Erectile dysfunction (ED) is a violation of the male sexual organ, in which its combat readiness and rigidity are insufficient to make a full-fledged intimacy with a woman.

In the future, we will write abbreviated ED.

Which specialists help in matters of this disease:

• urologists;
• sexopathologists;
• psychotherapist (if the ailment is psychological in nature).

Main symptoms

1. too fast completion of intimacy;
2. the attraction to the beloved woman disappears;
3. the combat readiness of the male organ can either disappear or appear, there is no constancy;
4. insufficient hardness and lethargy of the penis;
5. the man does not show himself the initiative for intercourse;
6. dulling of past sensations;
7. a decrease in the frequency of morning and night erections is also a symptom of erectile dysfunction of a weak or already advanced nature;
8. a man avoids love intimacy and finds all sorts of excuses.

Kinds

There are 3 types of ED depending on the occurrence:

• organic. It comes on gradually against the background of any disease. Attraction to women does not disappear, but during intercourse, the rigidity of the organ may suddenly disappear.
• Psychogenic. It comes quite unexpectedly. But at the same time, combat readiness during proximity is maintained.
• mixed. ED originates from organic and psychological factors combined.

Causes of the disorder

1. Organic

Problems of the cardiovascular system and blood vessels

• hypertension;
• failures of arterial and venous blood flow;
• thrombosis;
• atherosclerosis;
• vasculitis can also cause erectile dysfunction.

Decreased testosterone levels, disruption of the endocrine system

• diabetes;
• violation of the thyroid gland;
• prostate surgery;
• menopause (low testosterone is one of);
• prostate adenoma;
• excess weight.

Drug abuse

• drug use;
• taking harmful drugs that change the hormonal background;
• taking steroids and anabolics.

Disorders of the nervous system and the spine

• lower back or spine injuries;
• spinal cord injury;
• hernia in the lower back;
• multiple sclerosis;
• epilepsy.

Violations of the male reproductive system and the work of its organs

• circumcision or other surgical interventions;
• venereal diseases;
• bruises and burns of the penis.

2. Psychological

• an uncomfortable location for intimacy is also a reason and one of the main causes of psychological erectile dysfunction, the treatment of which is done by choosing a quieter place;
• severe psychological stress, depression or stress;
• lack of sleep;
• conflict with a girl;
• psychological childhood trauma;
• fear of failing;
• low self-esteem;
• first night with a new partner;
• limiting beliefs.

3. Mixed and others

• irregular sex life;
• passive lifestyle;
• adverse environmental factors.

Statistics on the appearance of ED depending on age

With age, the risk of developing the disease only increases.

• under 21 - 5%;
• 21-30 years old - between 10 and 30%;
• 30-40 years - between 30 and 40%;
• 40-50 years - between 40 and 50%;
• 50-60 years - between 50 and 60%;
• from 60 years - between 60 and 80%.

20 ways to fix the problem

Let's analyze in detail 20 methods of treating erectile dysfunction at home.

1. Choose the position where your body is upright

• Lying on your back during intimacy with your beloved - worst position for men suffering from a problem on the topic that their boyfriend is naughty and soft.
• This is so because outflow of blood from the body comes stronger according to the law of attraction.
• If you are lying on top and already getting on your stomach, then there is a big risk to quickly reach the finish line and lose the hardness of manhood.
• Better use positions where you don't lie at all. You are either on your knees or on your feet, the main thing is body located vertically and blood flow to the organ will be much better.

2. Method for replacing the tourniquet by grabbing at the base

1. The essence of the method in the fact that when you get an erection, you wrap your fingers around your friend at the base. This especially helps those whose friend is lethargic and combat readiness is quickly lost.
2. Thus, blood will not leave your dignity, will remain his firmness. Introduce and use this technique to reduce questions about what it is - erectile dysfunction in men.
3. embrace usually large, index and middle finger with medium strength. Many have seen how tourniquets are applied when bleeding, so as not to lose a lot of blood. It's pretty much the same pattern here. Use it wisely.

3. Do the Kidney Energy Strengthening Technique

• The technique is performed in the toilet when you go there in a small way. It consists in the fact that you emit a jet of liquid, standing on tiptoe while straightening your back and not slouching.
• Also, it is necessary strain your buttocks and press, deliberately releasing the liquid more strongly on exhalation.
• According to what jet force, you will evaluate the level of your skills in bed. If everything ends with his lethargy and dripping, then the male potential in bed is not in the best condition.
• Doing the technique frequently strengthens your kidneys and helps you avoid a quick finish. Why sometimes there is no stamina in bed, we wrote in another.

