Erectile dysfunction (erectile dysfunction)- symptoms and treatment

What is erectile dysfunction (erectile dysfunction)? We will analyze the causes of occurrence, diagnosis and treatment methods in the article by Dr. BV Skatov, a urologist with 26 years of experience.

Definition of disease. Causes of the disease

erectile dysfunction- long-term (at least 6 months) inability of a man to reach the tension of the penis sufficient for a full sexual intercourse.

Man is the only biological species on our planet that can maintain an erection for a long time. Violation of this ability is an important medical and social problem, leading to loss of self-esteem, family conflicts.

Causes of erectile dysfunction:

According to this scheme, there are 14 structures for the regulation of erection. A violation at any level can lead to a variety of violations in the intimate sphere of a man. These structures can be disrupted as a result of strokes, trauma, tumors of various localizations, multiple sclerosis, and other neurological diseases.

In addition, a group of reasons associated with disruption of the internal secretion organs (endocrine causes) is distinguished: diabetes mellitus, leading to damage to peripheral vessels and nerves, malfunction thyroid gland,. The decrease in testosterone levels is also important, including age-related, due to fatigue, an imbalance in the hormonal background.

Inflammatory diseases of the genitourinary organs (vesiculitis, urethritis) can be the cause of erectile dysfunction.

If you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of erectile dysfunction

1.Early:

• weak (to complete disappearance) night and morning erection;
• decreased sex drive (libido);
• an increase in the time between foreplay and an erection;
• "Blurring" of the brightness of orgasm, up to the disappearance of its sensation;
• premature ejaculation (ejaculation);
• inability to re-intercourse;
• problems associated with "habitual" sexual intercourse;
• increased recovery time between erections;
• a decrease in the volume of ejaculate (the amount of sperm released during intercourse).

2. Late:

The pathogenesis of erectile dysfunction

In pathogenesis erectile dysfunction plays a leading role in the pathology of endothelial tissue, which ultimately leads to a violation of the blood supply to the cavernous bodies of the phallus. A huge role is played by vascular atrophy, leading to sclerosis, replacement of healthy cells of the corpora cavernosa with coarse connective tissue. Consequently, the severity of erectile dysfunction depends on a combination of various causes and the degree of their effect on the corpora cavernosa.

Classification and stages of development of erectile dysfunction

Classification of erectile dysfunction (2017):

I. psychoactive:

1. Common form:

• general impairment of susceptibility;
• initial lack of libido;
• age-related decrease in sexuality;
• general impairment of libido;
• chronic disorder;

2. Situational:

a) In relation to a sexual partner:

• violation of libido for a particular partner;
• lack of libido to the preferences of the object;
• suppression of libido in connection with a conflict relationship with a partner;

b) Doubt about your capabilities:

• Dysfunctional disorders (rapid ejaculation);
• Expectation of failure (doubt about the onset of an erection, the ability to maintain an erection);

c) Chronic stress:

• Pathological mood (loss of a spouse, relative, dismissal from work).

II. Erectile dysfunction associated with organic lesions:

• vascular;
• neurogenic;
• anatomical;
• hormonal;
• medicinal.

III. Polyethiological erectile dysfunction.

Complications of erectile dysfunction

Diagnosis of erectile dysfunction

Diagnosis of erectile dysfunction should begin with a general history. At the first stage, they try to identify possible etiological factors, determine the individual characteristics of sexual activity. Should be allocated separately sexual behavior in the so-called "habitual" sexual intercourse. For this purpose, various questionnaires and scales are widely used, such as: the International Index of Erectile Dysfunction (ICEF-5), the Laurent-Segal scale, the profile of sexual intercourse (PSO) and others. A thorough examination reveals the nature of hair growth, defects of the penis, and the size of the testicles. Rectal examination is of great importance in order to judge the size, consistency and shape of the prostate.

Patients with erectile dysfunction should determine the hormonal background (free and bound testosterone, prolactin, estradiol, gonadotropin), determine the blood sugar level, glycated hemoglobin, blood lipid profile. The results of these tests will help to identify a certain type of pathogenesis of dysfunction.

Pharmacological test: the reaction of the tissues of the penis to the introduction of papaverine, prostaglandins and other medications into the cavernous bodies is investigated.

The study of neurological reflexes of the spinal cord roots also has a certain diagnostic value.

Ultrasonography:

Assessment of the state of the cavernous bodies:

• nuclear magnetic resonance imaging of the penis helps to determine the decrease in blood flow in the fibrosclerotic areas of the penis;
• biopsy of the tissue of the cavernous bodies, its histochemical study reveals the percentage of altered elements of the cavernous tissue.

Erectile dysfunction treatment

A real revolution in the therapy of potency disorders was made by phosphodiesterase-5 inhibitors, which have an effect on nitric oxide. This substance prevents a decrease in the tone of the veins of the penis and, therefore, improves erection. The name of the miraculous drug "Viagra" was prepared long ago and was waiting for its time for several years. This capacious and pleasant name translates as "the power of the huge Niagara waterfall." The hour came in 1993 when the American company Pfizer accidentally discovered an outstanding side effect of a new drug for lowering blood pressure - sildenafil citrate. The drug was quickly introduced into wide clinical practice and won first place among many pharmacological agents for the treatment of erectile dysfunction. This was followed by new generations of PDE-5 inhibitors. These drugs increased the clinical effect and minimized side effects. First of all, these are Levitra (vardenafil) and Cialis (tadalafil). The drugs can improve erection in many forms of erectile dysfunction, even with low testosterone levels in the blood of men.

Now a little about raising the level of testosterone in the body. Research in this area has been going on for many decades, but a real breakthrough has not happened yet. Testosterone does not want to accumulate in the male body, in addition, the drugs are expensive, have a lot side effects... Of these, one can distinguish "Nebido" - a medicine for intramuscular injection and "Androgel", which must be rubbed into the skin daily. The active use of testosterone and anabolic steroids is complicated by the widespread use of drugs of this group in bodybuilding and other strength sports, which makes it impossible to fully control their use and distribution.

Various herbal preparations are interesting in terms of mild stimulation and accumulation of their own testosterone. These are Altai "Red Root", African "Vuka-Vuka" and "Yohimbe", Thai "Butea Superba" and other natural remedies. However, the effectiveness ratio of these drugs is unclear, and clinical trials have not been carried out in the proper volume.

With most forms of erectile dysfunction, psychosexual therapy is of great importance, as well as lifestyle correction, elimination or reduction of adverse life factors.

Vacuum constrictor therapy (LOD therapy) plays a definite role in the therapy of erectile dysfunction. The main mechanism of this type of therapy is the creation of negative pressure (vacuum) on the corpora cavernosa of the penis with the help of special devices. Vacuum devices provide an adequate erection in 60% of cases.

Surgery for erectile dysfunction, they are used when conservative agents have been exhausted:

Forecast. Prophylaxis

The prognosis of the effectiveness of therapy for erectile dysfunction depends on the etiological factor, the neglect of the process (the degree of fibrosis of the corpora cavernosa), the age of the patient. Modern methods of treatment allow, basically, to restore potency. Even if therapy is ineffective, an erection can be achieved surgically.

