Erectile dysfunction

Erectile dysfunction is the inability of a man to achieve or maintain an erection for sexual intercourse. If the cases when “the penis is not worth it” are isolated, then we are not talking about impotence. The diagnosis is made with stable erectile dysfunction lasting at least 3 months.

Severe impotence is rare in young people, but warning signs may appear early. In Russia, only 10.1% of men did not show signs of this pathology. Mild erectile dysfunction was found in 71.3%, moderate – in 6.6%, severe – in 12% of participants in the domestic study (Pushkar et al., 2012). According to American data, there are 26 new cases per 1000 men per year (MMAS study). Among men 30-80 years old, the prevalence of erectile dysfunction increased from 2.3% to 53.4% ​​with increasing age and the addition of concomitant pathologies. There is no exact answer as to how many years this pathology develops, but experts note that the disease is getting younger.

Types of erectile dysfunction

There are psychogenic and organic impotence (it includes all types associated with organ damage). Psychological impotence accounts for about 40% of cases, organic - 29%, mixed - 25%. In 6% of cases, the cause cannot be determined. The guidelines of the European Association of Urology highlight in detail the forms of erectile dysfunction depending on the mechanism of development. Below are its types with diseases and risk factors that cause them.

• Vascular impotence:

- diabetes mellitus,

- hypertension,

- hyperlipidemia,

- damage to pelvic vessels.

• Neurogenic impotence:

- degenerative diseases (Parkinson's disease, multiple sclerosis),

- injuries and diseases of the spinal cord,

- stroke,

- tumors of the central nervous system,

- polyneuropathy,

- chronic renal failure.

• Anatomical or structural impotence:

- myropenis,

- Peyronie's disease,

- trauma (fracture of the penis or pelvic bones).

• Hormonal impotence:

- hypogonadism,

- hyperprolactinemia,

- hyper- and hypothyroidism,

- Cushing's disease.

• Drug impotence. Upon admission:

- antihypertensive,

- antidepressants,

- some hormones,

- drugs.

• Psychogenic impotence:

- General (decreased excitability and sexual dysfunction, regardless of the circumstances),

- Situational (depending on the partner and circumstances).

Symptoms and signs of erectile dysfunction

The main symptoms of impotence are indicated in its definition: difficulty achieving and maintaining an erection. This is often accompanied by decreased libido, impaired ejaculation and orgasm.

The dynamics of symptoms can help clarify their nature. In Table 1 we provide a comparison of psychogenic and organic erectile dysfunction (ED) (Papagiannopoulos D, et al., 2015).

In parallel with the signs of erectile dysfunction, symptoms of diseases that are associated with it are often found. In adulthood and old age, it is often accompanied by frequent urination, difficulty urinating, and a feeling of incomplete emptying of the bladder. The main disease causing these symptoms is prostate adenoma.

Causes of erectile dysfunction

Risk factors for erectile dysfunction include age, depression, excess body weight, smoking, drug use, alcoholism, vitamin deficiencies, metabolic syndrome, disorders in the lipid spectrum of the blood, exposure to external factors (radiation, electromagnetic radiation).

Previously, decades ago, impotence under the age of 40 was considered psychogenic by definition. Improved diagnostic capabilities and understanding of the disease in recent years have shown that at least 15-20% of young men with impotence have organic lesions. In one study, 14.8% of men under 40 years of age were found to have organic lesions causing erectile dysfunction. Its causes were atherosclerosis (32.1%), venous pathology (16.7%), neurogenic disorders (12.8%), endocrine diseases, and medication. The main risk factors were smoking, high blood cholesterol, groin injuries, spinal cord injuries, and drug use (Caskurlu T et al, 2004).

Among smokers, erectile dysfunction is 15-20% more common.

At the age of over 40, organic causes of erectile dysfunction begin to predominate, among which the most important are atherosclerosis, diabetes mellitus, and age-related decrease in testosterone levels.

A separate specific cause of impotence in men over 60 years of age is radical removal of the prostate gland for cancer of this organ.on. The surgery may damage the nerves that provide erections. The best opportunities for preventing erectile dysfunction are provided by endoscopic and robotic surgeries. The older you are and the wider the scope of the intervention, the more often impotence develops after surgery.

Diagnosis of erectile dysfunction

If you have complaints about potency disorders, you should contact a urologist or andrologist. The doctor asks the patient in detail about sexual life, both in the present and in the past, and is interested in the nature of the relationship with the partner. It is important how the first signs of impotence appeared, how often and under what circumstances it manifests itself.

