal problems, and forming adequate ideas about intimate relationships. Marital therapy techniques, training partners in effective interaction, and cognitive behavioral therapy methods are used.

When treating the organic form, eliminating the disease that led to erectile dysfunction is of paramount importance. If impotence has endocrine causes, hormone replacement therapy is prescribed.

Pharmacological agents are widely used to strengthen and prolong erections. First-line drugs are oral PDE type 5 inhibitors. PDE 5 is an enzyme contained in cavernous tissue. Blocking its work leads to relaxation of the smooth muscles of the cavernous bodies and the occurrence of an erection in response to sexual stimulation.

It has been proven that the psychological causes of erectile dysfunction are based on organic diseases.

It is also possible to inject drugs directly into the corpus cavernosum. In this case, a very thin needle is used, with which the patient can independently inject a vasodilator drug selected by the doctor. A unilateral injection is sufficient for bilateral penile enlargement due to cross-flow of blood. 15 minutes after this, an erection occurs that lasts up to two hours. The method has disadvantages - inconvenience of use and rare side effects, such as priapism and fibrosis of the penis (2%).

Another method that increases blood flow to the penis is vacuum constrictor therapy. In this case, the use of a vacuum device increases blood flow into the cavernous bodies of the penis, and the constrictive ring prevents venous outflow.

Humanity has long been aware of a condition called “male weakness.” Today, this formulation is considered outdated because it does not reflect all aspects of the problem and is judgmental, and the term “erectile dysfunction” is used instead.

Men often find it difficult to talk even with a doctor about problems with potency. Traditionally, it was not customary to talk about this problem, so as not to earn ridicule from others.

But times go by, as medicine develops, the issue of erectile dysfunction in men was periodically raised and studied, and at the same time, men’s understanding of the need to visit a doctor with this problem grew.

Previously, in the definition of “male weakness,” the Latin term “impotentia coeundi” was used, popularly referred to simply as impotence, which meant the inability of a man, in any form of penetrative contact, to insert the penis and complete sexual intercourse due to the absence or sufficient tension of the penis.

So what is it?

Erectile dysfunction is a disorder in the sexual sphere when the volume, straightness and hardness of the penis are insufficient for full sexual intercourse.

Impotence, or erectile dysfunction, is the inability to achieve or maintain an erection. Often it is based on somatic (related to the body) disorders, and in most cases, impotence is successfully treated. As a rule, erectile dysfunction is indicated when, over the course of 6 months, at least 70% of attempts to have sexual intercourse are unsuccessful.

On the contrary, short-term erectile dysfunction is not classified as erectile dysfunction.

And, by the way, erectile dysfunction does not affect the final process of sexual intercourse - ejaculation, as well as the quantity and quality of sperm.

According to statistics, approximately 20% of all men aged 30 to 80 years suffer from erection problems. But this figure is probably higher because it is still perceived negatively in male society and many men are afraid to seek help for this reason. Of these, approximately 2.3% of men suffer from erectile dysfunction at the age of 30-40 years, with a gradual increase to 53.4% ​​at the age of 70 years.

How does an erection occur?

Erection is a complex process. In response to stimulation of the penis or other erogenous zones, the parasympathetic nervous system sends nerve impulses through the spinal cord. These impulses are amplified or suppressed by other impulses sent from the brain to the spinal cord, which may be related to mood, sights, sounds or smells.

Erection depends on various mental and organic factors. Here, the corpora cavernosa, located on either side of the corpus spongiosum and around the urethra, play an important role. The surface of the cavernous bodies is covered with a dense tunica albuginea, from which the trabeculae of the cavernous bodies, formed by connective tissue and containing smooth muscle fibers, extend inward.

During an erection, the emptiness of the cavernous bodies is filled with tissue with blood and the penis rises, since due to the contraction of smooth muscles it does not flow back. It compresses the vessels that bring blood to the cavernous bodies, thus preventing its outflow, and as a result an erection occurs.

