Impotence

Erectile dysfunction
Classification and external resources
10 48.4
9 302.72, 607.84
DiseasesDB 21555
eMedicine med/3023
MeSH D007172

Erectile dysfunction (ED) is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance.[1]

A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. There are various circulatory causes, including alteration of the voltage-gated potassium channel, as in arsenic poisoning from drinking water.[2] The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological impotence is where erection or penetration fails due to response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor drugs (the first of which was sildenafil or Viagra). In some cases, treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery.[3]

The Latin term impotentia coeundi describes simple inability to insert the penis into the urology.

Contents

Signs and symptoms

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. It is analyzed in several ways:

  • Obtaining full erections at some times, such as when asleep (when the mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working.
  • Other factors leading to erectile dysfunction are neuropathy).

Causes

  • Drugs (anti-depressants (nicotine are most common)
  • Neurogenic disordersdead link]
  • Cavernosal disorders (Peyronie’s disease[5])
  • Psychological causes: not in citation given]
  • Surgery[8]
  • Aging. It is four times higher in men in their 60s than in men in their 40s.[9]
  • Kidney failure
  • Diseases such as diabetes and multiple sclerosis (MS). While these two causes have not been proven they’re likely suspects as they cause issues with both the blood flow and nervous systems.
  • Lifestyle: smoking is a key cause of erectile dysfunction.Tobacco and health.

A few causes of impotence may be iatrogenic (medically caused).

Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for prostate cancer.

ED can also be associated with bicycling due to both neurological and vascular problems due to compression.[14]

A recent study suggests an [17] In all the three conditions (erectile dysfunction, coronary heart disease and cerebrovascular diseases), despite the epidemiological association with periodontitis, no causative connection has proved yet.

February 2011: Men who use non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3 months are at a 22 percent increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed for different age, race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary diasease and other health problems. But due to benefit of NSAID, it’s too early for men to avoid NSAIDs based solely on the research stated at Journal of Urology.[18]

Pathophysiology

Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the prolonged exposure to bright light.

Diagnosis

There are no formal tests to diagnose erectile dysfunction. Some peripheral vascular disease.

A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Duplex ultrasound
blood pressure.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic infusion cavernosometry (DICC)
technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Corpus cavernosometry
[19] Digital Subtraction Angiography: In DSA, the images are acquired digitally.
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a “contrast agent” into the patient’s bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

Treatment

Treatment depends on the cause.

Exercise, particularly aerobic exercise is an effective treatment for erectile dysfunction.[20][better source needed]

When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other priapism.

All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.

Medication

Phosphodiesterase type 5 inhibitors

The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.

One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[21] They work by blocking the action of PDE5, which causes cGMP to degrade.

Alprostadil

Alprostadil in combination with the permeation enhancer DDAIP has been approved in Canada under the brand name Vitaros as a topical cream first line treatment for erectile dysfunction.[22]

Another treatment regimen is injection therapy. One of the following drugs is injected into the penis: papaverine, phentolamine, and prostaglandin E1.[23]

Surgery

Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[24][unreliable source?]

Devices

The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor’s prescription.

Alternative medicine

The FDA does not recommend alternative therapies to treat sexual function.[31]

History

An unhappy wife is complaining to the Ottoman miniature.

During the late 16th and 17th centuries in France, male impotence was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677.[32]

Dr. Serge Voronoff.

Modern drug therapy for ED made a significant advance in 1983, when British physiologist better source needed]

Research

Gene therapy

[38]

Tx2-6

A study done at the Medical College of Georgia has found that venom from the Brazilian wandering spider contains a toxin, called Tx2-6, that causes erections. Scientists believe that combining this toxin with existing medication such as Viagra may lead to an effective treatment for erectile dysfunction.[39]