4. Do special physical exercises

What areas of the body should be trained

The main focus of training should be to strengthen the following areas of the body:

• pelvic muscles;
• buttocks;
• abdominal muscles;
• press;
• lower back;
• waist.

pros

The strength and tone of these muscles will help you stay in bed longer, improve blood circulation to the main organ and increase male strength.

Exercise examples

Let us analyze in detail the question of which exercises for erectile dysfunction and the treatment of this disease are used most often.

1. Press exercise. Sitting on the floor, we fix our legs and begin to raise and lower the body. Repeat the movements until pleasant fatigue occurs. It pumps the abdominal muscles. Strong abs speaks volumes about your ability in bed.
2. Leg bends 45 degrees. You need to lie on your back with your legs up 90 degrees. Now we begin to lower both legs, first to the left by 45 degrees, and then also to the right, without hurrying anywhere. Repeat the procedure about 10 times.
3. boat. A well-known exercise, the essence of which is that while lying on your stomach, we begin to simultaneously raise and pull our arms forward and legs back so that only your stomach touches the floor. Hold on as long as we can and return to the starting position.
4. Bike. It is especially useful to do in the morning. Lying on the bed, we begin to turn the air pedals of an invisible bicycle. There should be a pleasant feeling of fatigue in the press area.
5. Raising and lowering the pelvis. We find support in the elbows on the edge of the sofa, the body is forward, the legs are bent at the knees, we lean on the soles of our feet. We begin with an open mouth to raise and lower the pelvis, simulating reciprocating movements. A slight tension in the groin muscles will appear - a sign of the correct exercise.
6. Leggings on the buttocks. We sit on the back point, arms, bent at the elbows, can be extended in front of us, legs forward. Now, alternately step each buttock with maximum amplitude and length. A good sign if it gets hot from doing it.
7. Squats. Everyone knows squats with a straightened back, which everyone did and knows how to do.

5. Apply the "Special Muscle Contraction" method from behind

The next technique for men on how to treat erectile dysfunction at home is the daily training of the pubococcygeus muscle.

1. Breathe in through your nose air and begin to take in the anus and the muscles around it, do not exhale the air.
2. You compress all these muscles as well as in the case when you are trying to restrain the urge to bowel.
3. Perform compressions with greatest force you can, for effective results. On a leisurely exhalation, you remove tension in the muscles and completely relax.
4. After a pleasant heat behind and in the crotch area. It means that everything is done correctly. We talked about the pubococcygeal muscle in detail in.

Benefits of exercising frequently:

• wakes up libido and energy in the pelvic area;
• the psyche relaxes;
• prostate massage;
• the ability to delay a premature finish appears (techniques for postponing the finish are described);
• the male sexual organ becomes stronger.

6. Know the Secret to Morning Testosterone

Use this 6th secret early in the morning to lessen your worries about dealing with mild erectile dysfunction in young or older men.

• Research shows that testosterone levels in men are highest in the morning, after waking up. By evening, testosterone levels drop. This rule applies to 80% of men.
• Build your day so as to get up in the morning, have breakfast and again go back to your beloved in bed. Be aware that in the morning your results will be better.

Breakfast number 1

• Porridge, milk.
• Fresh fruits.
• Bread.
• Boiled eggs.
• Curd.
• It will be useful to give up coffee and drink herbal tea.

Breakfast number 2

• Yogurt or tomato juice.
• Lentil soup with bread.
• Salad containing vegetables
• Lean meat or fish.
• Curd.
• Fresh juice.
• Nuts.

Dinner

• Vegetable salad.
• Fish meat or chicken without fat.
• Baked potatoes or brown rice.
• Boiled corn.

For dinner

• Milk with the lowest fat content.
• Varenets.
• Yogurt.
• Fruits.

Let us examine the issue of the treatment of erectile dysfunction in men with drugs. What helps?

8. Medicines

1. Products of partners of our site;
2. Kapikachu;
3. Viagra;
4. Cialis.

9. Vacuum pumps

There are special vacuum pumps that are applied to the genitals. Air is pumped out in it with a small pump, and the pressure created there makes get on alert for your friend.

Simply put, vacuum created there reinforces blood flow into dignity, and due to this it swells. This method also gives its positive effect.

10. Food of the goddess of love Aphrodite

Food is called that because it contains special substances - aphrodisiacs.

Aphrodisiacs are substances that increase sexual desire and ability in bed.

At home, the treatment of erectile dysfunction and the causes of its occurrence is also feasible due to some special products and dishes.

These foods include

• banana desserts;
• wild honey;
• garlic in dishes;
• goat milk;
• shrimps, crabs and other seafood;
• olive oil;
• parsley;
• artichokes;
• cinnamon;
• mussels;
• cod;
• dried fruits;
• walnuts;
• camel milk.