There is an expansion of the small arterial vessels of the penis and filling of the spongy cavernous bodies with blood. The increase in the size of the corpora cavernosa leads to compression of the veins and a decrease in the outflow of blood, so it becomes hard and straightened.

For a number of reasons, this process can be disrupted, leading to impotence, or erectile dysfunction.

Erection occurs reflexively in response to a stimulus and is controlled by the brain and spinal cord.

Causes of erection problems.

The causes of erection problems can be different. They are conventionally divided into mental, organic and mixed.

Today, many doctors agree that purely psychogenic causes make up a small percentage. The vast majority of problems have well-founded reasons.

While in young and middle age the mental factor is more common, with age organic causes come first. This occurs primarily due to the fact that in men over 50 years of age, approximately 80% of erectile dysfunction is organic.

In general, regardless of age, approximately half of all cases have a purely organic cause, one third are purely psychogenic disorders, and in 20% erectile dysfunction is of a mixed nature.

Organic erectile dysfunction.

For an erection to take place, nerves, blood vessels, hormones and the psyche must work in a complex manner.

Organic causes are quite varied:

• -cardiovascular diseases,
• -arterial hypertension,
• -diabetes,
• - increased cholesterol levels,
• - chronic renal failure,
• - consequences of operations on the prostate gland,
• - injuries and diseases of the spine,
• -hormonal disorders,
• - diseases nervous system(for example, multiple sclerosis),
• - diseases of the endocrine system,
• - side effects of some medications (for example, glucocorticosteroids),
• -alcohol and smoking,
• - damage to veins and arteries,
• - damage to the cavernous bodies, disruption of their innervation and blood supply,
• - injuries and surgical interventions on the penis (curvature of the penis, growth of scar tissue in the cavernous bodies).

Now a little more about the main physiological reasons.

■ problems with blood circulation

Any disease that affects the arteries, such as atherosclerosis, can be accompanied by erectile dysfunction. Impotence in this case indicates an increased risk of developing a heart attack or stroke in the future.

■ Diabetes mellitus

Approximately 60% of diabetic men suffer from some degree of impotence. In this case, it is the result of neurological and vascular disorders accompanying diabetes.

■ Neurological problems. Diseases that affect the nervous system, such as Parkinson's disease and multiple sclerosis, disrupt the neurological component of the erection process.

■ Surgery or injury to the pelvic area. Surgeries on the bladder, rectum or colon, and especially the prostate gland, can damage the blood vessels and nerves that support erections. Trauma can also cause this disorder.

■ Hormonal disorders

In about 3% of cases, endocrine disorders lead to a decrease in the level of the hormone testosterone, which causes a decrease in libido and suppresses the response of the parasympathetic nervous system.

■ Side effects of medications. Some medications, such as amphetamines, can cause impotence.

Thus, erectile dysfunction may be a warning sign for a serious condition that requires a visit to the doctor.

Psychogenic erectile dysfunction.

Along with the above organic reasons, the psychogenic factor should not be underestimated. And at a younger age it is often even decisive.

Each form of erectile dysfunction affects the male psyche. They often find themselves in a vicious circle from which they can hardly escape. Psychogenic dysfunction is especially common in men under 35 years of age and the main reason here is the fear of refusal of sex. And this fear is closely related to intrapersonal conflicts, alienation from others, self-reproach, failure in the profession or misunderstanding of the male role.

The more a man makes desire his main goal, the more he misses the mark.

Risk factors for psychogenic dysfunction are:

• -alcohol abuse,
• - drugs and smoking,
• -stress,
• -depression,
• -intrapersonal conflicts.

Some doctors identify another, more trivial cause of erectile dysfunction - bad bicycle saddles. After a series of studies in 1998, scientists came to the conclusion that bicycle saddles contribute to impotence. Due to the teardrop design of the saddle, approximately one-third of the total weight rests on the perineum, so long bike rides tend to restrict blood flow to the penis and not create enough pressure to achieve a full erection. Therefore, it is very important to choose the right saddle.

How to distinguish psychogenic erectile dysfunction from organic?

