Impotence can be a complete inability to achieve erection, inconsistency or her ability to sustain only brief erections. These variations make it difficult to define the evaluation of impotence and its frequency. Cause it is usually physical, for example. result of disease, injury or side effects of medications. Any disorder that affects the normal circulation of blood in the penis, is a potential cause of impotence. Its incidence increases with age: about 5% of men aged 40 years and between 15-25% at the age of 65 years is facing this problem. Nevertheless, impotence is not inevitable consequence of aging. Impotence may be primary or secondary. In primary impotence successful sexual intercourse is not possible, while in other situations, possible a normal erection. This rare condition is treatable difficult. Secondary Impotence is treatable at any age and an increasing number of people becoming aware of that fact. More and more men seek help and thanks to perfected and successful treatment of impotence, becomes capable of normal sex life. Except in cases of impotence caused by injury or sudden illness, secondary impotence usually occurs gradually. Only aging does not cause impotence.
Male infertility is something quite different from impotence. A man who can not maintain an erection, it is otherwise perfectly normal and to be capable of fertilization. Premature ejaculation when orgasm comes too quickly to satisfy some of the partners, is different from impotence. Partners with this problem may seek the advice of a healthcare professional.
To achieve an erection may take a few prerequisites:
appropriate emotional state of mind
normal pituitary function
appropriate levels of testosterone
intact brain and nervous system
supply adequate amounts of blood in the penis
Impotence is the constant inability to maintain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to distinguish it from other problems that prevent sexual intercourse, for example. decrease in sexual desire and problems with ejaculation and orgasm.
Description of disease
How does an erection?
The penis is composed of two porous bodies, so called. corpora cavernosa, which are provided along the entire body. These bodies are filled with spongy tissue. Corpora cavernosa is wrapped membrane, so called. tunica albuginea. Spongy tissue contains smooth muscles, fibrous tissues, cavities, veins and arteries. The urethra is the channel for the flow of urine and ejaculate, runs to the lower side of the corpora cavernosa.
Erection stimulates sensory and mental stimulation. Impulses from the brain and local nerves the muscles of the corpora cavernosa to relax, allowing blood flow and fill the empty cavity. Raises blood pressure in the corpora cavernosa, thereby increasing the penis. Tunica albuginea allows the retention of blood in the corpora cavernosa, which retains the erection. Erection ends when the muscles of the penis contraction (tightening), which stops the blood flow and opens the output channels.
What causes impotence?
Over the past decades, expert opinion on the causes of impotence has changed. The general attitude was that most of the causes of psychological nature. Today, researchers estimate that 70-80% of cases the medical cause: atherosclerosis in the first place, followed by complications of diabetes, prostatectomy (surgical removal of the prostate), and medications. Many experts believe that negative emotional states that occur as a side effect of this condition, the more likely a reaction to the experience of impotence rather than its cause. Psychological problems are more common cause of erectile dysfunction in younger patients, whereas in older men usually physical problems. Because so many physical and psychological conditions can lead to erectile dysfunction, men should be considered only short periods of impotence normal phenomenon like the common cold. (Actually, even the flu can cause temporary impotence!) A common cause of impotence is the lack of oxygen that can occur in many situations in which blood flow to the penis is insufficient. Erectile dysfunction can cause damage to nerves in the penis or pelvic and insufficient levels of hormones.
Since an erection requires a number of preconditions, impotence may occur due to disturbance of any of them. A number of prerequisites includes nerve impulses in the brain, spinal cord, the area of the penis and response in muscles, fibrous tissues, veins and arteries in and around the corpora cavernosa.
Damage to arteries, smooth muscles and fibrous tissues, often as a result of disease, a common cause of impotence. During the surgical procedure (eg, prostate) can lead to injuries of nerves and arteries near the penis, resulting in impotence. Violation of the penis, spinal cord, prostate, bladder and pelvis can cause impotence, if there is damage to nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
Impotence is a side effect of many drugs: antihypertensives, antidepressants, tranquillizers (sedatives), medicines to reduce appetite and cimetidine (antiulcer agent).
Other potential causes are smoking, which affects the circulation of blood in the veins and arteries, and hormonal disorders, for example. lack of testosterone.
Men with chronic diseases - including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis and cardiovascular disease (70%). Between 35% and 50% of men with diabetes suffer from impotence.
Men who had surgery (eg, prostate), and when he came to the injury of nerves and arteries near the penis, can suffer from impotence.
Men who have had injury to the penis, spinal cord, prostate, bladder and pelvis can be impotent due to injuries of nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
Men who take antihypertensives, antihistamines, antidepressants, tranquillizers, medicines to reduce appetite and cimetidine, can be as adverse drug events have impotence.
The characteristic symptom of impotence is a change in the quality of erections, whether in the hardness of the penis, the ability to maintain erection, or both. One of the indicators of physical impotence, as opposed to psychological, is the inability to experience or maintain an erection after the morning awakening. Psychological impotence occurs suddenly as a reaction to recent events. Physical impotence develops gradually, but steadily, over a period of time. A man who has impotence of psychological origin, in some cases can have an erection, while others do not. In the case of impotence, which lasts longer than three months and that can not be correlated with some obvious stressful event, drug, alcohol or health conditions, intervention is required urologist who deals with problems of impotence.
