How an erection works and what can go wrong
Erection is a vascular phenomenon controlled by the nervous system and hormones. When sexually aroused, nerve endings release substances that relax the smooth muscles of the arteries of the penis. Blood fills the cavernous bodies, they increase in volume and compress the veins, preventing blood from flowing out.
Failure can occur at any level: if the arteries are narrowed by atherosclerosis, not enough blood flows; if the nerves are damaged, the signal does not arrive; if there is not enough testosterone, both desire and quality of reaction decrease; if the veins are not pinched, the erection quickly subsides.
That is why not only the reproductive system is examined in a man with erectile dysfunction. The arteries of the penis are narrow, and atherosclerosis manifests itself in them earlier than in the coronary vessels of the heart - hence the idea of ED as an early harbinger of cardiovascular disease.
Reasons
- Vascular: atherosclerosis, arterial hypertension, high cholesterol - the most common group of causes
- Diabetes mellitus affects both blood vessels and nerves; ED in men with diabetes develops earlier and is more severe
- Hormonal: testosterone deficiency, increased prolactin, thyroid disease
- Neurological: multiple sclerosis, consequences of stroke, spinal cord injury, disc herniation
- Consequences of operations on the pelvic organs, especially on the prostate and rectum
- Medicinal: some blood pressure medications, antidepressants, hormone therapy
- Smoking is one of the strongest independent risk factors
- Obesity and metabolic syndrome
- Alcohol and drugs
- Psychogenic: anxiety, anticipation of failure, depression, stress, relationship problems
- Obstructive sleep apnea syndrome
- Peyronie's disease and consequences of penile trauma
Psychological or physical reason: how to distinguish
It used to be that most cases of ED were psychological in nature. Today the opposite is known: in men over forty years of age, organic causes predominate, and the psychological component is more often added secondarily - as a reaction to failures.
- Morning and night spontaneous erections are preserved, the problem occurs only with a partner, it began suddenly after a specific event - a psychogenic component is more likely
- Gradual onset, weakening of morning erections, decreased rigidity in all situations, presence of diabetes, hypertension or smoking - an organic cause is more likely
- Often both components are present at the same time, so examination is necessary in any case
Diagnostics
- Detailed conversation and completion of the ICEF questionnaire for an objective assessment of the degree of violation
- Examination of the genital organs, assessment of secondary sexual characteristics
- Total testosterone, if necessary - free testosterone, LH, FSH, prolactin
- Blood glucose and glycated hemoglobin
- Lipid profile
- TSH and thyroid hormones
- PSA in men over 45–50 years of age
- Ultrasound scanning of the vessels of the penis, including with a pharmacological test
- Blood pressure measurement, cardiovascular risk assessment
- Assessing the medications you are taking - sometimes replacing them is enough
- Consultation with a psychotherapist for a pronounced psychogenic component
Treatment: where to start
The first step is always to work with the reasons and lifestyle. These are not general words: in vascular forms of ED, such measures provide real improvement and increase the effectiveness of medications.
- Quitting smoking is one of the most effective factors
- Losing body weight and regular aerobic exercise
- Compensation for diabetes mellitus and blood pressure control
- Lipid profile correction
- Review of medications taken together with your doctor
- Limiting alcohol
- Sleep apnea treatment
- Normalization of sleep and reduction of stress levels
Medication and other methods
- PDE-5 inhibitors are first-line drugs; they do not cause an erection on their own, but enhance the natural response to arousal
- Testosterone replacement therapy - only with laboratory-confirmed deficiency and under the supervision of a physician
- Low intensity shock wave therapy - aimed at improving blood flow
- Intracavernosal injections - if tablets are ineffective
- Vacuum devices
- Psychotherapy and couples therapy with a significant psychogenic component
- Microsurgical treatment of varicocele with concomitant andrological pathology
- Penile prosthetics - for severe forms that do not respond to other methods
Prevention
- Quitting smoking
- Regular physical activity, especially aerobic activity
- Maintaining normal body weight
- Annual monitoring of glucose, cholesterol and blood pressure
- Limiting alcohol
- Full sleep
- Regular sex life
- Timely consultation with a doctor - with early treatment, the results are much better
Where to be examined and treated in Tashkent
A complete examination for erectile dysfunction requires a laboratory for hormonal and biochemical analysis, ultrasound with Dopplerography of the vessels of the penis and consultation with an andrologist.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Don’t delay your visit and don’t be shy about the topic: for an andrologist this is daily work, and early treatment often allows you to get by with lifestyle correction and treatment of the underlying disease. Clinic contacts and online registration are below.