Despite the general result - problems with potency, both reasons have differences.

So, the psychogenic factor is characterized by:

• -sudden onset
• -presence of spontaneous nocturnal erections,
• -problems in relationships,
• -episodic nature of erectile disorders,
• - potency is restored after the cause is eliminated,
• -during sexual intercourse, tension in the genital organ remains.

Manifestations of organic causes:

• - gradual development of the problem,
• - the disease gradually progresses,
• - erectile dysfunction is permanent,
• -no night or morning erection,
• -libido and ejaculation are preserved,
• -during sexual intercourse, an erection may weaken.

How to make an accurate diagnosis?

Since impotence has many different causes, the symptoms that appear may vary.

But there is one common manifestation that is characteristic of all reasons: the penis is not erect enough or the erection during the act weakens, which makes it impossible to complete it, while ejaculation occurs with a weak erection or prematurely. Men also often complain of decreased libido.

Along with this, men experience psychological discomfort; they feel fear that they cannot satisfy their partner, unpleasantness and shame. With each failed attempt, disappointment in oneself grows, often the consequence of all this is loss of self-esteem. Thus a vicious circle arises.

Today, the diagnosis of this disease is in the hands of urologists. A neurologist or psychotherapist is involved in treatment upon request. Diagnosis of the disease is as follows:

1. Interview with the patient: the doctor finds out when the disease first appeared, what preceded it, what were the first signs, whether there are mental factors, stress, or problems at work. They find out what diseases he had before and what he currently suffers from, whether the man takes medications, drinks alcohol or has a nicotine addiction, the patient’s lifestyle, what his sexual life was like before.

2. Examination of the patient: the doctor palpates (feels) the lower abdomen, genitals and prostate for the presence of visible diseases (adenoma or prostate cancer, trauma or curvature of the penis, etc.), determines the size of the testicles (the smaller they are, the lower the level testosterone in the blood), measures blood pressure levels.

3. Biochemical blood test: patients may experience increased levels of cholesterol in the blood, with diabetes there will be increased levels of sugar in the blood, with kidney problems, creatinine, urea and electrolytes increase, with liver diseases, ALT and AST levels are increased, the level is also determined testosterone and thyroid hormones.

4. General urinalysis: determine the presence of leukocytes, which indicates an inflammatory process; blood in the urine may indicate the oncological nature of the disease; if necessary, urine cultures are done for the presence of bacterial flora.

5. Ultrasound examination of the blood vessels of the penis allows you to evaluate blood flow in the cavernous bodies, the presence of atherosclerotic changes, venous outflow, the presence of scar tissue and calcifications. The study is carried out first in a calm state, then an injection is made into the penis of a drug that promotes erection (alprostadil, papaverine), and the degree of vascular dilation in the cavernous bodies is assessed and the pressure in the vessels of the penis is measured (pharmacocavernosometry). The conclusion is given after comparing the two results obtained. If the erection after the administered drugs lasts more than 15 minutes, then a vascular problem is more likely to be excluded.

6.Measurement of nocturnal erection. U healthy man at night, erections occur 3 to 6 times and in their presence, the organic nature of erectile dysfunction is excluded. If there are no nighttime erections, then a violation of the blood supply or innervation of the penis is assumed. The measurement is carried out using a special sensor attached to the penis.

7.Pharmacocavernosography. It is a series of x-rays of an erect organ in several projections after the introduction of x-ray contrast agents into it. It allows you to evaluate the structure of the cavernous bodies, the presence of foci of sclerosis or atrophy in them, and identify the pathological discharge of venous blood in case of damage to the venous vessels.

8.Electromyography allows you to evaluate the autonomic innervation of the penis. When it is violated, there is inhibition of neuromuscular impulse transmission, which leads to erectile dysfunction.

9.Testing the bulbocavernosus reflex allows assessment of innervation. The test is that when you press on the head of the penis, the anus instantly contracts.