Prevention:

1. Elimination of destructive habits - the use of nicotine, alcoholic beverages, drugs, masturbation and others.
2. Plays a huge role physical activity ... Massage of the pelvic and pubic areas is quite effective. Massage perfectly activates the vascular tone of the male genital organs. Constant physical education is required, since erectile dysfunction develops as a result of an inactive lifestyle. This leads to congestion in the prostate and other male organs. Regular squats are considered very effective. They are recommended to be performed 60–90 per day. This helps to normalize blood circulation in the vessels of the small pelvis. A very effective way of prevention is alternating tension and relaxation of the muscles of the perineum. Excellent results in the fight against insufficient erection are given by walking and running.
3. Balanced diet plays a leading role in the prevention of the development of erectile dysfunction. So, seafood is rich in essential trace elements such as potassium, zinc, magnesium, calcium, and omega acids, which are essential for a full erection. They are especially rich in oysters, crabs, red caviar, mackerel, soleus fish, sea crustaceans. Honey and nuts contain a significant amount of zinc, increase immunity, prevent the development of prostatitis, and increase male strength. Parsley, asparagus have significant reserves of tocopherol - the strongest antioxidant that has a regulatory function in relation to potency. Spices such as cardamom, ginger, and red pepper are unique for male strength. They are rich in vitamins E, C, B2, B6, which help to improve blood flow to the male organs, and promote a full erection.
4. Timely diagnosis and therapy of inflammatory diseases urogenital area.

All these preventive measures will help to postpone erectile dysfunction, up to the most venerable age.

From the point of view of official medicine, erectile dysfunction is the inability to achieve and maintain a full erection for sexual intercourse, continuing for three months. This situation requires treatment (penile rehabilitation). The rest of the cases refer to short-term situational sexual disorders.

Erectile dysfunction is commonly called impotence. The problem manifests itself in several ways:

• Too much (less than a minute);
• Unstable erection (the penis falls with the introduction or immediately after it);
• The member does not rise at all.

According to statistics, the first serious signs of impotence in men appear on the eve - from 45 to 55 years old, depending on the lifestyle and sexual constitution. Here we are talking not so much about physical erectile dysfunction, but about unwillingness to have sex due to increased fatigue, weakening of the body due to chronic diseases. The reason is a decrease in testosterone levels, which is responsible not only for libido, but also for the state of the cardiovascular system, muscle endurance, mood. In 40-50 years 40% of men complain of impotence, in 50-60 - not less than half, after 60 - more than 70%.

Risk factors for early andropause and impotence:

1. Physical inactivity (decreased physical activity).
2. Obesity (as a result of malnutrition and physical inactivity).
3. Smoking and drugs.
4. Alcoholism (relationship).
5. Avitaminosis.
6. Metabolic syndrome (the body does not respond to insulin, which leads to an increase in visceral fat).

For self-assessment, you can take an online AMS test to help assess the severity of androgen deficiency. To pass the test, follow the link.

How often do you have erection problems during intercourse?

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08.06.2019

Types and causes of impotence in men

The erection mechanism is disturbed due to organic reasons (in other words, various kinds of diseases and anatomical defects) and psychological problems. In most cases, impotence is combined.

Psychogenic impotence

Psychogenic impotence is officially called "failure of the genital response, not associated with organic pathologies." It is caused by situational factors (external circumstances) and neurotic abnormalities (phobias, dependence on drugs, alcohol).

Psychotherapist Grigory Ovtsov will talk about the psychological side of erectile dysfunction

Situational causes of psychogenic impotence:

• Fear of another sexual failure after several “failed” sexual intercourses;
• Chronic stress: problems at work, loans, dissatisfaction with the relationship with a partner;
• Depression: loss of interest in life, accompanied by physical weakness, apathy.

This type of erectile dysfunction is corrected with the help of consultations with a psychologist, medications, physiotherapy.

Organic impotence

An erection occurs due to the well-coordinated work of neurogenic (transmission of nerve impulses), vascular and hormonal mechanisms: a man sees or represents a sexual object, impulses are transmitted, blood flow to the penis is accelerated, due to squeezing of the veins of the penis, an erection occurs. Arousal is possible only with normal libido(here we talk about) , which is provided by an appropriate level of testosterone (hormonal factor). Depending on which link the failure occurred, there are three types of organic impotence:

1. ... Reasons: arterial hypertension, diabetes mellitus, atherosclerosis, cardiovascular pathologies, surgical interventions in the pelvic area, radiation,.
2. Neurogenic impotence. Diabetes mellitus (disrupts not only metabolism, but also causes dysfunction of nerve endings (it is also provoked by kidney disease)), parkinsonism, pathologies of the brain and spinal cord, alcoholism.
3. Hormonal impotence. Caused by congenital or acquired androgen deficiency.

At a young age, vascular impotence mainly occurs because of smoking(some start in school) and alcohol. Vessels and nerves resist nicotine and alcohol intoxication for a long time, but eventually give up. Young people who are sedentary also endanger their sexual function.... They develop stagnant processes in the pelvic area, congestive prostatitis, hemorrhoids.

Young people who achieve impressive fitness in the gym by taking anabolic steroids also run the risk of temporary impotence. After the course, a withdrawal syndrome will develop - there is no external testosterone, and the synthesis of its own has not yet been restored. If you get carried away a lot, then the testicles atrophy altogether.

In young men, neurogenic impotence sometimes occurs due to frequent masturbation, which takes the form of a heavy addiction. Intense masturbation leads to depletion of the spinal genital centers, the sensitivity of the head receptors decreases (about that), prostate atony may develop (muscle flabbiness due to frequent contractions, when the fibers simply do not have time to recover).

Organic impotence can also be penile - caused by structural abnormalities of the penis: curvature due to trauma, scarring, sclerosis (replacement of normal connective tissue) due to cavernitis (inflammation of the corpora cavernosa).

Another type of impotence is iatrogenic or drug induced. It is provoked by the intake of antidepressants, antihypertensive drugs, antiandrogens.

Infections causing impotence

Impotence is caused not by the infections themselves, but by the diseases provoked by them:

• Prostatitis;
• Vesiculitis (inflammation of the seminal vesicles behind the prostate);
• Inflammation of the seminal tubercle (due to it, painful early ejaculation is possible);
• , pyelonephritis.

The above pathologies can be caused by latent genital infections, as well as its own opportunistic microflora (Escherichia coli, staphylococcus from chronic foci of inflammation (tonsillitis) or from the skin). The most common cause of slowly developing impotence is prostatitis, provoked by chlamydia or Escherichia coli.

Signs of impotence

Men usually attribute the first signs of impotence in the form of an unstable erection to stress, depression, and alcohol intake. Such dysfunction can indeed be situational, but if it is repeated regularly, then we are already talking about a violation.

More a serious sign of impotence is the absence of night and morning spontaneous erections, the inability to cause it during masturbation. Symptoms gradually increase, the man loses the desire to have sex, he becomes withdrawn, irritable.

