Erectile Dysfunction: Causes and Treatment
“Erectile dysfunction is defined as inability to continue an erection sufficient for sexual intercourse. This is a disorder that affects millions of men around the world in different ways and with varying causes.”
What is it?
Erectile dysfunction is a medical term used to define the inability to get an erection with sufficient rigidity for penetration and / or keep it for a period of time adequate to the satisfaction of both partners during sex. It is important to understand that it can occur already with desire and orgasm (ejaculation) present.
Erectile dysfunction (ED) affects about two thirds of men over 50 years of age, representing 10 to 20 million Brazilians.
Most men, at some point in their lives, have experienced episodes of erectile dysfunction, usually due to tiredness, stress or alcohol abuse. Occasional failures should not be overrated. However, if the problem persists, a urologist should be sought.
The capacity of erection is just one of several aspects of male sexual function. The sexual response cycle has four stages of man main desire, erection, orgasm and relaxation. Each can change different.
The causes of ED are divided into organic, psychogenic and mixed, can be found with combined factors. Organic problems such as diabetes, cancer, arteriosclerosis and neurological injuries can often rule to psychological complications, for example. 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 be manifested in various ways, or delayed ejaculation, painful ejaculation and already impotence. There may also be loss of libido (sexual desire), without of orgasm and phobias (fears) sex, all for anxiety, depression or guilt. An individual who has an unpleasant experience, such as loss of erection to have sex or ejaculate very early, tends to the next relationship, remember these “failures” and become eager. This provides a new fault, creating a vicious course of action.
Organic causes are subdivided according to the etiology. The vasculogênicas are more common, particularly the flow changes, arteriosclerosis and trauma (resulting in injury to blood vessels).Venous flow abnormalities are less shared. The neurogenic causes are diabetic neuropathy, multiple sclerosis, alcohol abuse, trauma, spinal cord and nerve damage by drastic prostatectomy (surgery to remove the prostate). Since the causes are hormonal hipoandrogenismo dominant or secondary (disorders of male hormones).
The ED may also occur, for use and abuse of drugs like marijuana, alcohol, heroin, cocaine, barbiturates, antidepressants.
The DE has several risk factors as progressive age, diabetes, hypertension, peripheral vascular diseases; neurological diseases, endocrine disorders, spinal cord injuries, drastic pelvic surgery, radiation therapy, alcoholism, smoking, marijuana use 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 deviation.
The objectives of the initial evaluation of the patient are to determine the probable cause of ED and clarify organic or psychological factors that may influence the associated therapeutic.
A detailed medical interview is the most important factor in evaluating patients with this problem. The history should clarify the duration, progression and severity of ED and associated factors.
Once you have identified a problem in the patient’s sexual performance, the next step is to differentiate it from other sexual problems such as loss of libido and ejaculatory disorders.
Physical examination is to estimate the patient’s health, with particular attention to the cardiovascular, neurological and genitourinary, due to its contribution to the erection. The neurological evaluation should include a perception of their patient’s anxiety or depression. Since the assessment of genital herpes is directed to detection of local abnormalities.
Some are basic laboratory tests to clarify disorders that can consequence in ED.
In situations of psychogenic DE, psychotherapy is indicated. Several factors should be evaluated by the urologist and if possible, by an expert in psychology or psychiatry. Factors such as physical, psychiatric, psychological, conflicted relationship with the partner and sexual inadequacy should be addressed to the associate.
Penile injections have been the first efficient and objective, with little or no side effects, with meaningful improvement of erection, already in harsh OF and organic. They were the main complication, painful erections. Also had the disadvantage of limiting the time limitation of erections and frequency of application (3 times per week). This method tends to be abandoned with the advancement of technology.
With the improvement of treatment, some oral medications are obtainable in the market. They are:
– Viagra (Sildenafil) of Pfizer: acts on the penis by relaxing muscles and increasing blood flow to the vicinity. Effective in situations of uncompletely impotence, erection of providing 40 to 60 minutes after ingestion of the medication, with stimulation of the penis. Its effect can last up to six horas.Tem side responses such as headaches, nasal congestion, facial flushing and dyspepsia. Heart patients, especially in drug treatment of nitrate (Sustrate, Monocordil, Isordil, Nitradisc, Nitroderm TTS, Isocord, Isosorbide, nitroglycerin) can not take this medicine.
– Uprima (apomorphine), from Abbott Laboratories, acts on the central nervous system, easing the conduct of sexual stimulation of the brain to the penis. Generates erection 10-20 minutes after oral administration sublingually. May cause headache, nausea, dizziness, fainting and flushing, but can be used by heart patients.
– Cialis (Tadalafil), manufactured by Eli Lilly, acts directly on the penis by inhibiting the enzyme phosphodiesterase. Leads to an erection in 30 minutes, and consistent for up to 36 hours. Can cause headache, gastric intolerance, nasal congestion, back pain, muscle pain, dizziness and flushing. As Viagra, can not be used for heart disease in the use of nitrates.
– Levitra (Vardenafil) of Bayer and Glaxo, also acts directly and selectively on the penis by inhibiting the enzyme phosphodiesterase, with fewer side effects (headache, flushing and runny nose). Leads to an erection in 15 minutes, and keeps up to 8 hours. As Viagra and Cialis, can not be used for heart disease in the use of nitrates. One of the main advantages is the most affordable price and being sold in single packs.
Although drug treatments mentioned, some patients may not fit and require treatment with mechanical devices such as vacuum erection devices or penile implants inflatable or malleable. Others may need surgery to repair vascular arteries that supply the penis with blood, in specific situations.
Because erectile dysfunction can have many causes, there are several treatments that act by different mechanisms, with specific contraindications, a urologist should be consulted.