10.Biothesiometry is used to assess the innervation of the penis and its sensitivity under the influence of vibration. A decrease in sensitivity indicates a violation of its innervation, which can occur with some diseases (for example, diabetes). Increased sensitivity occurs at a young age and is characterized by premature ejaculation.

Treatments are simple and radical.

Today, treatment for erectile dysfunction is carried out quite successfully, allowing a man to maintain his sex life. At the same time, the range of proposed measures is quite wide, starting from pills and ending with the implantation of penile prostheses. So, what is possible and what is better to do?

The choice of treatment method depends on the cause of impotence. In approximately 90% of cases, it is successfully cured, but many men are simply embarrassed to discuss their condition with a doctor. Treatments for impotence are selected individually depending on the cause of the disease and the severity of the condition.

Drug therapy, surgical correction of blood vessels, installation of implants and mechanical procedures - all these methods have a high percentage of effectiveness. Treatment depends on the cause of impotence and may include surgery, mechanical and drug therapy.

1.Psychotherapy.

Indicated in cases of psychological causes of problems, as well as after injuries and surgical interventions on the penis or prostate.

A man, with the help of a psychotherapist, by developing the right motivation, can overcome his fear of failure and correctly assess the causes of failure. Often men are silent about problems with erection, which only increases the pressure on themselves and their sexual partners.

For successful therapy, you need to talk openly with your sexual partner about the problem and involve him in treatment and help.

2. Drug treatment.

Is the simplest and sufficient effective way restoration of potency at the initial stage of treatment.

IN last years Many drugs have appeared in the world to help solve the problem of impotence. They allow for highly effective treatment. However, their appointment requires consultation with a specialist due to the presence of possible side effects and contraindications.

One of the additional methods of treating impotence is saturating the body with vitamins and minerals.

The pituitary gland plays an important role in the production of sex hormones. For its normal functioning, substances such as niacin (vitamin PP), pantothenic acid, B vitamins, vitamins C and E, and zinc are required.

Well-known stimulants of sexual activity are preparations based on ginseng, Chinese lemongrass, deer antlers, seahorse. They have a general stimulating effect, enhance the functioning of the gonads and nervous system, and have a good effect on sexual disorders, especially due to neurotic reactions.

Widely known to male audiences pills— Viagra, Cialis or Levitra, Yohimbine. In order to determine which drug is right for you, you must first consult with your doctor, since they have a number of side effects. Basically, taking them is very simple: take the prescribed dosage 15-20 minutes before the intended contact. Their effect can last throughout the day and makes it possible to get a good erection within 20-30 minutes after administration. Within this period of time, it is possible to obtain sexual pleasure several times. In addition, their effect does not decrease after eating.

Another type of medication for the treatment of erectile dysfunction is intraurethral beads.

A modern development in the treatment of erectile dysfunction involves inserting a small ball into the urethra using a special applicator.

The ball contains the hormone prostaglandin, which stimulates an erection. How it works?

Prostaglandin dilates the arteries, causing compression of the veins. As a result, the penis becomes filled with blood.

Can be done injections into the penis. They ensure the delivery of drugs for obtaining an erection directly into the tissue of the penis (at its base). For many men, this type of treatment is associated with great psychological discomfort and resistance. The procedure is carried out immediately before sexual intercourse. This results in an erection for about an hour.

The injections are quite painful and have a number of side effects: swelling of the penis and scrotum, proliferation of connective (scar) tissue (formation of scars on the genital organ), hematoma at the injection site, possible infections.

If you approach the issue radically and do injections while taking them simultaneously with pills to restore potency, a prolonged erection may develop as a side effect.

After the injection, you must use a condom to avoid accidentally introducing an infection to the injection site.

There is also a way to administer the drug Alprostadil in the form of candles in the urethra. It promotes relaxation of the pelvic muscles and free flow of blood to the penis, which leads to an erection. Erection occurs quickly, the effect lasts 30-60 minutes.

Applicators and gel for skin are used if impaired potency is associated with a lack of the hormone testosterone.

3.Mechanical aids.

Despite the fact that Viagra has become widely known, vacuum therapy is much more effective.