To indirectly determine hormonal disorders, the genitals, skeletal structure, body hair, and muscle condition are examined. Assessing the state of the cardiovascular system is of particular importance. For example, if a patient with erectile dysfunction has more than 3 risk factors for developing coronary artery disease, he is asked to undergo a stress ECG and cardiac ultrasound. This is due to the fact that in case of severe pathologies of the heart and blood vessels, sexual life or treatment of impotence may be contraindicated.

Erectile dysfunction in 49% of cases precedes the onset of symptoms of coronary artery disease.

Treatment of erectile dysfunction

It is important to understand that impotence can be treated and you need to see a doctor. Practice shows that not all men know this.

A study conducted in the USA showed that 71% of men had never discussed the issue of erectile dysfunction with a doctor, and 68% of patients were afraid of embarrassing the doctor.

Treatment should be accompanied by normalization of lifestyle: eliminating risk factors and establishing a healthy rhythm of sexual activity. You should also discuss with your doctor whether any of the medications you are taking are affecting your erections and whether they can be changed.

If erectile dysfunction has removable causes, treatment begins with them.

Let us give examples when it can be carried out radically.

- Psychogenic impotence. In this case, the patient is referred to a psychotherapist; rational psychotherapy can provide a complete cure.

- Vascular impotence in young men with traumatic injuries to the arteries of the pelvis and groin. Surgical repair of arteries is effective in 60-70% of cases.

- Hormonal disorders (lack of testosterone, excess prolactin). Their treatment by an endocrinologist also gives a good effect. Testosterone preparations are administered intramuscularly or in the form of a gel applied to the skin.

When effective radical therapy is not possible, symptomatic treatment is resorted to.

• Phosphodiesterase type 5 inhibitors are the main symptomatic agents for the treatment of erectile dysfunction. These include sildenafil, tadalafil and some others. They act by increasing blood flow and work for all types of impotence. These medications are taken some time before sexual intercourse.

• Local negative pressure or vacuum therapy is used when the patient is unable or unwilling to take phosphodiesterase inhibitors. In this case, the penis is placed in a special container in which negative pressure is created using a pump. As a result, blood flows to the cavernous bodies of the penis; to maintain an erection, a ring is placed at the base of the penis. Older people use this method more often.

• Injections into the corpora cavernosa of the penis with drugs that dilate blood vessels (phentolamine, prostaglandin E1, papaverine). This type of treatment is not considered a priority and belongs to the second line of treatment for erectile dysfunction. The method has unpleasant side effects: priapism, erection that lasts too long, pain in the penis.

• Surgical treatment of erectile dysfunction. When all options have been exhausted, penile prosthetics is possible. For this purpose, semi-rigid prostheses or hydraulic implants are used that simulate an erection. Other types of operations (for example, slowing down venous outflow) are proposed, but their benefit today is questionable.

During treatment, it is necessary to maintain contact with your doctor so that he can monitor how the drugs are tolerated. In addition, the specialist may want to talk with the patient's sexual partner to better understand the nature of the disorders and the outcome of treatment.

Prevention of erectile dysfunction

Many causes of impotence are removable, and this is the basis for its effective prevention. Its main principles include:

• stopping smoking;

• regular physical exercise;

• maintaining normal body weight;

• if possible, eliminating medications that have a bad effect on potency (this is always requiredadvice from a doctor);

• refusal of large doses of alcohol;

• giving up drugs;

• control of blood pressure and cholesterol levels in the blood;

• avoid stress whenever possible;

• rational nutrition.

The same diet is suitable for prevention as for preventing heart disease. It should include enough vegetables and fruits, fish, vegetable oil, and whole grains. It is recommended to limit the intake of fatty, fried and processed foods.

Increasing physical activity reduces the likelihood of erectile dysfunction in middle-aged men by 70%.

For any illness, self-medication should not be allowed; you should always consult a doctor. Timely and competent treatment of diseases of the heart, genitourinary system, endocrine glands and others is also an important aspect of preventing erectile dysfunction. After treatment for erectile dysfunction, you must regularly visit an andrologist or urologist.

For questions, you can contact us by phone +998 55 055 10 03, +998 55 055 10 03 and at the address Tashkent, Uchtepa district, 12th quarter, st. M. Shaikhzoda.