11. Take Hot and Cold Baths

• Start off need a hot bath. Then go cold. Each bath should be about two minutes.
• About temperature cold water - it should be moderately cold, then gradually, after getting used to it, you can lower the temperature.
• For the process to be successful, change hot to cold baths 6 times, that is, a total of 12 alternations.
• The plus is that it improves blood circulation and also increases the production of hormones in the body. The use of a contrast shower or bath will be one of your effective solutions to the question of how to cure erectile dysfunction at home. We give similar advice on the topic in another.

12. Raisin decoction with milk

1. Black raisins are thoroughly washed and allowed to boil in milk in a ratio of 30 grams per 300 ml, respectively.
2. Remove from heat after boiling and let cool.
3. Such a mixture can be consumed once a day, eating raisins boiled in milk and drinking it with milk.

13. Mix with walnuts

They take a handful of walnuts, peel them and eat them either together with honey, pre-chopped and chopped, or eat whole, while drinking the nuts themselves with goat's milk.

14. Buckwheat porridge according to a special recipe

1. They take buckwheat, clean it and very well washed by changing the water several times. Cleaned and washed pot with buckwheat poured already boiled water.
2. The mixture is allowed to stand overnight. The next morning they get rid of the water. Then pour buckwheat kefir with the lowest fat content.
3. Refuse from adding various spices to the dish in the form of salt and other seasonings.
4. You can eat porridge as many times a day as you like.
5. Many do not pay due attention to their diet and eat everything: fatty, fried. It must be understood that this erectile dysfunction in men thus acquires only more power.

15. Pumpkin or melon seeds

• Pumpkin seeds and also melon seeds are useful. You can choose any of the seeds and well clear. For example, in a coffee grinder.
• Powdered seeds can be eaten with honey or just drink water one teaspoon in the morning, afternoon and after dinner.

16. Decoction of carrots

Pass the peeled carrots through a fine grater. Take already boiled milk and mashed carrots in the ratio of two tablespoons per glass, respectively, and mix.

The resulting mixture is kept on low fire about 15 minutes. Then you can let it cool and drink three times a day.

17. Garlic and onions

The next way to treat erectile dysfunction with folk remedies in men is to cook and eat various dishes along with garlic or onions.

• Garlic and onions help increase male power. They can also be added to salads as ingredients, eat a few onions a day when you eat soups or other heavy meals.
• Onions can be cut into rings, and garlic is usually finely chopped, and this can be added to various meat dishes.
• If you have thoughts about smell after eating garlic, you can remove it parsley, which is also useful in male disorders.

18. Don't forget to run

The benefits of regular running are enormous. At least if you give it 30-40 minutes per day, the result will not keep you waiting.

You can also run on a treadmill at your own pace.

Improves with running circulation in the pelvis, the blood fills the manhood better and its hardness improves.

19. Give up bad habits

For the treatment of mild erectile dysfunction, when your male libido weakens by half, it is recommended to give up old bad habits.

What should be abandoned:

• smoking;
• alcohol;
• fatty or fried foods;
• caffeine (it is better to drink freshly squeezed juices instead).

20. Preventive measures

1. Get physical as often as possible activity. This will prevent the occurrence of stagnation of blood in the pelvis. Do not give up walking, do gymnastics.
2. During intimacy with beloved elderly Not recommended often lose seed. Older men are advised to come to the finish line less often. You will see how many advantages this will give you in terms of energy, well-being and potential for the next caresses in bed.
3. Help solve the problem faster monogamous relationship with a beloved woman. The constancy of relationships and feelings will greatly help you.
4. Be with your woman in one team, not in different ones. Communicate with each other, listen, ask questions and give feedback to each other. A beloved girl can both help speed up the restoration of male strength, and suppress because of her condemnation and reproach.
5. Loads both for the psyche and for the body must be moderate, do not forget to take time to just take a break from the routine and unload your head from work.
6. Don't let obesity and make sure that you are not overweight. And for this, in addition to playing sports, you need to monitor your diet.

That's all. Now you know a lot about drugs for the treatment of erectile dysfunction in men and about effective techniques for eliminating this disorder and raising libido.

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 quality of life of the patient is significantly reduced. Patients complain of the impossibility of conception and sexual weakness due to a weakened erection. Such a pathology in young men is increasingly due to negative psychological factors, but physiological disorders should not be ruled out.

Impotence in most cases is diagnosed in men older than 40 years. The disorder of the sexual sphere is often associated with chronic diseases of the genitourinary system that affect the condition of the prostate gland and 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 restore the function of the genital organs.