A vacuum pump is used when the above means are ineffective. A tight cylinder is placed on the genital organ, from which all the air is pumped out, thereby creating a vacuum space. As a result, the corpus cavernosum fills with blood, which leads to an erection. After this, a cuff is put on it, which will maintain an erection and prevent the outflow of blood through the veins.

This is a rather uncomfortable method, but it provides an erection within 30 minutes. Of course, for such manipulations an anatomically selected specimen must be used.

However, using vacuum therapy takes away the spontaneity of sex. After all, a special preparatory procedure is needed here.

An erection created using vacuum therapy lasts approximately half an hour. The fact is that the cuff on the penis should not last longer than 30 minutes, as otherwise the blood supply to the organ will suffer.

4.Electrotherapy.

It is based on the fact that harmless low-frequency currents from electrodes located on the penis are conducted under the skin, which improves the conduction of neuromuscular impulses. The muscles react to this by contracting.

Electrotherapy is a fairly simple, low-cost treatment with virtually no side effects. To achieve an erection during electrotherapy, a certain time is required, because... Direct stimulation will not cause any erection immediately. The effect occurs after several weeks of training. When used correctly, side effects are extremely rare. However, there may be:

Muscle pain due to muscle overload. Therefore, in the initial stages it is limited to a maximum of 40 minutes with a gradual increase in stimulation time. Subsequently, this effect quickly passes.

Skin irritation in the form of redness, itching or pimples in the area where the electrodes are located. Therefore, it is necessary to consult a doctor to avoid such reactions.

Temporary pain at the stimulation site. In most cases, changing the position of the electrodes or reducing the time of their contact with the penis helps. The pain disappears quickly and occurs in most cases only at the beginning of electrotherapy.

5. Implants are the most drastic remedy.

If the cavernous bodies are not sufficiently supplied with blood or the blood flows out too quickly, then vascular surgery must be performed. Of course, the guarantee of success is not very high, so this intervention is carried out only in exceptional cases.

Also, the use of prostheses on the cavernous bodies is problematic, since during this operation most of the cavernous bodies are destroyed and cannot be restored. That's why this treatment is only discussed in severe cases of erectile dysfunction. It is the most radical way to restore potency, ensuring success in 95% of cases.

In this case, a two-cylinder prosthesis is implanted into the cavernous bodies, and the pump that activates it is placed in the scrotum. Simply put, a pair of inflatable cylinders are inserted into the penis, which connect to a valve mechanism (pump) in the scrotum and a reservoir of fluid in the abdominal cavity.

An erection is caused by squeezing the pump in the scrotum, and is removed by pressing a button on a special device.

There are several types of dentures: rigid, plastic or inflatable. The type of prosthesis, as well as the need for its use, is determined by the doctor.

Implantation is a surgical procedure after which the patient returns home the same day or, if necessary, can remain under observation for 1-2 days. Implantation restores erectile function by replacing non-functioning erectile tissue with a prosthetic.

When the implant is not in use and not inflated, no one will know that you have it. When deflated, it does not protrude from under the pants.

Compression of the valve mechanism in the scrotum causes a special fluid to flow into the implant, which leads to an erection.

The penis looks exactly the same as during a normal erection. It is impossible to tell from its appearance whether this phenomenon is natural or whether it was created using an implant.

This device does not affect sensitivity or the possibility of orgasm. It only allows you to get a stable erection. And then everything will be fine with orgasm.

In order to prevent the development of erectile dysfunction, as a rule, it is enough for men to eliminate risk factors such as alcohol and smoking, be active and healthy image life, control your blood pressure, prevent atherosclerosis and diabetes mellitus, and when the first signs of the disease appear, do not hesitate to seek help from a doctor!

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Erectile dysfunction (the previously used term “impotence” is now considered incorrect and is practically not used in the medical community) is a very delicate male problem, which, unfortunately, is becoming more and more common every year. If previously men older than 40-45 years old encountered sexual dysfunction, now the disease has become “younger”, and young men, often under 35 years of age, often turn to doctors.

