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Erectile dysfunction (impotence)
Erectile dysfunction (impotence) is defined as the inability to achieve and / or maintain satisfactory sexual activity adequate erection.Slight erectile dysfunction is indicated when the patient has difficulty maintaining an erection, disturbance is temporary and does not affect the sexual life. Moderate erectile dysfunction is indicated when the patient is difficult to achieve an erection, the disorder is a temporary disorder and affect the sexual life. Severe erectile dysfunction is indicated when an erection does not get at all, the disorder is permanent, and sexual activity is reduced by at least half.
Erectile dysfunction can be classified as the number of successful sexual intercourse attempts ten companies:
Mild disturbances when 7-8 sexual intercourse out of 10 to succeed
Moderate erectile dysfunction after 4-6 sexual intercourse out of 10 to succeed
Severe erectile dysfunction after 0-3 sexual intercourse out of 10 to be successful.
Erectile dysfunction can often be a number of different factors, such as vascular disease, medications, and psychological factors. Today, almost all erectile dysfunction can be treated with medication or requesting assistance worth prolonging.
Symptoms
A symptom of erectile dysfunction is weak or absent erections. Premature ejaculation, or ejaculation is not a symptom of impotence.
Cause
in the background of erectile dysfunction has many causes. Often, a single element or element group may be dominant. factors affecting the prevalence of organic erectile dysfunction most often associated with chronic diseases, surgery and trauma, medical treatment, excessive use of tobacco and alcohol. the most common cause of organic erectile dysfunction is impaired blood supply to the corpus cavernosum, and it occurs especially ateroskleroosi- and diabetes patients (see. Diabetes type I and type II diabetes). On average, 78% of the patients of erectile dysfunction caused by organic or nonorganic factors, either alone or in combination with psychogenic, that is, with psychological factors.
detection of the disease
A good medical history or medical history of the patient, which can be used for questionnaires (eg. IIEF-form to identify erectile dysfunction).
Examination of the patient's length, body weight, lowering body mass index (BMI), blood pressure, pulse, listening to the heart, body hair, beard growth, testicular size and consistency (firmness), palpation of the prostate (TPR).
Laboratory tests: The following tests may be helpful: CRP, pvk, blood sugar, cholesterol, testosterone (or free testosterone), prolactin and LH (pituitary hormone tests), free T4 (or TSH, thyroid), prostate-specific antigen (S-PSA, more than 50- years of age).
If necessary, can be made by ICI test (intrakavernoottinen injection): alprostadil is injected into the corpus cavernosum and 10-20 ug of penis swelling and hardening monitored for 15 minutes; at the same time you can listen to Doppler arteries, to calculate the PBI (penile-brachial index = index of blood flow).
If necessary, can be made of duplex Doppler ultrasound study analyzing the blood flow to the penis.
If necessary, a infuusiokavernosonometria and -grafia, if it is suspected penile venous circulatory system.
If necessary, a pudendalisangiografia for the study of the penile arteries for a possible revaskularisaatioleikkausta.
If necessary, a neurophysiological studies of clinical neurology research unit, if you want to further explore the neural regulation of the penis.
Care
Erectile dysfunction in the primary treatment is medication. The most effective drugs for erectile dysfunction are the so-called. enzyme phosphodiesterase 5 inhibitors (PDE5), which are sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), and most recently entered the market in 2013 avanafiili (Spedra). The medicine is taken only when needed. They have no effect in the absence of sexual stimulation. Alternatives to Viagra are Kamagra and Kamagra UK. Tadalafil based alternative is Tadalis SX or Vidalista.
A relatively new form of therapy is also a once-daily, low-dose tadalafil (Cialis) containing tablets. Use of the product is subject to a previous positive experience of tadalafil and regular sexual activity. Daily dosing of achieving a stable condition, whereby the effect of the drug is the hour.
Nitrates (. Mm short- and long-acting nitro), patients who can not use PDE5 blocking drugs, because the interaction of these drugs blood pressure drops dramatically and even may lead to loss of consciousness. Nitro frequent users should select a treatment other than blocking the PDE5 enzyme.
In addition to drug therapy should keep in mind the potential lifestyle changes and good treatment of the basic disease. Erectile dysfunction is treatable in most patients. The patient and her partner plays a key role in making the treatment solution. The importance of sexuality activity, as well as the benefits and drawbacks of treatment vary greatly from person to person.
Erectile dysfunction treatment options
1. Changes in lifestyle
smoking cessation
no heavy drinking (tea Audit test, pdf-file)
obesity treatment (see. Slimming-patient instruction)
lowering cholesterol
an open discussion with your partner
Maintaining spiritual balance
2. Sexual therapy and psychiatric care
settlement of problematic situations
misunderstandings straightening
somatic (bodily) crisis-related diseases treatment
Treatment of depression, or depression
the family of a struggle for power detection and termination
3. Phosphodiesterase type 5 (PDE5) enzyme inhibitor drugs
sildenafil (Viagra)
tadalafil (Cialis)
Vardenafil (Levitra)
avanafiili (Spedra)
4. Other possibilities for the treatment of erectile dysfunction
Vacuum pump: a cylinder placed around the penis and vacuumed and the rubber band is slipped around the base of the penis; achieve an erection-like state, or swelling of the penis but not fully hard erection; the device can hold time of 30 min.; the unit is very mechanical, but safe.
Alprostadil: a drug which is either injected into the corpus cavernosum of the penis (CaverjectDual) or placed in a sort of a pipette into the urethra (Muse).
Vascular (arterial and laskimokirurgia): surgery as a treatment for erectile dysfunction have decreased due to good medicines; surgery can be done in less than 50 years of age, with primary erectile weakness, and it is because of circulatory disorder or the patient has had a pelvic injury, and then come to erectile dysfunction.
Prosthetic surgery: the inside of the penis is placed in silicone-implants; satisfaction with treatment is a form of high
Gene therapy: experimental stage; vectors used, for example. adenovirus plasmid and naked DNA; transferred mm. eNOS, nNOS and Maxi-K; any form of treatment for the future.
Tracking
Erectile dysfunction does not require monitoring. However, erectile dysfunction can be as high as the first symptom of incipient coronary heart disease, so the subject holistic medical revision might be there.
heritability
Erectile dysfunction causes are so varied, that the inheritance is difficult to say anything more precise.
Prevalence
Men's aging study has found 35% of 40 - 70-year-olds suffer from some degree of erectile dysfunction of men. Erectile dysfunction (mild, moderate and severe), the overall incidence in the men's 40 age group, approx. 39%, in the age group of 50 years of age approx. 48%, in the age group of 60 years of age approx. 57% to 70 age group, approx. 67%.
Prognosis
Failure to take care of erectile dysfunction does not cause any permanent physical health problems. Instead, it can be a great emotional burden for both him and his partner.
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