More about pathology

Erectile dysfunction (impotence) is a violation of the function of the penis in men, manifested by insufficient blood supply to the organ. At the same time, erectile dysfunction leads to sexual weakness, because with impotence, the penis is not hard enough to perform intercourse. 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 exclusively psychogenic in nature, therefore, during the diagnosis, doctors always evaluate the actual possibility of blood supply to the organ.

Erection is a complex physiological process associated with the nervous system, blood vessels, muscles and humoral factors. Violation of any component of the regulation of the penis can cause impotence. It is assumed that psychological ailments more often lead to a disorder of the sexual sphere in young men, while inflammatory processes and structural disorders are usually detected in older patients. 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 could be comparable in severity to disability, since sick men could not maintain full-fledged relationships with women. In the 21st century, methods for correcting the disease have improved significantly: doctors have studied new diseases that affect erection and have created more reliable methods for restoring penis function.

The work of the body 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 intercourse, the cavernous bodies are filled with blood, resulting in an increase and straightening of the organ. At the bottom of the penis is a spongy body through which the urethra passes. The urethra of the penis is necessary for the excretion of urine and ejaculation during intercourse.

Several anatomical components are involved in the process of penis enlargement (erection), including the nervous system, smooth muscles, blood vessels, and endocrine factors. Electrical impulses coming from the human brain contribute to the release of regulatory substances that affect the vascular tone of the penis. As the cavernous bodies are filled 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 the erection.

The main stimulus for the blood supply to the penis is nitric oxide, which is produced by endothelial cells. This regulatory substance sets off a chain reaction of molecular changes leading to smooth muscle relaxation and blood vessel dilation. In this regard, most of the 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 pathologies associated with vessels, muscles and other components.

Physical reasons

In most cases, erectile dysfunction is a polyetiological condition. The primary disease may be organic or functional in nature, but often the pathology is aggravated by psychological factors. If the cause of impotence is not immediately detected by symptoms and special examinations, it is necessary to assess the condition of several systems at once that can have a negative impact 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. This may be a myocardial infarction, inflammation of the vessels, or. Anomalies in the structure of the vessels of the pelvic cavity should also be taken into account.
2. Violation 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, spinal cord injury or.
3. Pathologies of the respiratory system, 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 of the regulatory systems of the body. Thus, dysfunction of the thyroid gland, which controls the work of most organs and systems, can lead to impotence.
6. Injuries resulting from surgery. Patients undergoing pelvic surgery are at risk.

The organic etiology of erectile dysfunction is not always eliminated with the help of medications. Irreversible violation of the functions of the penis in this case 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 higher brain structures on the functioning of the genital organs. Even in the absence of any structural disorders that impede the blood supply to the penis, a man may suffer from periodic or permanent impotence.

Possible reasons

1. Clinical depression is a pathology of higher nervous activity, manifested by a persistent decrease in mood. Episodes of a large often affect the performance of organs and libido.
2. characterized by fear and social discomfort. Presumably, anxiety can disturb the balance of activity of the sympathetic and parasympathetic components of the nervous system.
3. Post-traumatic mental disorder. The cause of such a disease may be physical abuse, the death of a loved one, or another tragic incident. The disorder is manifested by anxiety, depression and psychosomatic symptoms.

Do not forget that many drugs in psychiatric practice have a negative impact on potency and libido in men. First of all, these are antidepressants, neuroleptics 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 etiological factors listed above 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 medicines. (Erectile dysfunction in some cases occurs when taking antihypertensive drugs, 5-alpha reductase inhibitors and gastric therapy);
• chromosomal and genetic disorders affecting the development of the genitourinary system;
• and chronic cardiovascular pathologies;
• and inactive lifestyle;
• smoking and frequent consumption of alcoholic beverages.
• low stress resistance, difficult working conditions;
• taking hormonal drugs;
• spinal and pelvic injuries.

Accounting for risk factors helps to create conditions for the prevention of impotence. Older men need to monitor the state of the cardiovascular system and regularly undergo urological examinations.

Additional symptoms

Since impotence is usually a complication of the primary disease, it is necessary to consider a holistic 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 (violation of libido);
• soreness of 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 filling of the penis is revealed even in the presence of chronic diseases of the urogenital area, so not all signs can be taken into account.

Diagnostics

The main examinations aimed at finding the cause of impotence are carried out by urologists and andrologists. During the initial appointment, the specialist will clarify the patient's complaints, study the anamnestic information and conduct a physical examination. Palpation of the prostate gland sometimes helps to detect the pathology of the organ 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 procedures

1. Duplex scanning of the penis. This ultrasound technology allows you to assess the condition of the blood vessels and cavernous tissue of the organ.
2. Bulbocavernous reflex electromyography - detection of neurological disorders that cause erectile dysfunction.
3. An intracavernous test with a caverject is a high-precision instrumental study that involves the introduction of erection stimulants into the penis, followed by visualization of the organ using. This method allows to exclude the psychogenic nature of impotence and to detect structural pathologies.
4. and - laboratory tests to diagnose pathologies of various organs and systems.
5. Additional methods of visual examination for the search for organic disorders. It can be computed or magnetic resonance imaging. With the help of or MRI, doctors obtain three-dimensional 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 supply to the cavernous bodies 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 functions of the male genital organs.
3. Injectable preparations that relax smooth muscles. These are papaverine and alprostadil.
4. Hormone replacement therapy for low testosterone.