Immunologist Georgy Alexandrovich Ermakov in more detail about how erectile dysfunction manifests itself

Signs of impotence in men over 50

In men after 50 years of age, impotence often occurs against the background of urinary disorders (delay or, conversely, increased frequency) associated with an enlarged prostate (age-related hyperplasia).

Due to the decrease in testosterone levels, libido decreases. Sex does not want as such, because of which there is no arousal and erection.

Diagnosis of erectile dysfunction

In case of impotence, they first turn to a urologist-andrologist. He prescribes a primary set of tests: blood (including hormones, cholesterol and sugar), urine (general and biochemical analysis), digital examination of the prostate and ultrasound (duplex scanning) of the pelvic organs.

Impotence due to disturbances in nerve conduction is dealt with by a neuropathologist (neurologist). If the analysis showed a hormonal imbalance, then the patient is referred to an endocrinologist.

Erectile Dysfunction Treatment

Restoring a normal genital response usually involves a whole a set of measures: medicines, lifestyle correction, surgical intervention if necessary(change in the vascular bed, ligation of the veins of the small pelvis, removal of varicocele, adenoma).

Can impotence be cured?

The first-line drugs for the treatment of impotence are PDE-5 inhibitors (sildenafil, tadalafil). For the treatment of vascular erectile dysfunction, they are taken in courses. A single pill intake helps to cope with most cases of psychogenic impotence.

The best remedies for impotence:

• "" - 1538 rubles. for 2 tablets;
• "" - 795 rubles. per pill;
• "" - 3576 rubles. for 28 tablets.

Generics are much cheaper than the original, but many complain of significant side effects after taking them. According to men on thematic forums about impotence, the best option is PDE-5 inhibitors from the Russian company Severnaya Zvezda:"" (335 rubles for 20 tablets), "" (752 rubles for 30 tablets).

Comparison of popular generics (click on the image to enlarge)

For men taking drugs for high blood pressure, PDE-5 is prescribed together with Tamsulosin to avoid its critical decrease (orthostatic hypotension).

If there is no effect from oral drugs, then intracavernous injections of vasodilating drugs (prostaglandin E1) are used. The injections are first given by the doctor in the treatment room, then the patient learns to do them on his own.

For the treatment of impotence in men after 50 years, the same remedies are used, but taking into account the existing chronic diseases. There will be more contraindications. For elderly patients, PDE-5 inhibitors are often prescribed in conjunction with androgens, alpha-lipoic acid ("Thioctacid"), which improves the condition of nerve fibers. Particular attention is paid to the condition of the prostate.

Physiotherapy

Vacuum erectors are used as an alternative to drug treatment for impotence. - expansion of the vessels of the penis by acting on the organ with negative pressure in a special flask. The task is to achieve an erection and fix it with the help of the worn on the base of the penis. This type of therapy is more suitable for older men with reduced sexual activity.

More about LOD-therapy, urologist-sexologist Kurinov Artyom Nikolaevich

If PDE5 inhibitors fail to respond, mild impotence can be treated with shock wave therapy (SWT). During the procedure, acoustic waves are applied to the corpora cavernosa. It is assumed that in this way it is possible to stimulate the synthesis of nitric oxide, which dilates blood vessels.

Surgery

Radical surgical treatment of impotence involves the implantation of implants into the corpora cavernosa (penile implantation). This method is used when all the previous ones are ineffective.

Installation diagram of a hydraulic phalloprosthesis in case of irreversible impotence

An erection occurs flawlessly when a valve in the scrotum is pressed. Ejaculation and orgasm remain the same.

At home

Several methods can be used to correct a mild degree of erectile dysfunction and as an adjunct to the main treatment at home:

• LOD therapy with vacuum pumps;
• Course reception of dietary supplements with long-leaved eurycoma, tribulus, burning flour, amino acids;
• The use of local stimulants: lubricants with aphrodisiacs, gels, ointments, sprays;
• Massage of the penis and groin area (you can use heparin ointment);
• to strengthen the pubococcygeal muscle and enhance receptor sensitivity;
• Rectal suppositories for the treatment of prostate diseases ("Prostatilen", "Propolis DN").

Prostatilen is a drug of animal origin used for diseases of the prostate gland. Price from 318 RUR

There are also alternative methods of treating impotence, including rubbing the penis with heparin, taking a tincture on a beaver stream, a decoction of beesworm, a natural drone homogenate.

An important (and in some cases key) point in the treatment of impotence is nutritional correction... Fundamental rules:

1. Exclude fast food, including convenience stores.
2. Don't drink beer.
3. In no case should you exclude natural vegetable and animal fats (butter, cheese, eggs, sour cream), since testosterone will not be synthesized without them.
4. 2/3 of the diet should be vegetables, fruits, cereals, leafy greens. It is a source of antioxidants that improve vascular elasticity and prevent cell destruction.

Dried fruits, honey, nuts are useful.

How a woman can help a man with impotence

If a man has become impotent, and his woman is interested in continuing an intimate relationship with him, then she is capable of much. It is women who raise these topics on forums, develop whole treatment programs that are no worse than doctors and in most cases achieve success. To help her husband, they register him with specialists, persuade him to be examined and monitor the implementation of all points of the prescribed therapy. The main condition is mutual trust. If he is not there, then the man will withdraw into himself, and the woman will be angry at first, then she will withdraw.

The situation is even worse when a man suffers from impotence and does not bother him, but a woman suffers. He does not want to put implants, drink Viagra and any such proposals cause aggression. In this case, the only option for a sexually active woman would be to part with this person in order to avoid the development of severe psychosomatic disorders in her.

Prices for treatment and which clinics to contact

Many clinics offer treatment programs for impotence, especially in large cities. For instance:

• Andrology clinic (Moscow, 2nd Syromyatnichesky per.): Consultation with an andrologist - 1,500 rubles, selection of drugs - 500 rubles, drug therapy - from 10,000 rubles.
• Clinic "IAKI" (Moscow): consultation - 3250 rubles, course treatment with the device "Androgin" - 7500 rubles. for 5 procedures.
• "CM-clinic" (Moscow): consultation - 1,500 rubles, a course of treatment for impotence without the cost of medicines - 17,600 rubles.

A complete list of clinics where you can undergo a course of treatment for impotence is presented on the resource https://docland.ru/russia/urologija-i-nefrologija/impotentsija.

How to avoid impotence

If there are no congenital health problems, then it is not difficult to avoid impotence. Enough adhere to a few rules:

1. No smoking anything: no cigarettes, no hookah, no vape.
2. Do not abuse alcohol, exclude beer.
3. Eat wisely.
4. Check with a urologist once a year.
5. Ejaculate 1-2 times a week (no matter how this is achieved).
6. Do not sit in front of the monitor, periodically perform Kegel exercises, squat. Play sports 3-4 times a week.

Particular attention should be paid to its potency in the case of constant intake of certain medications. In case of deterioration of erectile function, it is necessary to notify the doctor, who must adjust the therapy.

Frequently asked Questions

Can coffee cause impotence?