Medical history and personal data
In determining its causes impotence and apply several diagnostic tests. First of all, open discussion in which the patient requires honesty, facilitating diagnosis. In addition to data on past and current health problems, the patient is seeking information on previous and current treatment and medication and psychological problems he has had, including stress, anxiety or depression. Search and history of sexual life, which includes the nature of early dysfunction, its frequency, quality, duration of erection and time of its occurrence (morning / night). If you want to help, the patient should not be considered unnecessary Ťkopanjemť these questions in his intimate life, or take them too personally. It is very important in choosing the right approach to the problem. If necessary, the doctor will interview you and a partner.
Then the doctor performs a thorough physical examination of the genital area and digitorectal review (review of last bowel finger) to determine possible changes in the prostate. Performed and the results speak in favor of other medical conditions, especially high blood pressure, diabetes, atherosclerosis, and nerve damage.
Investigation of erectile function
To test the reaction of erectile doctors usually recommend a trial of sildenafil, which is often a substitute for invasive and costly and prostaglandin E1 papaverin injections or medicines to dilate the blood vessels of the penis.Ten to fifteen minutes after the injection, in patients with normal circulation of blood in the penis and an erection occurs. Then it examines the erectile response, curvature of the penis, and response after erection.
Blood tests are used to measure testosterone levels and, where appropriate, prolactin. This defines the possible disturbances of the endocrine system. Other reviews, as appropriate: the control function of the thyroid and adrenal glands and specific tests of erectile dysfunction.
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Monitoring of nocturnal erections
Snap-Gauge test used to monitor the ability to achieve erections during sleep. The test is very simple. At bedtime, a man tied ribbon around the root of the penis. Shooting one or more of them during the night proves the existence of an erection. In this case the possible psychological basis of erectile dysfunction.
More sophisticated device is the RigiScan monitor, which measures the stiffness of consecutive root and tip of the penis. This test is fairly accurate, but usually not helpful in the detection of mild cases of erectile dysfunction. In the absence of nocturnal erections, in determining its physical cause is not helping any one of these methods.
Penile brachial index
Penile brachial index is a measure to compare the blood pressure of the penis with blood pressure measured in the arm. This method can determine the problem with inflow of arterial blood into the penis.
Kavernosometrijska kavernosografijska and dynamic infusion (DICC) is a four-fold test that is usually applied only to young men suspected of blocking the penis physical injury or pelvic area. After preparation of causing erections, determined brachial index of the penis, measured its capacity, carried ultrasound examination of the arteries of the penis and X-ray of an erect penis. Unfortunately this test and other similar imaging techniques applied to determine blood flow in the penis are still not sufficiently efficient and accurate for diagnosis or choice of treatment. Ultrasound diagnosis could be useful in some cases, erectile dysfunction, for example. permeability of blood vessels.
The implementation of these tests and analysis of data obtained, it should be left to a specialized institution that has experienced professionals in the treatment of impotence.
According to data obtained from surveys conducted in Europe, less than 20% of men in case of problems with impotence sought professional help, even if using oral preparations could cure. The specific problem that causes impotence dictates the mode of treatment. The first step is to define the cause, if possible, and then finding the simplest and least risky solution. Sildenafil is the hope for many men. For those who can not or decided not to take medication, there are other methods: products that are placed or injected into the penis, vacuum devices or intracavernous injection therapy can be lifesaving to a wide range of erectile problems. Invasive procedures, eg.implants or surgical procedures, should be limited to patients where other therapy has not helped and who are thoroughly screened (selected).
Priapism is an erection lasting for more than four hours, in the absence of any sexual stimulation.
If prijapizma recommended going to the emergency urological clinic. If the patient uses injection for local use and the erection lasts longer than 2 or 3 hours, it is recommended dekongestant pseudoephedrine which is commercially available, and in many cases alleviates potential priapism. A high percentage of suspicion, a detailed history and thorough professional treatment are essential for successful treatment prijapizma.
Maintenance of general health
Given that in many cases impotence is caused by reduced blood flow from blocked arteries, it is important to maintain the same lifestyle that they have the high risk group of heart patients. These habits include a diet rich in fresh fruits and vegetables, whole grains and fiber and low in saturated fat and sodium. Alcohol consumption should be moderate. It is extremely important regular exercise, and it is very important to stop smoking.
Can prevent permanent impotence sexual activity. Frequent erections stimulate blood flow to the penis. It is important to note that erections are the strongest in a dream just before waking. Autumn is the season when the highest levels of male hormones, and sexual activity frequently.
Kegel exercise is a simple exercise commonly practiced by men with urinary incontinence and pregnant women. It can help in cases where erectile dysfunction is a result of impaired blood circulation. The basic technique consists of contraction and relaxation of muscles controlling the pelvic urine. As the muscle inside and sometimes it is difficult to isolate, doctors often recommend practicing it during urination. It is recommended to tighten the muscle until the flow of urine can be slowed down or stopped, and then release it again. It is necessary to make the 5-15 contractions, each lasting 10 seconds. The exercise is carried out 3-5 times a day.
Changing the drug or drug dose that causes impotence
If the problem is caused by some medication, it is necessary that the patient s doctor to consider his alternatives or dose reduction. In the treatment of high blood pressure, the less likely it will for example. ACE inhibitors, unlike many other products, can cause sexual dysfunction.
Psychotherapy and behavioral therapy
Often, impotence, regardless of etiology, treated with some form of psychological, behavioral, sexual, or combined therapy. In such cases it is good to include partners, regardless of whether the treatment of sexual therapy or not. The therapy can facilitate the adaptation period after the start or the end of treatment.