Many drugs have only a temporary effect, so the main task is to eliminate the root cause of impotence. Also, patients need to consider 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 an artificial material. Vascular operations rarely lead to the restoration of erection, however, with organic damage to the arteries and veins, such treatment may be the only way out.

Modern methods of correction

1. The use of vacuum devices for blood supply to the penis. This method of treatment leads only to a temporary improvement in erection, so pumps must be used immediately before sexual intercourse.
2. Plastic and inflatable prostheses that give the penis a certain shape. During intercourse, the patient can independently straighten the penis, 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 eliminates the common root cause of the disease, and the subsequent psychological correction favorably affects the patient's social interactions.

Forecast and prevention

In most cases, the prognosis is favorable. New methods of treatment can eliminate the root cause of impotence in 60% of men. At the same time, cardiovascular and neurological factors that affect the functioning of the penis can lead to more severe disorders. Psychogenic erectile dysfunction is best treated.

Prevention methods:

• examination by a urologist or andrologist at least once a year;
• regular examination of the cardiovascular, nervous and endocrine systems, if indicated;
• lifestyle improvement: weight loss, regular physical activity, refusal of 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 of therapy can 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 satisfactory sexual intercourse impossible.

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 Older Men Study, MMAS). ). Erectile dysfunction is especially common in highly developed countries. So, for example, in the USA, ED affects from 10 to 30 million men, in Germany - from 3 to 4 million.

Etiology of ED. Allocate psychogenic, organic and mixed ED. If earlier various psychological problems were considered the main cause of ED, it is now believed that ED in 80% of cases is of an organic nature and occurs as a complication of various somatic diseases. The main causes of ED are presented in Table. 1.

Modern studies that have clarified the true causes and mechanisms of erection have shown that ED in about 80% of cases is the result of various somatic diseases. At the same time, almost all epidemiological studies on ED have revealed a relationship between its occurrence and arterial hypertension (AH), diabetes mellitus, coronary 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 in the presence of a history of the following diseases is indicated 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 disturbed, the elasticity of the vessels decreases.

Hypertension can cause ED regardless of whether a person suffers from atherosclerosis or not. If hypertension is not treated for a long time, the walls of the vessels, constantly exposed to increased blood pressure, become dense and inelastic, and the vessels are unable to supply the organs with the necessary 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 causes of organic ED in DM are diabetic polyneuropathy, macro- and microangiopathies.

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

Psychogenic ED. In men with depression, the likelihood of developing ED ranges from 25% for mild depression to almost 90% for 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).

Diagnosis 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 adapted questionnaires for patients with ED. In clinical studies, 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)

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

Table 3
Medications that cause erectile dysfunction

Table 4
The speed and degree of development of an erection according to the Unem scale

Physical examination includes a general examination (body weight, height, body mass index, blood pressure level, etc.), assessment of androgen status (development of the external genital organs and secondary sexual characteristics), rectal examination. The pulse is measured on the femoral and peripheral arteries and their auscultation is performed.

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

The next screening study may 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 phase of REM sleep, there are 4-6 episodes of erections, lasting 10-15 minutes. In men with ED, there is a decrease in the quality and quantity of spontaneous erections during nocturnal sleep. The method allows to differentiate between organic and psychogenic ED and suggests the nature of erectile dysfunction (vasculogenic, neurogenic).

Of great importance is the study of pharmacological artificial erection. The rate of development of an erection, its degree on a six-point scale of Unem (1987), duration, nature of changes in ortho- and clinostasis are estimated (Table 4).

A positive response to a pharmacological load is considered if a full erection (Er5) develops within 5-10 minutes, lasting 30-60 minutes. The 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 stress may indicate sclerosis of the cavernous tissue or decompensated arterial or venous insufficiency. With Er4-Er5 results, a Doppler study is not performed. With the results of Er0-Er3, dopplerography of the vessels of the penis is indicated.

Doppler ultrasound (USDG) of the vessels of the penis is indispensable in the diagnosis of vasculogenic erectile dysfunction. In the power Doppler mode, microcirculation can be better assessed, the B-mode is necessary to detect 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. Ultrasound of the vessels of the penis is more informative, if it is performed at rest and with pharmacologically induced erection.

