Erektilny dysfunction - the reasonsErektilny dysfunction (ED) - disorder of the sexual function which main manifestations are constant inability of men to reach increase in volume of a penis and also to support a penis erection for a while, sufficient for commission of sufficient duration of sexual intercourse in full. The term "impotence" applied earlier in the last decade in the international literature is not applied, as out-of-date, inexact and having unreasonably osuditelny implication.

Prevalence of this frustration increases with age. According to data of populyatsionny researches, prevalence of the ED heavy form among men of 40-49 years makes 5 %, moderately expressed degree of ED meets at this age at 17 % of men. In 70-79 years frequency of emergence of these forms increases to 15 % and 34 % respectively. By 2025, according to calculations, prevalence of ED in the world will reach 322 million cases.

At the heart of formation of an erection two main mechanisms lie. The first is the reflex erection arising at a touch to a penis. Stimulation of a penis causes allocation of oxide of nitrogen (NO) that in turn conducts to a relaxation of walls of vessels of peshcheristy bodies, filling with their blood that leads to increase in volume of a penis. The second mechanism - a psychogenic erection which results from erotic incentives. The reflex erection copes peripheral nerves and departments of the lower part of a spinal cord. The psychogenic erection copes limbic system of a brain. Neurologic violations of these reactions can conduct to ED. Sufficient level of testosterone is also necessary for development of an erection in blood

Allocate psychological (psychogenic), organic and mixed ED. Results of the last researches testify that EL in 80 % of cases has the organic nature, developing, as complication of somatic diseases. Classical psychogenic ED comes to light only in 10-20 % of cases. The mixed ED type rather often meets. All versions of this pathology demand not only rendering and a psychological assistance, but also carrying out the complex inspection directed on identification of the organic nature of a disease.

Psychogenic ED
Distinctive signs of psychogenic ED:

  • Sudden beginning of a disease
  • Incidental emergence of symptoms
  • Safety of spontaneous, night/morning erections
  • Safety of tension of a penis throughout all sexual intercourse
  • Existence of problems in relationship, stressful situations
  • Restoration of a normal erection after elimination of an external problem

Organic ED

Most often such conditions are associated with ED, as: metabolic syndrome, good-quality giperplaziya of a prostate gland, cardiovascular diseases, number of endocrinological diseases (diabetes, gipogonadizm, giperprolaktinemiya), TsNS diseases (-n Parkinson, Altsgeymer, syndrome of Shy-Drager, ONMK, encephalitis). At smokers frequency of emergence of ED is increased twice (see tab. 1).

Table 1

Risk factors of development of ED

Risk factor

Mechanism or reason

Treatment

Metabolic syndrome

Endotelialny dysfunction and decrease in development of NO

Diet, physical exercises, weight reduction

S-we are prostate gland giperplaziya

Decrease in synthesis of NO in a penis, a bladder, a prostate

Inhibitors фосфодиэстеразы 5 types

Kardiovaskulyarnye of frustration

Endotelialny dysfunction in penis vessels

Inhibitors фосфодиэстеразы 5 types - with care; the combination to nitrates is contraindicated

Tobacco smoking

The Endotelialny dysfunction connected with early atherosclerosis, hyperactivity of sympathetic NANOSECOND

Refusal of smoking

TsNS diseases

Violation of neyralny control of preerektilny processes

Medicamentous therapy

Damages of a spinal cord

Depends on defeat level.

Inhibitors фосфодиэстеразы 5 types (depending on damage level)

Psychogenic depression

Are unknown

Change of a way of life, medicamentous therapy

Endocrinological violations

Violation testosterone - mediated regulation NO синтетазы; decrease in level of testosterone

Correction of endocrinological violations. Use of inhibitors фосфодиэстеразы 5 types is possible

Diabetes

Vaskulopatiya because of endotelialny dysfunction and an independent neyropatiya

Normalisation of a glikemichesky profile

Distinctive signs of organic ED:

  • Gradual beginning of a disease
  • Progressing deterioration of symptoms
  • Constancy of ED
  • Lack of spontaneous, night/morning erections
  • Disappearance of tension of a penis throughout sexual intercourse
  • Safe libidos and ejaculation

Besides the somatic reasons leading to development of ED, it is necessary to consider possibility of its emergence against reception of a large number of medicamentous preparations of various groups (see tab. 2).

Table 2

The preparations associated with emergence of ED

Group

Representatives

Diuretiki

Tiazida, Spironolakton

Hypotensive in-va

Blockers of calcic channels, ?-блокаторы, Metildop, Clonidine, Rezerpin, Guanetidin

Kardialnye, hypocholesteric

Digoxin, Gemfibrozil, Klofibrat

Energizers

Selective inhibitors of return capture серотонина, tritsiklichesky energizers, lithium preparations, inhibitors моноамин oxidases

Tranquilizers

Butirofenona (haloperidol, дроперидол), Fenotiazina (хлорпромазин, фторфеназин, etc.)

H2 inhibitors

Ranitidin, Tsimetidin

Hormones

Progesterone, estrogen, corticosteroids, antagonists of a rileasing-factor of a lyuteiniziruyushchy hormone (бусерелин, гозерелин, лейпрорелин, трипторелин, etc.)

Cytostatics

Methotrexate

Immunomodulators

Интерферон-?

Antikholinergichesky preparations

Antikonvulsanta, дисопирамид

Others

Alcohol, Cocaine

Continuation: Erektilny dysfunction, therapy strategy>>>

On materials: Kevin T. McVary. Erectile Dysfunction. N Engl J Med 2007; 357:2472-2481

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