No. A couple of cups of ground brewed coffee, on the contrary, will only improve potency. This is a kind of exercise for blood vessels. Beer is more likely to cause impotence.

How to have sex with impotence?

In serious cases (if not worth it at all), place the penis in a vacuum pump (an erection will appear in it quickly), then fix an erection ring on the base of the penis (preferably a soft adjustable lasso), remove the pump. You can additionally lubricate the head with an aphrodisiac, for example, Persian Shah cream. If erectile dysfunction is of moderate severity, then it is possible, with the permission of the doctor, to take PDE-5 inhibitors in the "on demand" mode. Some people use rigid condoms as an option.

Conclusion

Erectile dysfunction of varying degrees occurs from time to time in any man. In such cases, you should not be nervous and break down on loved ones. You need to pull yourself together, objectively assess your condition and sign up for a consultation with an andrologist. It is better to contact government agencies, where specialists are mostly impartial and do not make unnecessary appointments.

Erectile dysfunction, or impotence (from Latin impotens - powerless) is an integral part of the problem of sexual dysfunctions, the persisting inability to achieve and maintain an erection at the level necessary to ensure a full sexual intercourse.

Erection (from Lat. Erectio - to straighten) is a neurovascular process that is directly related to the magnitude of blood pressure inside the cavernous (cavernous) bodies of the penis. During sexual stimulation, biologically active substances (mainly nitric oxide) are released from the nerve endings, which relax the smooth muscles of the cavernous bodies of the penis, as well as the muscles of the arteries. This leads to vasodilation, increased blood flow in the penis, expansion and filling of the cavernous spaces with blood. At the same time, the veins that perforate the tunica albuginea of ​​the cavernous bodies of the penis narrow, and passive venous outflow is hampered.

Squats are considered the most effective exercise for strengthening erection; it is recommended to perform 50-100 squats a day.

Filling of the cavernous bodies of the penis with blood and veno-occlusion lead to an erection. During intercourse, this state of the vessels remains, the inflow and outflow of blood stops, intracavernous pressure rises. There is an increase in the volume of the penis and a further increase in erection.

Erectile problems over a prolonged period (3–6 months) are grounds for suggesting erectile dysfunction.

According to the WHO, about 160 million men worldwide suffer from erectile dysfunction. Every tenth man over 21 suffers from an erectile dysfunction, about 50% of men over 40 experience various difficulties associated with erectile dysfunction, every third man over 60 is not able to perform intercourse.

Forms

According to the etiological factor, the following types of erectile dysfunction are distinguished:

• psychogenic;
• organic;
• mixed.

Among psychogenic erectile dysfunctions, primary and secondary forms are also distinguished:

• the primary (congenital) form is rare and is characterized by the complete absence of normal sexual function throughout life;
• secondary erectile dysfunction is characterized by the gradual extinction of the previously existing ability to erect.

Erectile Dysfunction Causes and Risk Factors

The causes of erectile dysfunction are subdivided according to the pathophysiological mechanisms underlying its occurrence.

When treating the organic form, it is of paramount importance to eliminate the disease that led to erectile dysfunction.

Organic causes are associated with malfunctioning of internal organs or systems. These include:

• vascular. Insufficient blood pressure in the vessels of the arterial bed leads to inadequate blood supply to the cavernous bodies, and contraction of smooth muscles opens the way for passive venous outflow. Weakening or absence of erections can be a manifestation of arterial hypertension, obliterating endarteritis, hyperlipidemia, atherosclerosis, arterial damage caused by irradiation of the pelvic region, as well as heart failure, coronary heart disease and myocardial infarction;
• neurological. Diseases of the parasympathetic pelvic visceral nerves and pathology of the nerve pathways can lead to impaired redistribution of blood flow, insufficient pressure in the cavernous bodies, impaired ability to erections. Potency is affected by neurological disorders in Alzheimer's disease, Parkinson's disease, polyneuropathy, multiple sclerosis, hemorrhagic or ischemic stroke, injuries of the spinal cord, small pelvis and perineum, degeneration of intervertebral discs, cerebral insufficiency, etc.;
• endocrine. The reasons for impotence of endocrine genesis include increased levels of prolactin, endogenous estrogens and a decrease in the level of androgens, diseases associated with dysfunction of the pituitary and adrenal glands;
• iatrogenic. They are explained by the side effects of a number of drugs (neuroleptics, tranquilizers, antihypertensive drugs, anticonvulsants, cytostatics, antidepressants, antihistamines of the 1st generation, corticosteroids, etc.) on sexual function;
• toxic. Due to the toxic effects of alcohol, drugs, nicotine.

The consequence of erectile dysfunction is unsatisfactory sex life, which leads to further disorders.

Psychogenic causes are associated with central suppression of the erection mechanism. These include increased anxiety, lack of sexual arousal, neuroses, mental illness (depression, schizophrenia). It has been proven that the psychological causes of erectile dysfunction are based on organic diseases. In most patients with erectile dysfunction, a combination of psychogenic and organic components is found.

Aging is an independent risk factor for erectile dysfunction. The leading causes of erectile dysfunction with aging are age-dependent decrease in testosterone levels, vascular pathologies and chronic infectious diseases of the urogenital sphere. Sexual dysfunctions progressively increase with aging: in the 50-60 age group, the number of patients is 10%, and after 80 years - already 80%.

Symptoms

Symptoms of erectile dysfunction include:

• insufficient quality morning erections or their absence;
• inability to enter the penis due to insufficient tension;
• premature ejaculation;
• an increase in the time interval between sexual stimulation and erection;
• defective erections or complete absence of an erection during stimulation;
• inability to introject and maintain an erection until ejaculation;
• decrease in ejaculate volume;
• an increase in the recovery period between erections.

Psychogenic and organic erectile dysfunctions have their own characteristics.

Psychogenic erectile dysfunction begins suddenly. Characterized by the presence of problems in relationships, the presence of nocturnal spontaneous erections. As a rule, erection problems are episodic. After eliminating the external problem, a normal erection is usually restored.

Massage and self-massage of the pelvic area and pubic bone is effective, since it has a beneficial effect on the vascular tone in the genital area.

Erectile dysfunction of organic origin is accompanied by systematic erectile dysfunction. This form of the disease begins gradually and is rarely accompanied by spontaneous nocturnal erections.

Diagnosis of erectile dysfunction

Diagnosis of erectile dysfunction begins with the collection of a general history that identifies etiological factors, and an assessment of sexual activity. A number of questionnaires have been developed to identify the pathophysiological basis of impotence.

Physical examination often reveals signs of vascular, neurological or hormonal disorders, confirming the pathophysiological hypothesis based on the history data: the presence of signs of hypogonadism, fibrotic changes, gynecomastia, phimosis, detection of La Peyronie's plaques, disturbances in perineal sensitivity, decreased tone of the anal sphincter of the lower extremities, atrophy , changes in peripheral pulsations.

Diagnostics should include screening of major vascular, metabolic and endocrine diseases, determination of testosterone levels.