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

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

Treatment of erectile dysfunction

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

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

Drugs 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 blocker yohimbine. Peripherally acting drugs include prostaglandin EJ drugs, phentolamine, and phosphodiesterase type 5 inhibitors.

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

The effect of apomorphine is due to 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 inhibitors (PDE5). During sexual stimulation, due to the 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 leading to the onset and maintenance of an erection. Normally, its concentration decreases with the cessation of sexual stimulation due to the destruction of PDE5. In ED, cGMP deficiency is noted due to various pathogenetic factors, and its destruction of PDE5 leads to insufficient or no erection. PDE5 inhibitors do not have a direct relaxing effect on the cavernous bodies, 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 administration 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 introduction of the first PDE5 inhibitor, sildenafil citrate, marked a new era in the treatment of ED.

Recently, another drug from this group became 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 vast majority 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. Simultaneous intake of fatty foods and alcohol does not affect the concentration of tadalafil in the blood serum.

Vardenafil hydrochloride - a new powerful 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 sexual intercourse. If necessary, the dose is increased to 20 mg. In patients taking other drugs (for example, alpha-blockers), or in conditions accompanied by a reduced metabolism of vardenafil (for example, in elderly patients), the dose should be 5 mg. Do not take the drug more than once a day.

You should also avoid concomitant 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 a prolonged QT interval due to the possibility of cardiac arrhythmias.

Some medicines may interfere with the metabolism of vardenafil, and therefore patients should consult their doctor if they are prescribed a new drug. For example, for patients taking erythromycin, the maximum allowable dose of vardenafil is 5 mg, and for patients taking ritonavir, 2.5 mg once every 72 hours.

The drug is also contraindicated in persons who have had a myocardial infarction over the past 6 months, with a constitutionally low level of blood pressure (systolic blood pressure of 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 conducted at the Department of Urology at 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 record-breakingly quickly - within 15 minutes after administration. The duration of the drug is 4-5 hours (according to the latest data - 8-12 hours). Studies have shown that vardenafil helps in more than 50% of cases where sildenafil is ineffective.

77% of patients already after the first dose of vardenafil * (10 mg) noted the occurrence of an erection sufficient for successful sexual intercourse. In clinical trials, vardenafil was also found to be effective in 72% of diabetic patients and in 70% of patients undergoing prostate surgery.

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 micrograms (average dose 20 micrograms). The main side effect is pain during the injection. The effectiveness of the method of intracavernous injections of PGE-1 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 constantly take nitrates.

To avoid the need for self-injection, the 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 inguinal region, 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 mcg), which makes therapy very expensive. In addition, 10% of partners after sexual intercourse had a burning sensation in the vagina and the phenomena of vaginitis. The effectiveness of intraurethral therapy is lower than intracavernous 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: with the help of a special apparatus, a rarefaction of atmospheric air around the penis is created, as a result of which blood flow to the cavernous bodies increases and an erection occurs. 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 cavernous bodies. The penis remains in an erect state, which makes it possible to have sexual intercourse for up to 30 minutes. Clinical efficiency is complemented by 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 hemorrhages, pain syndrome, etc.) does not exceed 5%.

Surgical methods for the treatment of 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 (method efficiency over 90%). If the patient wants to use invasive techniques, he must choose the best way for himself to treat ED. The doctor's task is to control and guide the patient's choice of pathogenetically sound methods of treatment.

Conclusion

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

Drug therapy with PDE5 inhibitors is a simple, effective and fairly safe way to treat ED, available not only to urologists and andrologists, but also to general practitioners with some training. The advantages of vardenafil include high efficiency in patients suffering from erectile dysfunction on the background of 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 combination with antihypertensive and antianginal drugs (with the exception of nitrates) .

* - see pharmacological guide

The other day I gave another comment to a medical publication. I already wrote about some points, I will repeat myself in some ways, and added some points to the question. So the conversation was about

erectile dysfunction

Which doctors can diagnose erectile dysfunction? And which specialists should deal with the treatment of ED - urologists, andrologists, endocrinologists, sexologists, psychotherapists? Is there a difference in approaches to ED therapy in our country and in the West, for example?
Let's begin with erectile disfunction is, in fact, a symptom. Same as temperature rise. Successful treatment in medicine should be, first of all, pathogenetic, and then symptomatic. This is logical. Why might a patient have erectile disfunction? Perhaps this is a syndrome of anxious expectation of sexual failure with the causes of incorrect attitudes? Or psychological disharmony, as a result of which the patient simply “does not want” a rival? Or is it a different direction of sexual attraction, due to regular viewing of pornography? Or maybe this is a consequence of maladaptive masturbation and other reflexes? Or maybe these are gaps in psychosexual development? The reasons are thousands. Man is too complex. It is worth noting that erection is often a response. response to a stimulus. Agree, it is important diagnosis of erectile dysfunction evaluate both the situation and this stimulus. After all, sexual function is a steam room. A sexologist is one of the few doctors who pays attention not only to the patient himself, but also to his sexual partner. Without this, a full-fledged therapeutic approach is unthinkable.

