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Erectile Dysfunction: Causes and Therapy
"Erectile dysfunction is defined as inability to maintain an erection enough for sexual intercourse. This is a disorder that affects thousands and thousands of males world wide in different ways and with various causes."
What is it?
Erectile dysfunction is a medical term used to define the inability to get an erection with adequate 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 happen even with want and orgasm (ejaculation) present.
Erectile dysfunction (ED) impacts about thirds of men over 50 years of age, representing 10 to twenty million Brazilians.
Most males, at some point of their lives, have skilled episodes of erectile dysfunction, usually attributable to tiredness, stress or alcohol abuse. Occasional failures shouldn't be overrated. Nevertheless, if the problem persists, a urologist ought to be sought.
The capacity of erection is just one in every of a number of elements of male sexual function. The sexual response cycle has 4 stages of man predominant desire, erection, orgasm and relaxation. Each can change different.
The causes of ED are divided into natural, psychogenic and combined, might be found with combined factors. Organic problems comparable to diabetes, cancer, arteriosclerosis and neurological accidents can typically lead to psychological complications, for example. It may also be secondary, and seem as the primary manifestation of various disorders reminiscent of hypertension, diabetes, cardiovascular illness and renal failure.
ED of psychological origin may be manifested in numerous ways, or delayed ejaculation, painful ejaculation and even impotence. There may additionally be lack of libido (sexual want), lack of orgasm and phobias (fears) sex, all for nervousness, depression or guilt. An individual who has an unpleasant expertise, such as loss of erection to have intercourse or ejaculate very early, tends to the next relationship, keep in mind these "failures" and turn out to be anxious. This provides a new fault, making a vicious circle.
Natural causes are subdivided in line with the etiology. The vasculogênicas are more prevalent, particularly the flow changes, arteriosclerosis and trauma (resulting in injury to blood vessels).Venous flow irregularities are less common. The neurogenic causes are diabetic neuropathy, multiple sclerosis, alcohol abuse, trauma, spinal wire and nerve damage by radical prostatectomy (surgery to remove the prostate). Because the causes are hormonal hipoandrogenismo primary or secondary (problems of male hormones).
The ED might also occur, to be used and abuse of medication like marijuana, alcohol, heroin, cocaine, barbiturates, antidepressants.
The DE has a number of risk factors as advanced age, diabetes, hypertension, peripheral vascular ailments; neurological diseases, endocrine disorders, spinal twine injuries, radical pelvic surgical procedure, radiation remedy, alcoholism, smoking, marijuana use and / or cocaine; use of antihypertensives, tranquilizers and psychotropic substances; relationship problems with partner, stress, anxiousness and worry of failure, depression, obsessive-compulsive personality, sexual deviation.
The objectives of the initial evaluation of the affected person are to determine the probable cause of ED and identify organic or psychological factors that will affect the related therapeutic.
A detailed medical interview is a very powerful factor in evaluating patients with this problem. The history should identify the period, progression and severity of ED and related factors.
Upon getting identified a problem in the patient's sexual performance, the next step is to differentiate it from other sexual problems equivalent to lack of libido and ejaculatory disorders.
Physical examination is to assess the affected person's health, with particular attention to the cardiovascular, neurological and genitourinary, because of its contribution to the erection. The neurological analysis should embrace a perception of their patient's anxiousness or depression. Because the evaluation of genital herpes is directed to detection of local irregularities.
Some are basic laboratory tests to establish issues that may end up in ED.
In cases of psychogenic DE, psychotherapy is indicated. A number of factors must be evaluated by the urologist and if potential, by an knowledgeable in psychology or psychiatry. Factors reminiscent of physical, psychiatric, psychological, conflicted relationship with the partner and sexual inadequacy needs to be addressed to the couple.
Penile injections have been the primary efficient and goal, with little or no side effects, with significant improvement of erection, even in extreme OF and organic. They have been the principle complication, painful erections. Also had the disadvantage of limiting the time limitation of erections and frequency of application (three instances per week). This technique tends to be deserted with the advancement of technology.
With the advance of treatment, some oral medications are available within the market. They are:
- Viagra (Sildenafil) of Pfizer: acts on the penis by enjoyable muscle groups and growing blood flow to the region. Efficient in cases of partial impotence, erection of providing 40 to 60 minutes after ingestion of the medicine, with stimulation of the penis. Its effect can last up to six horas.Tem side reactions equivalent to headaches, nasal congestion, facial flushing and dyspepsia. Heart patients, particularly in drug remedy of nitrate (Sustrate, Monocordil, Isordil, Nitradisc, Nitroderm TTS, Isocord, Isosorbide, nitroglycerin) cannot take this medicine.
- Uprima (apomorphine), from Abbott Laboratories, acts on the central nervous system, facilitating 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, however can be utilized by heart patients.
- Cialis (Tadalafil), manufactured by Eli Lilly, acts directly on the penis by inhibiting the enzyme phosphodiesterase. Leads to an erection in half-hour, and sustained for as much as 36 hours. Can cause headache, gastric intolerance, nasal congestion, back pain, muscle pain, dizziness and flushing. As Viagra, cannot be used for coronary heart illness in the usage 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, cannot be used for coronary heart disease in using nitrates. One of many primary advantages is essentially the most affordable value and being sold in single packs.
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