Erectile dysfunction – male inability to achieve or maintain erection sufficient for sexual intercourse. At the same time, erectile dysfunction is condition in which these problems exist for at least three months. From the term: “impotence” – recently began to be abandoned, since this diagnosis implies extreme degree of sexual function violation, and impossibility to achieve success of conservative treatment.
Erectile Dysfunction Causes
Considering causes and mechanisms of development, ED is divided into several types:
psychogenic erectile dysfunction – at the base: defatigation, depression, various phobias and deviations, associative psychotraumatic factors. As a result of these factors, cortex causes a number of negative effects on normal erection mechanism:
- direct inhibitory effect;
- inhibitory action, mediated through spinal centers, responsible for erection mechanism;
- increased adrenaline and norepinephrine level.
- arteriogenic erectile dysfunction occurs because of vascular lesions: atherosclerosis, penile trauma, penile congenital abnormalities, smoking, diabetes, hypertension. Often, with this form, in addition to erection deterioration, there are dystrophic changes in cavernous tissue, caused by insufficient blood supply. In this case, vicious circle is formed, and in absence of timely treatment, irreversible changes in cavernous bodies take place.
venogenic erectile dysfunction develops due to violation of veno-occlusal mechanism:
- ectopic drainage (pathological blood shunt): through large subcutaneous veins, dorsal veins, through enlarged cavernous or leg veins;
- cavernous-spongy shunt (blood shunt from cavernous bodies into spongy bodies);
- insufficiency of gall bladder (traumatic rupture, Peyronie’s disease, primary or secondary thinning);
- functional deficiency of cavernous erectile tissue (lack of nephrotransmiters, psychogenic inhibition, smoking, ultrastructural changes).
- cavernous tissue dysfunction (cavernous insufficiency). The causes of cavernous insufficiency are different. They lead to intra- and extracellular changes in cavernous bodies, their vessels and nerve endings, which interfere with the normal functioning of erection mechanism.
- neurogenic erectile dysfunction occurs due to various injuries and brain and spinal cord diseases, as well as in defeat of small pelvis peripheral nerves (for example, after open surgery for adenoma or prostate cancer).
- anatomical ED causes is associated with violation of penile anatomy. This is primarily a pronounced penile curvature (Peyronie’s disease, fibrous penile cavernous bodies, congenital curvature). Fibrosis of cavernous bodies is often associated with injuries, introduction of foreign bodies into urethra, surgical interventions, etc. ED treatment of anatomical genesis often requires surgical intervention. And, as experience has shown, often in such cases, optimal choice is falloprosthetics.
- hormonal erectile dysfunction. The enzyme responsible for nitric oxide synthesis (which, in turn, causes vasodilation) is androgen-dependent, that is, when male sex hormone level (testosterone) decreases, activity of this enzyme decreases and, accordingly, erection worsens. That is why, in case of hormonal erectile dysfunction, treatment with drugs inhibiting phosphodiesterase type 5 (Viagra, Cialis, Levitra) is not effective. It is also known that a decrease in concentration of testosterone leads to increased deposition of fat cells in cavernous bodies, dystrophy of smooth muscle cells, which ultimately leads to veno-occlusal mechanism violation.
- age – related erectile dysfunction. Age, in itself, has effect on erection usefulness and duration. In elderly people, blood flow rate, testosterone level, nervous system sensitivity and vascular walls elasticity decrease, which accordingly affects erection. However, it is necessary to distinguish natural age-related decrease in erectile function, from impotence caused by somatic diseases, probability of which increases significantly with age. It is known that people who do not suffer from various chronic diseases live a full sexual life (taking into account age norms) in 80 years.