Definition
Erectile dysfunction is defined as a persistent or recurring inability to get a penis that is sufficiently aroused for intercourse. The penis is unable to penetrate the vagina. Erectile dysfunction can occur at any age. On average, 50% of 40-70-year-old men have erectile dysfunction, with complete erectile dysfunction increasing with age. 50-80% of the disorders are of organic origin, 30% are attributed to purely psychogenic disorders and 20% of men are mixed, Levitra can be perfect for them to recover. Organic erectile dysfunction can be divided into vascular and nonvascular causes (cause related to the blood vessels).
Cause and diagnosis
Psychogenic causes mainly affect younger men. Psychogenic here means that the psyche is mainly the cause of erectile dysfunction. Psychogenic causes are diagnosed by examining the patient’s psychosexual behavior and thinking and by excluding organic disorders that affect body function. In the case of psychogenic erectile dysfunction, nocturnal penile swelling and morning erections persist, which can make it easier to distinguish between psychogenic and organic causes.
Organic causes are assigned to a vascular (affecting the blood vessels), neurogenic (affecting the nerves), iatrogenic (caused by the doctor), or traumatic development.
Vascular causes can affect the man’s arteries or veins. The penis has three cavernous bodies that are filled with blood during an erection. They are supplied with blood from the deep arteries of the penis and lead to an erection. The venous valves are responsible for keeping the blood in the erectile tissue. Causes of an arterial impotence disorder are lipid metabolism disorders, diabetes mellitus, hypertension, and nicotine abuse because these factors lead to vascular changes that are associated with circulatory disorders. The erectile function of the penis, which slowly declines over the years, is usually evident here.
In the case of venous or erectile tissue dysfunctions, a slow increase in erectile dysfunction with premature or complete loss of erection can also be observed. They are responsible for 70% of vascular erectile dysfunction. When the erectile tissue is disrupted, its muscles are converted into connective tissue and slowly perish. As a result, the muscles can no longer relax in order to allow the erectile tissue to be filled. The result is a weakened swelling of the penis.
In another disorder, cavernous-venous insufficiency, the muscle cells of the erectile tissue are also functionally impaired. The relaxation of the muscles required for the swelling and the occlusion system of the erectile tissue is disturbed and there is no proper erection. On the other hand, there are also real venous leaks, which are accompanied by an outflow of the blood required for an erection. This disorder occurs when the veins are not in the right place in the penis and mostly affects young men.
Neurogenic causes affect nerves that are responsible, among other things, for an erection. These causes include herniated discs, multiple sclerosis, surgery-related nerve lesions after operations in the pelvic area, accidents with nerve lesions, nerve disorders due to alcohol or diabetes mellitus. The polyneuropathies caused by diabetes mellitus often lead to erectile dysfunction. Endocrinological erectile dysfunction should always be clarified, especially in older men. The erection can be impaired by hypogonadism (underactive testicle), hypo- or hyperthyroidism (thyroid gland), or a prolactinoma (tumor of the anterior pituitary gland). The naturally falling level of testosterone from the age of 50 can also be a cause of erectile dysfunction. In addition to erectile dysfunction, a falling testosterone level can also lead to a loss of libido, depressed mood, listlessness, rapid fatigue, decreased performance, and hot flashes. Testosterone deficiency can be treated with testosterone substitution after prostate cancer has been ruled out, but this must be checked regularly.
Symptoms
As already mentioned, in erectile dysfunction the duration and strength of the erection are not sufficiently pronounced to allow sexual intercourse. In addition, there is no ejaculation during sexual intercourse. With masturbation, on the other hand, both are possible. Usually, there is no excitement because of private or professional worries. In addition, the lack of erection can impair pleasure.
Doctor and diagnosis
What is important is the sexual and medication history in which the patient is interviewed. In addition, it must be found out whether alcohol, drug or nicotine abuse is being pursued. Furthermore, the relevant hormones are determined, metabolic disorders are excluded (diabetes, vascular problems) and a neurological status is determined (function of the nerves). The nocturnal swelling of the penis is also measured (tumescence measurement), laboratory values (testosterone, blood sugar, FSH, LH, prolactin) are examined and Doppler sonography (ultrasound) is carried out to examine the penis and blood vessels.
Treatment
The basic building blocks of therapy are physical training, psychotherapeutic treatment, testosterone substitution, and treatment of the dysfunction of the nerves (neuropathy). In addition, erectile dysfunction can be counteracted with medication (….., tadalafil, vardenafil). Another form of therapy is cavernous body auto-injection therapy, in which substances are injected that promote the development of an erection. Furthermore, so-called vacuum pumps can be used to promote an erection or even have an operation carried out in which erectile tissue implants are inserted into the penis.