Source: umedp.ru

For an objective assessment of the state of physiological mechanisms that control the erection process, a number of techniques are used:

• assessment of the state of the vascular system- determination of the level of blood flow in the pelvic arteries using vascular Doppler ultrasonography of the arteries of the penis, plethysmography and radioisotope studies;
• assessment of neurological status- determination of the threshold of sensitivity of the penis to vibration using a biothesiometer (helps to detect early manifestations of peripheral sensory neuropathy), electromyography of the muscles of the perineum, study of the refractoriness of the sacral nerves, registration of brain potentials during irritation of the external genital organs (helps to determine erectile dysfunction of neurogenic origin). If, during the screening tests, a neurological pathology is detected in the patient, electroencephalography, computed tomography of the brain or myelography are performed;
• endocrine system assessment- measurement of the concentration in the blood plasma of testosterone, prolactin, luteinizing hormone;
• assessment of the patient's mental state- identification of a psychological, causal relationship (situational impotence), mental disorders (anxiety, depression, feelings of shame, guilt).

Erectile problems over a prolonged period (3–6 months) are grounds for suggesting erectile dysfunction.

For the differential diagnosis of forms of erectile dysfunction, a procedure for evaluating nocturnal erections (NEE) using a plethysmographic sensor is used. The differentiation is based on the fact that patients with psychogenic erectile dysfunction develop normal erections during sleep, while in patients with organic erectile dysfunction, nocturnal erections are inferior.

Erectile Dysfunction Treatment

The goal of treatment is to achieve satisfactory erections with minimal side effects.

In the treatment of the psychogenic form of erectile dysfunction, psychotherapy plays an important role. It should be aimed at eliminating the causes that led to sexual maladjustment, resolving intrapersonal and interpersonal problems, and forming adequate ideas about intimate relationships. The techniques of matrimonial therapy, training partners in effective interaction, methods of cognitive-behavioral therapy are used.

When treating the organic form, it is of paramount importance to eliminate the disease that led to erectile dysfunction. If impotence has endocrine causes, hormone replacement therapy is prescribed.

Pharmacological agents are widely used to enhance and prolong erection. The first-line drugs are oral PDE-5 inhibitors. PDE 5 is an enzyme found in the cavernous tissue. Blocking its work leads to relaxation of the smooth muscles of the corpora cavernosa and the emergence of an erection in response to sexual stimulation.

It has been proven that the psychological causes of erectile dysfunction are based on organic diseases.

It is also possible to inject drugs directly into the corpus cavernosum. In this case, a very thin needle is used, with the help of which the patient can independently inject a vasodilator selected by the doctor. A unilateral injection is sufficient for bilateral enlargement of the penis due to cross blood flow. 15 minutes after this, an erection occurs, which lasts up to two hours. The method has disadvantages - inconvenience of use and rare side effects such as priapism and fibrosis of the penis (2%).

Another method of increasing blood flow to the penis is vacuum constrictor therapy. In this case, the use of a vacuum device enhances blood flow into the cavernous bodies of the penis, and the constrictive ring prevents venous outflow.

Diseases of the genitourinary system in men are often the cause. In most cases, we are talking about chronic inflammatory processes, but doctors often diagnose functional disorders. If the pathology affects the activity of the reproductive system, the patient's quality of life is significantly reduced. Patients complain of the impossibility of conception and sexual weakness due to a weakened erection. Such pathology in young men is increasingly arising from negative psychological factors, but physiological disorders should not be ruled out.

In most cases, impotence is diagnosed in men over 40 years of age. Disorder of the sexual sphere is often associated with chronic diseases of the genitourinary system, affecting the condition of the prostate gland and the blood vessels of the pelvic organs. Modern medical technologies make it possible to solve this problem with the help of medicines, surgical interventions and special implants. Unfortunately, in some cases, even the most effective treatment does not allow the restoration of the functions of the genitals.

More about pathology

Erectile dysfunction (impotence) is a dysfunction of the penis in men, manifested by insufficient blood supply to the organ. At the same time, erectile dysfunction leads to sexual weakness, since with impotence the penis is not firm enough to perform coitus. In most cases, erectile dysfunction is not an independent disease - it is a common complication of pathologies of the nervous system, endocrine organs, heart and blood vessels. Also, erectile dysfunction can be of an exclusively psychogenic nature, therefore, during the diagnosis, doctors always assess the actual possibility of blood filling of the organ.

Erection is a complex physiological process involving the nervous system, blood vessels, muscles and humoral factors. Violation of any component of the regulation of the penis can lead to impotence. It is assumed that psychological ailments are more likely to lead to sexual dysfunction in young men, while in older patients, inflammatory processes and structural abnormalities are usually detected. Modern examination methods allow you to quickly determine the real cause of erectile dysfunction.

Scientists managed to develop an effective treatment for impotence only in the second half of the 20th century, when new drugs were discovered that affect the state of blood vessels. Up to this point, erectile dysfunction in its severity could be comparable to disability, since sick men could not maintain full-fledged relationships with women. In the 21st century, the methods of correcting the disease have improved significantly: doctors have studied new diseases that affect erection, and have created more reliable methods for restoring the functions of the penis.

The work of the organ is normal

The male penis is the main organ of the reproductive system. This soft tissue anatomical structure combines the functions of the urinary and reproductive systems. During coitus, the cavernous bodies are filled with blood, resulting in an enlargement and straightening of the organ. At the bottom of the penis is the corpus spongiosum through which the urethra passes. The urethra of the penis is necessary for the flow of urine and ejaculation during intercourse.

Penile enlargement (erection) involves several anatomical components, including the nervous system, smooth muscle, blood vessels, and endocrine factors. Electrical impulses coming from the human brain promote the release of regulatory substances that affect the tone of the vessels of the penis. As the corpora cavernosa fills with arterial blood, the intensity of venous outflow decreases, as a result of which an erection is maintained for a long time. After ejaculation, the parasympathetic components of the nervous system restore the venous outflow of blood and eliminate an erection.

The main stimulus for blood circulation in the penis is nitric oxide, which is produced by endothelial cells. This regulatory agent triggers a chain reaction of molecular changes that relax smooth muscles and dilate blood vessels. Therefore, most drugs needed to restore an erection enhance the action of nitric oxide or stimulate the release of this chemical compound. Such treatment does not help patients with severe structural abnormalities associated with blood vessels, muscles and other components.

Physical reasons

In most cases, erectile dysfunction is a polyetiological condition. The primary disease can be of an organic or functional nature, however, pathology is often aggravated by psychological factors. If the cause of impotence is not immediately detected by symptoms and special examinations, it is necessary to assess the state of several systems at once that can have a negative effect on the male reproductive organs.