- it is always a combination of reasons, both above the belt and below the belt. Without high-quality and full-fledged diagnostics, it is impossible to provide high-quality assistance. Based on this, it is worth considering the issues of the boundaries of competence.

Urology (from Greek - urine and - teaching, science) - literally, the science of urine. The male penis has two functions: urinary and sexual. Therefore, patients who have problems with the urinary function of the penis, of course, should consult a urologist, and if these are problems with the sexual function of the penis, a sexologist. If you look at the list of diseases included in the scope of the urologist, according to the 10th International Classification of Diseases (ICD-10), we will see there: inflammatory diseases of the genital organs, testicular torsion, infertility, urolithiasis, bladder stones, chronic pyelonephritis, varicocele , hydrocele, hydronephrotic transformation, purulent lesions of the kidney, anomalies in the development of the kidneys, undescended testicle, hypospadias, foreign body of the urinary tract, prostate adenoma, prostatitis, pyelonephritis of pregnant women, urinary incontinence, kidney cysts, priapism, urogenital fistulas, urethral stricture, injuries of the external genital organs , bladder and urethra, kidney injury, cystitis, neurogenic bladder, neoplasms of the genital organs, neoplasms of the urinary tract. There is not a single word about erectile dysfunction and sexual disorders here. Therefore, very often urologists send patients with sexual problems to me.

If a person suspects infertility and wants a child, then, of course, he should consult an andrologist and take a spermogram. Every professional should do his job . The mechanism of erection, as noted above, involves not only the penis, but also hormones, the human psyche. Therefore, it is very strange, short-sighted and ineffective to treat only the executing organ in isolation, without diagnosing the “command post”. As well as to deal only with the “upper floor”. Specialists in the field of psychology and psychotherapy have previously tried to correct the behavior of their patients with their own methods, without taking into account, for example, their sexual constitution, sometimes devoting a lot of time, for example, to the patient's childhood. Psychotherapy is certainly necessary, but in treatment erectile dysfunction it is not enough, it must be specific, and this may require both physiotherapy and drugs.

It is worth noting that the monodisciplinary approach is a voice from the past. Previously, neuropathologists also believed that the main problem was a decrease or increase in sensitivity and transmission of nerve impulses. Endocrinologists tried to treat patients with hormones, not interested in who the patient was going to realize his potential with. At the beginning of the 20th century, Samuil Voronov and Eigen Steinakh, with the aim of rejuvenation, including sexual rejuvenation, performed hundreds of monkey testicle transplants in humans. The testosterone revolution was not so successful - the increasing incidence of prostate cancer cooled the ardor of many pioneers.

Each of the specialists wanted to make a breakthrough, but the limited specialization prevented them from doing so. The creation of sexopathology as a separate science, with its own methodology, examination methods, made it possible to approach the assessment, diagnosis, and promotion of sexual health in a comprehensive manner. Modern sexology takes into account both mental and endocrine, mental, vascular factors in the etiology, that is, the causes of sexual disorders. A sexologist is trained in these areas of medicine, and is able to see the whole clinical picture, and not just the "upper" or "lower" floor. In addition, the sexologist takes into account the principle of pairing. After all, it is obvious that attraction has not only an energy component, this is called a neuro-humoral component in sexology, but also a vector. Selectivity is important. Human sexual behavior is no less complex than that of animals, and this factor must be taken into account. Therefore, based on both common sense and the law, the treatment of erectile dysfunction is the prerogative of a sexologist.

Regarding the differences in therapeutic approaches to therapy erectile dysfunction in the West and here. There are many similarities. Appointment of PDE-5 or hormones to everyone indiscriminately and without indications. Or psychoanalytic sessions. Sex - therapeutic concepts based on behavioral psychotherapy. Also, unfortunately, there is a monodisciplinary approach. But I would like to note that such a school, created by our domestic scientist, G.S. Vasilchenko, from whom I was lucky to learn at one time, is not abroad to this day. At scientific events, Western colleagues present as part of their discoveries what Georgy Stepanovich and his team of scientists wrote about several decades ago. We still don't appreciate our successes.

Is there any statistics on what proportion of men suffer from erectile dysfunction? Or how often do patients come in with similar problems?