This is, of course, connected primarily with people’s lifestyles, especially in megacities. Constant stress, disruption of sleep and wakefulness, poor environment, poor diet, smoking and other bad habits have a detrimental effect on the health of the entire body, including the reproductive system. However, there are actually many more reasons that cause sexual dysfunction. With timely identification of the problem and proper treatment, potency can be completely restored.

Causes of erectile dysfunction

Depending on the reasons, there are 3 forms of potency disorders.

Psychogenic form

Most often, this type of erectile dysfunction is diagnosed in men at a young age. In this case, there are no organic disorders in the structure of the genital organs and the hormonal system, libido is preserved or reduced, spontaneous erection is not impaired, and when an erection occurs, the man, as a rule, completes sexual intercourse. Main reasons:

• chronic fatigue, stress, depression, neuroses, including those caused by conflicts between sexual partners;
• consumption of alcohol, narcotic and psychotropic substances.

Organic form

Most men think that erectile dysfunction is a problem that comes with age, but in fact it is not. With age, the number of chronic diseases increases, metabolic and other processes may be disrupted, which entails disorders in the sexual sphere. Most “age-related” diseases can be treated with medications, and many medications also have a negative effect on potency. That is why men who lead a healthy lifestyle from a young age and maintain good health longer face problems in the intimate sphere much later.

The causes of this pathology can be divided into several large groups:

1. Impaired blood supply to the penis. This may be due to angiopathy, which developed as a complication or.
2. Decreased levels of sex hormones as a result of endocrine disorders. The main reasons: dysfunction of the hypothalamic-pituitary system, congenital underdevelopment of the gonads, taking medications that reduce testosterone production, sometimes sports nutrition gives this effect.
3. Diseases of the nervous system: disruption of the innervation of the genital organs as a result of injuries and infringement of the spinal cord, tumors or displacement of the vertebrae, myelitis, etc.
4. Diseases of the reproductive system. In recent decades, the number of cases of detection of sexually transmitted diseases has increased, often their consequences play an important role in the occurrence of erectile dysfunction. In addition, this pathology can be caused by previous surgeries on the genital organs, injuries to the penis and its curvature (often congenital), and cavernitis.

Mixed form

Sometimes impaired potency is the result of a combination of organic and psychogenic factors. Identifying problems with potency of an organic nature is a huge stress for a man, as a result of which the disease is aggravated by psychological trauma.

Briefly about the symptoms

Usually a man himself pays attention to the emergence of problems in the intimate sphere. The organic form of potency disorder develops gradually. To achieve a state of erection, an increasingly longer time is required; in the end, a situation is possible when, if a man desires sexual intercourse, he cannot achieve a normal erection at all. It is also possible that it weakens during sexual intercourse, as a result of which it becomes impossible to complete it. Orgasm disturbance is also possible.

It should be noted that, for various reasons, almost every man encounters such situations at least once in his life, and this is not yet a reason to sound the alarm. You should think carefully about your health and consult a doctor when, in 25% of cases, normal completed sexual intercourse becomes impossible.

Unlike the organic, psychogenic form of erectile dysfunction most often occurs in young men; sexual intercourse, which was preceded by a traumatic situation, suddenly becomes impossible. At the same time, memories of this event cause even greater psychological trauma to the man.

Treatment of erectile dysfunction

Treatment for this sensitive issue A doctor should be involved; the sooner a man turns to specialists, the greater the chance of completely restoring normal sexual function or slowing down the progression of the disease. In order to prescribe the correct comprehensive treatment, the doctor must first find out the cause of problems in the intimate area.

If the problem is psychogenic in nature, then treatment is carried out together with a psychotherapist. In any case, a man needs to change his lifestyle. Should be completely abandoned bad habits, with a sedentary lifestyle, you need to increase physical activity, avoid stressful and conflict situations. The doctor may recommend taking vitamins, dietary supplements, antidepressants, etc.