The main organic causes of the disease

1. Pathologies of the cardiovascular system, causing insufficient blood supply to the penis. It can be myocardial infarction, vascular inflammation, or. You should also take into account the anomalies in the structure of the vessels of the pelvic cavity.
2. Disruption of the nervous system. Impotence can be simultaneously caused by a disorder of the central and peripheral nervous systems, since the activity of the penis is controlled by various structures. Usually we are talking about a stroke, a spinal cord injury or.
3. Respiratory system disorders, including chronic obstructive pulmonary disease and breath holding during sleep.
4. Systemic disorders that simultaneously disrupt the work of several components of regulation. In this case, the cause of impotence may be a metabolic disorder or soft tissue disease.
5. Diseases regulatory systems organism. Thus, dysfunction of the thyroid gland, which controls the work of most organs and systems, can lead to impotence.
6. Injuries as a result of surgery. Patients who have undergone pelvic surgery are at risk.

The organic etiology of erectile dysfunction is not always eliminated with medication. Irreversible dysfunction of the penis is most often due to the pathology of the nervous system.

OUR DOCTORS

Psychogenic etiology

Sexual activity in many aspects relies on the reflexes of the nervous system, which a person practically does not control consciously, but one should not forget about the influence of the higher structures of the brain on the functioning of the genitals. Even in the absence of any structural abnormalities that prevent blood flow to the penis, a man may suffer from intermittent or permanent impotence.

Possible reasons

1. Clinical depression is a pathology of higher nervous activity, manifested by a persistent decrease in mood. Large episodes often affect organ performance and libido.
2. characterized by fear and social discomfort. Presumably, anxiety can disrupt the balance of the activity of the sympathetic and parasympathetic components of the nervous system.
3. Post-traumatic mental disorder. The cause of such an illness may be physical violence, the death of a loved one, or other tragic incident. The disorder manifests itself with anxiety, depression, and psychosomatic symptoms.

Do not forget that many drugs in psychiatric practice have a negative effect on potency and libido in men. First of all, these are antidepressants, antipsychotics and some anxiolytics. If erectile dysfunction occurs during the treatment of a mental disorder, the patient should first consult with the attending physician.

Risk factors

The above etiological factors do not always determine the development of the disease. It is necessary to take into account additional forms of predisposition to erectile dysfunction associated with a man's lifestyle, heredity and other aspects.

Possible risk factors:

• taking certain medications. (Erectile dysfunction in some cases occurs when taking antihypertensive drugs, 5-alpha-reductase inhibitors and stomach therapy);
• chromosomal and genetic disorders affecting the development of the genitourinary system;
• and chronic cardiovascular pathologies;
• and an inactive lifestyle;
• smoking and frequent consumption of alcoholic beverages.
• low stress resistance, difficult working conditions;
• taking hormonal drugs;
• spine and pelvic injuries.

Taking into account risk factors helps to create conditions for the prevention of impotence. Older men need to monitor the cardiovascular system and undergo regular urological examinations.

Additional symptoms

Since impotence is usually a complication of the primary disease, it is necessary to consider the complete symptomatic picture. Additional signs indicating the root cause of erectile dysfunction are most often associated with the work of the genitourinary system.

Possible symptoms:

• lack of sexual arousal (impaired libido);
• soreness in the perineum, penis, or pubic area;
• discomfort during urination or ejaculation;
• , constant weakness;
• , false urge to defecate;
• the occurrence of phobias;
• everyday anxiety, discomfort when dealing with women.

It is important for a specialist to immediately exclude the psychosomatic nature of the symptoms and detect a specific disease that affects the functioning of the penis. In many patients, during the examination, a healthy blood supply to the penis is revealed, even in the presence of chronic diseases of the genitourinary sphere, therefore, not all signs can be taken into account.

Diagnostics

The main examinations aimed at detecting the cause of impotence are carried out by urologists and andrologists. During the initial appointment, the specialist will clarify the patient's complaints, examine the history information and conduct a physical examination. Palpation of the prostate gland sometimes helps to detect organ pathology already at this stage. Also, clear signs of cardiovascular and neurological disorders are detected during the examination. To clarify the diagnosis and select an effective treatment, the specialist will need the results of instrumental and.

Necessary diagnostic manipulations

1. Duplex scanning of the penis. This ultrasound technology makes it possible to assess the condition of the blood vessels and cavernous tissue of the organ.
2. Bulbocavernosus electromyography - detection of neurological disorders that cause erectile dysfunction.
3. The intracavernous test with a caverject is a high-precision instrumental study involving the introduction of erection stimulants into the penis, followed by visualization of the organ using. This method allows you to exclude the psychogenic nature of impotence and detect structural pathologies.
4. and - laboratory tests to diagnose pathologies of various organs and systems.
5. Additional visual inspection methods for finding organic disorders. This can be computed tomography or magnetic resonance imaging. With the help or MRI, doctors obtain volumetric images of anatomical structures.

If there are additional indications, psychologists are also involved in the examination.

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Prescribed drugs

1. PDE5 inhibitors that enhance the action of nitric oxide and improve blood circulation in the corpus cavernosum of the penis. This is the most common group of medicines, which include Viagra and Cialis.
2. Herbal medicines. According to some studies, ginseng has a beneficial effect on the function of the male genital organs.
3. Preparations for injection, relaxing smooth muscles. These are papaverine and alprostadil.
4. Hormone replacement therapy for low testosterone levels.

Many drugs have only a temporary effect, so the main task is to eliminate the root cause of impotence. Also, patients need to take into account the side effects of certain medications that affect the state of the cardiovascular system.

Other correction methods

The modern approach to the treatment of impotence is not limited to drugs. Depending on the identified etiology of the disease, the doctor may prescribe the patient a surgical intervention aimed at eliminating the anatomical defect or implanting artificial material. Vascular operations rarely lead to the restoration of an erection, however, with organic damage to the arteries and veins, such treatment may be the only way out.

Modern methods of correction

1. Using vacuum devices to fill the penis with blood. This method of treatment leads only to a temporary improvement in erection, so the pump must be used immediately before intercourse.
2. Plastic and inflatable prostheses that shape the penis. During intercourse, the patient can straighten the penis on his own, which will make it possible to insert the penis into the vagina.
3. Resection of blood vessels, restoration of patency of the cavernous bodies and other methods of surgical intervention.

Also, additional methods of treating impotence can be attributed. Relief of depression and anxiety with the help of psychotropic drugs allows you to eliminate a common root cause of the disease, and subsequent psychological correction has a beneficial effect on the patient's social interactions.

Forecast and prevention

In most cases, the prognosis is good. New treatments can eliminate the root cause of impotence in 60% of men. At the same time, cardiovascular and neurological factors affecting penile function can lead to more severe disorders. The best therapy is psychogenic erectile dysfunction.

Prevention methods:

• being examined by a urologist or andrologist at least once a year;
• regular examination of the cardiovascular, nervous and endocrine systems, if indicated;
• improving lifestyle: weight loss, regular physical activity, avoiding fatty foods, alcohol and cigarettes;
• treatment of inflammatory diseases of the genitourinary system;
• psychotherapeutic treatment of anxiety, depression and other emotional disorders;
• regular sex life.

Thus, impotence is a polyetiological condition. Erectile dysfunction in young men is accompanied by a significant deterioration in the quality of life, however modern methods therapies allow you to quickly and reliably eliminate the root cause of the pathology.

