Erektilny 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 The term "impotence" applied earlier in the last decade in the international literature is not applied, as out-of-date, inexact and having unreasonably osuditelny implication.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.
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
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).
Risk factors of development of ED
Mechanism or reason
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
The Endotelialny dysfunction connected with early atherosclerosis, hyperactivity of sympathetic NANOSECOND
Refusal of smoking
Violation of neyralny control of preerektilny processes
Damages of a spinal cord
Depends on defeat level.
Inhibitors фосфодиэстеразы 5 types (depending on damage level)
Change of a way of life, medicamentous therapy
Violation testosterone - mediated regulation NO синтетазы; decrease in level of testosterone
Correction of endocrinological violations. Use of inhibitors фосфодиэстеразы 5 types is possible
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).
The preparations associated with emergence of ED
Blockers of calcic channels, ?-блокаторы, Metildop, Clonidine, Rezerpin, Guanetidin
Digoxin, Gemfibrozil, Klofibrat
Selective inhibitors of return capture серотонина, tritsiklichesky energizers, lithium preparations, inhibitors моноамин oxidases
Butirofenona (haloperidol, дроперидол), Fenotiazina (хлорпромазин, фторфеназин, etc.)
Progesterone, estrogen, corticosteroids, antagonists of a rileasing-factor of a lyuteiniziruyushchy hormone (бусерелин, гозерелин, лейпрорелин, трипторелин, etc.)
Continuation: Erektilny dysfunction, therapy strategy>>>
On materials: Kevin T. McVary. Erectile Dysfunction. N Engl J Med 2007; 357:2472-2481