A problem of organic origin is somewhat less treatable, it all depends on how severe the disease is, the consequence of which, in fact, is a violation of potency. For each disease, be it obesity, atherosclerosis, hypertension, infectious diseases, hormonal disorders, etc., appropriate therapy is selected.

Symptomatic treatment

Medications

In the 90s, a drug for the treatment of erectile dysfunction appeared on the pharmaceutical market, which simply “blew up” the medical community and broke all imaginable and inconceivable records in the first year of sales. Many have already guessed that we are talking about Viagra. The active ingredient in this drug, sildenafil, was originally studied as a medicine for the treatment of hypertension. However, it was not possible to achieve significant results in this area, but a side effect in the form of persistent long-term erection, which was observed in men, was noticed by doctors. As a result, the drug almost completely changed its profile and began to be successfully sold throughout the world, thereby making millions of men happy.

The mechanism of action is simple, the drug increases blood flow to the pelvic organs, resulting in a normal erection under the influence of sexual arousal.

Today in the pharmacy you can find a dozen drugs that have a similar effect: Zidena, Levitra, Dynamico, Cialis, etc. They are mainly sold without a prescription, however, it is still not worthwhile to self-medicate, much less abuse these drugs, since they have there are significant side effects and contraindications. Therefore, you should consult a doctor to prescribe the drug.

Taking these medications is the simplest and most affordable way to correct disorders in the intimate area. Other non-surgical methods can be called quite specific, but they also “work”.

Intracavernous injections

In some cases effective method To achieve an erection is to perform injections into the cavernous bodies of the penis. The doctor selects vasodilators, most often regular Papaverine, which the patient must administer to himself before sexual intercourse. As a result of the injection, blood vessels dilate, blood flow to the penis increases, and an erection occurs. However, not every man will be able to perform such a procedure on his own, and if you violate the rules of asepsis, you can get a number of unpleasant complications, and it is not recommended to resort to this method more than once a week.

An analogue of this method is the introduction of special suppositories into the urethra. This option, of course, is easier to implement, but also requires certain skills, and the drugs are not cheap.

Vacuum pumps

Special vacuum constrictor devices have been developed that can be used to bring the penis into an erect state. The device consists of a cylinder and a pump (manual or automatic) that pumps air out of it, creating a vacuum. The penis is placed in this cylinder, and the vacuum created causes blood flow to it. A silicone ring is placed on its base, preventing the reverse flow of blood; an erection caused by a vacuum pump lasts on average about 30 minutes. This method is quite easy to use, does not have many of the side effects of drugs, but it also has some disadvantages and contraindications.

Surgical treatment

Modern medicine has made great progress over the past decades, so in the vast majority of cases, it is possible to cope with the problem without resorting to surgery. The main thing is to be patient and strictly follow the doctor’s instructions. If medication and other treatment methods still do not bring the desired result, or a man is diagnosed with a disease that is useless to treat with conventional methods, then the doctor may recommend surgical treatment.

Vascular surgeons can perform shunting of the vessels that bring blood into the cavernous bodies of the penis, or, conversely, ligation of the vein to reduce the outflow of blood from them. However, as practice shows, the effectiveness of such operations is not high.

In recent years, penile prosthesis surgery has become increasingly common and in demand. Special prostheses are installed into the corpora cavernosa of the penis; to date, several types of such devices have been developed and successfully used.

More accessible are semi-rigid and plastic prostheses, which are silicone rods implanted into the corpora cavernosa of the penis. The first option is the cheapest, but it can cause inconvenience for a man (the penis is constantly in a state of erection, which causes discomfort in Everyday life). Plastic prostheses are more convenient than semi-rigid ones, since they are created from materials that have a “memory effect”, which allows the penis to maintain any given position.

Today, happy family relationships are the most important thing in life. Great importance It also has a sexual aspect. Very often, nowadays, men have some sexual problems, as a result of which they cannot fully satisfy a girl or are unable to perform sexual intercourse. All this means. Its extreme degree is called impotence. This term should not be confused with infertility. Infertility implies the inability of male reproductive cells to fertilize and often has a slightly different etiology. This is a more serious disease.