Catad_tema Erectile dysfunction - articles

Erectile dysfunction - modern methods of diagnosis and treatment

D.Yu. Pushkar
Department of Urology, MGMSU

In the modern sense, erectile dysfunction (ED) is the inability to achieve and / or maintain an adequate erection of the penis, which limits or makes it impossible to have satisfactory sexual intercourse.

Epidemiology. ED is an extremely common disorder, affecting 40% of men aged 40-50, 50% of men aged 50-60, and 70% of men over 60, regardless of country or ethnicity (Massachusetts Study of Older Men, MMAS ). Erectile dysfunction is especially common in highly developed countries. For example, in the United States, ED affects from 10 to 30 million men, in Germany - from 3 to 4 million.

Etiology of ED. There are psychogenic, organic and mixed ED. If earlier various psychological problems were considered the main cause of ED, now it is believed that ED in 80% of cases has an organic nature and arises as a complication of various somatic diseases. The main causes of ED are presented in table. one.

Modern studies that have clarified the true causes and mechanisms of an erection have shown that ED in about 80% of cases is a consequence of various somatic diseases. At the same time, almost all epidemiological studies on ED have identified a relationship between its occurrence with arterial hypertension (AH), diabetes mellitus, ischemic heart disease and atherosclerosis. Moreover, according to some authors, the detection of ED may indicate that the patient has one of these diseases in a latent form. The frequency of ED with a history of the following diseases is shown in Table. 2.

Due to atherosclerotic lesions of the vessels of the penis, not only a mechanical disturbance of blood flow occurs, but also the production of neurotransmitters is impaired, and the elasticity of the vessels decreases.

Hypertension can cause ED whether or not a person suffers from atherosclerosis. If hypertension is not treated for a long time, the walls of the vessels, being constantly exposed to high blood pressure, become dense and inelastic and the vessels are unable to supply the organs with the required amount of blood. In diabetes mellitus, ED develops three times more often and 10-15 years earlier than in a healthy population, it occurs, according to A. Guay et al. (1998) in 50-75% of diabetic men.

According to A. Guay (2002), the main reasons for organic ED in DM are diabetic polyneuropathy, macro- and microangiopathies.

The development of ED is often associated with the intake of various medications (Table 3).

Psychogenic ED. In men with depression, the likelihood of developing ED ranges from 25% in mild depression to almost 90% in severe depression. ED can be triggered by severe stress. More often, however, there is a psychogenic variant associated with a man's disbelief in his own sexual usefulness (situational ED).

Diagnostics of ED

The examination begins with the collection of anamnesis. First of all, it is necessary to identify predisposing factors (including atherosclerosis with its various manifestations, hypertension, diabetes mellitus, dyslipidemia, renal failure, mental and neurological diseases, smoking, alcoholism, etc.), which often requires the involvement of a therapist. The collection of information facilitates the use of tailored questionnaires for patients with ED. In clinical trials, the International Index of Erectile Function (IIEF) is most widely used - see appendix.

Table 1.
Causes of erectile dysfunction (O.B. Laurent et al., 2000)

Psychogenic	Depression, anxiety
Neurogenic	Neurotransmitter disorders at the level of the spinal cord or brain
	Spinal myelodysplasia
	Intervertebral disc damage
	Multiple sclerosis
	Diabetes (peripheral neuropathy)
	Alcohol abuse
	Operations on the pelvic organs
	Hormonal deficiency - low testosterone levels
Arterial	Hypertension
	Hyperlipidemia
Venous	Functional damage to the veno-occlusive mechanism
Medicinal	Taking antihypertensive drugs, antidepressants, luteinizing hormone and its analogues
Peyronie's disease
Multifactorial (mixed)

Table 2.
The frequency of ED in various diseases (G.S. Krotovsky, A.M. Zudin, 2003)

Table 3.
Medicines that cause erectile dysfunction

Table 4.
The speed and degree of erection development according to the Yunem scale

Physical examination includes a general examination (body weight, height, body mass index, blood pressure, etc.), assessment of androgenic status (development of the external genitalia and secondary sexual characteristics), rectal examination. The pulse of the femoral and peripheral arteries is measured and auscultated.

Laboratory examination necessarily includes the determination of testosterone and blood glucose levels; according to indications determine the level of blood lipids, prolactin, PSA.

The next screening study can be monitoring of nocturnal spontaneous erections using a computer monitoring system for the quality and quantity of erections (RigiScan).

In healthy men, during the night, in the REM sleep phase, there are 4-6 episodes of erections, lasting 10-15 minutes. Men with ED show a decrease in the quality and quantity of spontaneous erections during nighttime sleep. The method allows to differentiate organic and psychogenic ED and suggests the nature of erectile dysfunction (vasculogenic, neurogenic).

The study of pharmacological artificial erection is of great importance. The rate of development of erection, its degree according to the six-point scale of Yunem (1987), duration, nature of changes in ortho- and clinostasis are assessed (Table 4).

The response to the pharmacological load is considered positive if a full-fledged erection (Er5) develops within 5-10 minutes, lasting 30-60 minutes. Delayed development of an erection (20-25 minutes) may indicate arterial insufficiency of the penis. Rapid detumescence indicates venous leakage. The absence of tumescence or the development of incomplete tumescence after pharmacological loading may indicate sclerosis of the cavernous tissue or decompensated arterial or venous insufficiency. For Er4-Er5 results, the Doppler test is not performed. With Er0-Er3 results, Doppler ultrasonography of the vessels of the penis is shown.

Doppler ultrasound (USDG) of the vessels of the penis is indispensable in the diagnosis of vasculogenic erectile dysfunction. In the power dopplerometry mode, it is possible to better assess microcirculation, the B-mode is necessary to identify structural changes in cavernous fibrosis and Peyronie's disease, however, the results of the study using the duplex method are much more complete than with the separate use of modes B and D. if it is performed at rest and with pharmacologically induced erection.

According to the indications, other studies are performed, namely:

• cavernosometry (determination of the volumetric velocity of the physiological solution pumped into the cavernous bodies, necessary for the occurrence of an erection) is the main test that directly evaluates the degree of violation of the elasticity of the sinusoidal system and its closure ability;
• cavernosography (demonstrates venous vessels, through which blood is mainly discharged from the corpora cavernosa);
• neurophysiological studies, in particular, determination of the bulbocavernous reflex in patients with diabetes mellitus, with spinal cord injury.

Erectile Dysfunction Treatment

First of all, after assessing the somatic status, the therapist treats the underlying disease - arterial hypertension, diabetes mellitus etc. Also, drugs that worsen sexual function are canceled.

Treatment for ED includes non-invasive (drug therapy, use of vacuum constrictor devices) and invasive methods (intracavernous injections of vasoactive substances, surgical treatment.

Medicines intended for the correction of ED are divided into two groups: central and peripheral action. Centrally acting drugs include the dopaminergic receptor agonist apomorphine, testosterone, and the selective a2-adrenergic receptor blocker yohimbine. Peripheral drugs include prostaglandin EJ, phentolamine, and type 5 phosphodiesterase inhibitors.