References

  1. ^ Erectile dysfunction glossary – MUSC Health
  2. 18414639.
  3. 15947645.
  4. ^ “Erectile Dysfunction causes”. Erection Problems (Erectile Dysfunction). Healthwise. 2006. http://health.msn.com/centers/mensexualhealth/articlepage.aspx?cp-documentid=100062424. Retrieved 2007-10-07.
  5. ^ “Male Sexual Dysfunction Epidemiology”. Erectile dysfunction. Armenian Health Network, Health.am. 2006. http://www.health.am/sex/more/male_sexual_dysfunction_epid/. Retrieved 2007-10-07.
  6. ^ Tom F. Lue, MD (2006). “Causes of Erectile Dysfunction”. Erectile dysfunction. Armenian Health Network, Health.am. http://www.health.am/sex/more/causes_of_erectile_dysfunction/. Retrieved 2007-10-07.
  7. ^ “Erectile dysfunction”. Erectile dysfunction. Mayo Clinic. 2006. http://www.mayoclinic.com/health/erectile-dysfunction/DS00162/DSECTION=3. Retrieved 2007-10-07.
  8. ^ “Erectile Dysfunction Causes”. Erectile Dysfunction. Healthcommunities.com. 1998. http://www.urologychannel.com/erectiledysfunction/causes.shtml. Retrieved 2007-10-07.
  9. ^ “Erectile Dysfunction”. http://www.medicinenet.com/impotence/symptoms.htm. Retrieved 2010-07-01.
  10. 15924009.
  11. 15146084.
  12. 15753970.
  13. 20102446.
  14. 16422816.
  15. 19170861.
  16. http://www.ajconline.org/article/S0002-9149(09)01025-X/abstract.
  17. 15455730.
  18. ^ “Most Popular E-mail Newsletter”. USA Today. http://yourlife.usatoday.com/health/story/2011/03/New-study-links-pain-relievers-to-erectile-dysfunction/44363996/1?csp=34news&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+usatoday-NewsTopStories+%28News+-+Top+Stories%29.
  19. http://www.bmj.com/cgi/content/full/312/7035/902.
  20. ^ Sexual Function in Men Older Than 50 Years of Age, annals.org, August 5, 2003
  21. ^ John P. Mulhall, M.D., Saving Your Sex Life: A Guide for Men with Prostate Cancer, Chicago, Hilton Publishing Company, 2008
  22. ^ Bujdos, Brian. “New Topical Erectile Dysfunction Drug Vitaros Approved in Canada; Approved Topical Drug Testim Proves Helpful for Erectile Dysfunction”. http://www.accessrx.com/blog/current-health-news/vitaros-testim-topical-drugs-treat-erectile-dysfunction-a1115. Retrieved 15 April 2011.
  23. ^ American vein and aesthetic institute, “Intra-Corporeal Injections For Erectile Dysfunction” http://www.medrehab.com/ICI_Impotence.php
  24. ^ Penile prostheses (implants) Chris Steidle, MD, SeekWellness.com
  25. ^ “Dangers of Sexual Enhancement Supplements”. http://www.medscape.com/viewarticle/562177.
  26. 19150190.
  27. 18567304.
  28. 17532168.
  29. 17207601.
  30. ^ Enforcement Report for June 30, 2010, United States Food and Drug Administration
  31. ^ Hidden Risks of Erectile Dysfunction “Treatments” Sold Online, United States Food and Drug Administration, February 21, 2009
  32. 9780393334791.
  33. 16225508.
  34. 6626852.
  35. 8831873.
  36. ^ Emma Hitt (May 29, 2009). “Gene Therapy May Offer Long-Term Impotence Remedy”. Reuters Health. http://www.erecthard.com/gene_therapy_for_impotence.php.
  37. http://www.spiritindia.com/health-care-news-articles-4359.html.
  38. ^ “Smooth-Muscle–Specific Gene Transfer with the Human Maxi-K Channel Improves Erectile Function and Enhances Sexual Behavior in Atherosclerotic Cynomolgus Monkeys”. European Urology 56 (6): 891–1104. December 2009. http://www.europeanurology.com/article/S0302-2838%2808%2901491-7/abstract.
  39. ^ Hernandez, Vladimir (4 May 2007). “Spider venom could boost sex life”. BBC News. http://news.bbc.co.uk/1/hi/world/americas/6625397.stm.

External links



Source: Wikipedia

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