Modern men, starting from adolescence, are active sex life. During this period they are full of strength. But by the age of fifty, the body of any man begins to gradually wear out and age. At this time it is not yet noticeable, but it becomes increasingly difficult for the male body to satisfy a woman. Today it is difficult to find men who would not complain about erectile dysfunction. Over time, men's erection strength decreases. This is senile erectile dysfunction. It’s another matter if symptoms occur at a young age for no reason.

This indicates the development of some disease. If the first signs of decreased potency appear, then you need to seek help from a sexologist, andrologist or urologist. Signs of decreased potency can cause an irreparable psychological blow to men. Depression or stress may occur. In this case, a man may lose interest in sex. How does erectile dysfunction manifest in men? What are its causes, clinical symptoms, treatment?

Causes of erectile dysfunction

Weakening of erection in men can occur for various reasons. Firstly, the reason may lie in changes in hormonal levels. The thing is that erection and sexual desire are largely determined by the level of sex hormones in the blood. The most important of these is testosterone. With endocrine diseases, its amount can sharply decrease, which causes erectile dysfunction. We must not forget about such a hormone as prolactin. This substance is produced in both the female and male bodies. A healthy man has a small amount of prolactin circulating in his blood. With pathology, its volume increases, which leads to suppression of testosterone production. The result is erectile dysfunction in men.

Secondly, male erectile dysfunction can occur in the presence of sexually transmitted infections. Even if the male genital organs have been completely cured, infections still reduce erection. The most dangerous in this regard are the following sexually transmitted infections: syphilis, gonorrhea, trichomoniasis and some others. Important place play a role in the occurrence of erectile dysfunction inflammatory processes organs genitourinary system. These include prostatitis, orchitis, vesiculitis, urethritis, etc. Tumors (prostate adenoma), traumatic lesions, and systemic diseases can reduce erection and libido.

Psychological Cause of Erectile Dysfunction in Men

The causes of erectile dysfunction may be psychogenic in nature. can occur at an early age as a result of psychological trauma received in childhood. Another reason is improper sexual education of the child by parents. Modern theories of decreased erection are largely based on the relationship between a man and a woman. The reason for this pathology can be traced in everyday life. sexual relations, a man's fear of doing something wrong. Sexual desire is also important. It largely depends on the woman herself.

The attending physician must know not only the symptoms of the pathology, but also the methods of diagnosing it. The patient is prescribed a whole series of studies, which includes an ultrasound, a study of the sexual reflex, nocturnal erections, a biochemical and general blood test, the introduction of vasoactive agents into the penile cavity, a Viagra test, and Doppler sonography. Phalloscintigraphy may be prescribed. Important role plays anamnesis collection, external examination of the patient. To obtain more complete information about the sexual sphere of the patient’s life, it is recommended to conduct a questionnaire or detailed survey.

Treatment of erectile dysfunction

The disease must be treated only under the supervision of a doctor. There is no need to treat at home, because a more serious illness may be hidden behind a mask of low potency. Drug treatment is divided into symptomatic and pathogenetic. The latter is aimed at treating the underlying cause of the disease. The most common and popular medications are Viagra, Cialis, and Levitra. Treatment also includes the use of drugs from the group of adaptogens. The product “Pantocrine” gives a good effect. It is advisable to include vascular agents in the treatment regimen, for example, Xanthinol. Vitamins and sedatives are used for treatment.

Drug treatment alone is not always enough. It is advisable to include hyperbaric oxygenation, magnetic therapy, and physical therapy in complex therapy. Vacuum devices are very popular. With their help, a flow of venous blood is created in the cavity of the penis due to negative pressure.

This treatment method is more suitable for older people. If conservative treatment is ineffective, it is indicated surgery- penile prosthesis. Along with medications massage, psychotherapy, folk remedies(ginseng). Thus, a decrease in potency is not a death sentence. If you follow all the doctor’s recommendations, the disease can be cured.