Until recently, yohimbine was the main method of drug therapy, but its effectiveness does not exceed 10%. Currently, the drug is used mainly for psychogenic ED.

The effect of apomorphine is due to the stimulation of central dopaminergic receptors (mainly D2 and, to a lesser extent, D1) in the paraventricular nuclei of the hypothalamus and the brain stem.

The most recommended treatment for both psychogenic and organic ED is the use of phosphodiesterase type 5 (PDE5) inhibitors. During sexual stimulation, due to activation of the nervous system and the release of nitric oxide (NO), cyclic guanosine monophosphate (cGMP) accumulates in vascular smooth muscle cells. As described earlier, it is cGMP that triggers a cascade of biochemical reactions that lead to the onset and maintenance of an erection. Normally, its concentration decreases with the termination of sexual stimulation due to the destruction of PDE5. With ED, there is a deficiency of cGMP due to various pathogenetic factors, and its destruction by PDE5 leads to insufficient erection or lack thereof. PDE5 inhibitors do not have a direct relaxing effect on the corpora cavernosa, but enhance the relaxing effect of nitric oxide by inhibiting PDE5 and increasing the concentration of cGMP during sexual arousal (see figure).

A contraindication to the use of PDE5 inhibitors is the simultaneous intake of nitrates. With caution, drugs in this group are used in the presence of anatomical deformities of the penis, diseases that contribute to the occurrence of priapism (for example, sickle cell anemia, leukemia) or accompanied by increased bleeding.

The emergence of the first PDE5 inhibitor drug, sildenafil citrate, heralded a new era in the treatment of ED.

Recently, another drug from this group has become available for clinical practice in Russia - tadalafil, which differs from sildenafil in chemical structure, selectivity, pharmacokinetic profile and, accordingly, in clinical action: the clinical effect of tadalafil develops in a third of patients after 16 minutes and in the overwhelming most patients (79%) persist for 36 hours after taking the drug. The long-term effect of the drug allows the couple to more freely choose the time of intimacy. The simultaneous intake of fatty foods and alcohol does not affect the serum concentration of tadalafil.

Vardenafil Hydrochloride - New Potent Selective PDE5 Inhibitor

Vardenafil * is available in dosages of 2.5; 5; 10 and 20 mg. The drug in the recommended dose of 10 mg should be taken 15-25 minutes before intercourse. If necessary, the dose is increased to 20 mg. In patients taking other drugs (for example, alpha adrenergic blockers), or for conditions accompanied by a reduced metabolism of vardenafil (for example, in elderly patients), the dose should be 5 mg. You should not take the drug more than once a day.

You should also avoid the combined use of the drug with nitrates or alpha-adrenergic blockers (drugs for the treatment of benign prostatic hyperplasia and / or lowering blood pressure), since combined use with these drugs can lead to a sharp decrease in blood pressure and collapse. The drug is not used in patients with an extended Q-T interval due to the possibility of cardiac arrhythmias.

Some medications can interfere with the metabolism of vardenafil, therefore patients should consult a physician if a new drug is prescribed. For example, for patients taking erythromycin, the maximum allowable dose of vardenafil is 5 mg, and for patients taking ritonavir, 2.5 mg once a day over 72 hours.

The drug is also contraindicated in persons who have had myocardial infarction during the last 6 months, with constitutionally low blood pressure (systolic blood pressure 90 mm Hg and below), uncontrolled increase in blood pressure, unstable angina pectoris, severe liver failure, end-stage renal failure requiring dialysis, with retinopathy pigmentosa.

According to studies carried out in the Department of Urology of the Medical Center at the University of Cologne, vardenafil * is more than 10 times more effective than sildenafil and 13 times more effective than tadalafil in blocking the action of the PDE5 enzyme. At the same time, vardenafil begins to act in record time - within 15 minutes after administration. The duration of the drug is 4-5 hours (according to the latest data - 8-12 hours). Research has shown that vardenafil helps in over 50% of cases where sildenafil is ineffective.

77% of patients already after the first dose of vardenafil * (10 mg) note the occurrence of an erection sufficient for a successful intercourse. In clinical trials, it was also found that vardenafil is effective in 72% of patients with diabetes mellitus and in 70% of patients who underwent surgery to remove the prostate gland.

Since Virag (1982) first proposed intracavernous injections (ICI) of papaverine for the treatment of impotence, phentolamine, prostaglandin E1 and some others have been used for this purpose. Currently, prostaglandin E1 is the most popular. Doses of drugs vary from 5 to 60 mcg (average dose 20 mcg). The main side effect is pain during the injection. The efficiency of the PGE-1 intracavernous injection method is 70-80%. This method expands the possibilities of restoring sexual function, avoiding surgical methods. Also, the method of intracavernous self-injection is indicated for patients who are constantly taking nitrates.

To avoid the need for self-injection, a transurethral drug delivery system PgE1 MUSE (Medicated Urethral System for Erection) was developed. Despite the greater ease of use, the system has its drawbacks - pain in the penis, testicles or groin area, in about a third of patients, a decrease in blood pressure up to fainting, an irritating effect of the drug on the mucous membrane of the urethra, the need to administer large doses of the drug (125-1000 μg), which makes the therapy very expensive. In addition, in 10% of partners after intercourse, there was a burning sensation in the vagina and the phenomenon of vaginitis. The effectiveness of intra-urethral therapy is lower than intra-cavernous and is about 66%. Currently, the share of using this method is no more than 5%.

The mechanism of action of vacuum devices (VP) is simple: a special apparatus creates a rarefaction of atmospheric air around the penis, resulting in increased blood flow to the corpora cavernosa and an erection. To maintain an adequate erection, a compression ring is put on the root of the erect penis, which reduces the outflow of blood from the corpora cavernosa. The penis remains in an erect state, which ensures the ability to have intercourse for up to 30 minutes. The clinical efficacy is complemented by the low cost and safety of the procedure. The success of vacuum therapy is achieved in 53-85% of patients, and the frequency of complications (subcutaneous hemorrhage, pain syndrome, etc.) does not exceed 5%.

Surgical methods for treating ED include surgical treatment of venous insufficiency (the effectiveness of the method is 50-60%), arterial insufficiency (the effectiveness of the method is 20-80%); implantation of penile prostheses (the effectiveness of the method is more than 90%). If the patient wishes to use invasive techniques, he must choose the best way for himself to treat ED. The physician's task is to control and guide the patient's choice of pathogenetically based treatment methods.

Conclusion

Thus, timely correction of a therapeutic disease, modern methods of treating ED - drug therapy, vacuum devices, surgical treatment - in most cases, allow to achieve sexual rehabilitation of patients.

Drug therapy with PDE5 inhibitors is a simple, effective and fairly safe method of treating ED, available not only to urologists and andrologists, but also to general practitioners if they have some training. The advantages of vardenafil include high efficacy in patients with erectile dysfunction associated with diabetes mellitus, as well as good tolerability of the drug (no serious side effects in patients with arterial hypertension and angina pectoris), the possibility of combining with antihypertensive and antianginal drugs (with the exception of nitrates) ...

* - see the pharmacological reference book