Strictly speaking, prevalence erectile dysfunction among men - 100%, because any man during his life may face the inability to have an erection. In some cases it is due to lack of sleep, sometimes due to the abundance of alcohol, sometimes cause of erectile dysfunction strained relations with a partner or poor living conditions may become. Of great importance is how often failures occur and what the dynamics of the development of complications is. Therefore, a man who is faced with the first "misfire" should not immediately label himself erectile dysfunction and worry. Another thing is if there is a negative trend and in the future there are more and more failures. For a man, this is an important area for self-esteem. Therefore, almost everyone is trying to solve this issue. Most begin their journey as part of self-medication, taking all sorts of advertised pills and tablets. After that, many go to urologists (they simply do not suspect a separate specialty - a sexologist). There they often treat prostatitis. After such treatment erectile dysfunction and experiments with PDE-5 (everyone knows Viagra, Cialis, Levitra, Zidena) they often hear as a consolation that “everything is fine with your physiology, you need a psychotherapist or psychologist.” After attending consolation sessions and fascinating conversations with the patient, he rushes to the Internet and begins to study the issue. In the end, he finds a specialized sexologist doctor. For example, patients often come to me with a huge bundle of tests and studies, which, unfortunately, are prescribed in the format of overdiagnosis. Although, for example, it turns out that during masturbation, for example, the patient does not have any erectile dysfunction. But in recent years, many have studied the issue even before the “therapeutic carousel” and come straight to the right place. When taking an anamnesis, the details are sometimes horrifying - a 25-year-old patient with “clean” and mild psychogenic ED may report that he was persuaded to have a penile arthroplasty at a previous clinic: “we will do an operation for you and you will forget about your problems”

Is it possible to say that ED is an age-related disease or is there a trend towards “rejuvenation” now?

According to my observations, and I have been engaged in sexology for about 20 years, the predominance of somatic causes is observed over 50 years. Up to 50 more often psychogenic causes. Of course, it could be a combination of reasons. Over the past 5-10 years, the audience has rejuvenated. And this is a warning sign. It is worth recognizing that some patients from 20 to 30 years old, even 10 years ago, perhaps simply could not find a sexologist. By the way, even today this specialty is piecework, since it is very laborious. Many doctors have about 10-20 minutes to see a patient. Only a sexologist is recommended to allocate 1 hour or more for the initial appointment. Now the search for information is facilitated by the widespread development of the Internet. My patients, for example, often come to their appointments already prepared, having read many articles on the subject.

What proportion of men have a problem erectile dysfunction associated with psychology, and which one is physiological in nature (for example, systemic diseases)? Or is it always a complex of reasons and such a division is incorrect? Is it possible to completely solve this problem, or do patients still have to constantly take drugs to maintain sexual activity?

As already mentioned, patients with a leading psychogenic cause are more common. erectile dysfunction under the age of 50, and in older people, somatic causes are not uncommon, that is, associated with the body, and not with the psyche, because the general state of health, as a rule, worsens. But even in these cases, a psychogenic component is often added. Therefore, we can say that psychogenic erectile dysfunction is observed almost always, it can simply be complicated or not complicated by a somatic component. As for the somatic causes, they can be listed endlessly, only a sexologist can make an accurate diagnosis. . It is important to evaluate all factors when making a diagnosis - from the analysis of the drugs that the patient takes to the endocrine status, reflexes, vascular conditions, lifestyle and bad habits. If necessary, a sexologist involves specialized specialists. As far as maintenance therapy is concerned, I usually recommend a prophylactic course every three to five years. After all, sometimes we even send a car for MOT annually. It is worth taking care of yourself.

In most cases, erectile disfunction treated with drugs? Which doctors can prescribe them or do patients most often purchase drugs on their own without a doctor's supervision? How acute is the problem of dietary supplements (do they, on the contrary, worsen the condition of men)?

Different words and concepts: treated and cured. And so it is cured often and without drugs. Sometimes it is important to normalize the patient's life. Conduct a lecture on the hygiene of sexual life. Invite the other half. Sometimes pharmacotherapy is also required. To treat patients with sexological disorders, including prescribing drugs, both legally and from the side of common sense, only a sexologist has the right. The choice of drugs and dietary supplements is very wide, and patients often try many options. Taking independently and dietary supplements, and even PDE-5, patients can sometimes worsen their condition. Unjustified hopes are fraught with disappointments and drops in self-esteem (“even such a magical drug did not help me”). Few patients know that PDE-5 "does not work" against the background of high stress. And they are disappointed in drugs that could be effective and could help, but with the right prescription. That is why drugs should be prescribed by a doctor. I often use the metaphor of a car at a patient appointment: if the car is on the handbrake, it is pointless and unjustified to put more and more pressure on the gas pedal. You need to see the full picture. Both doctor and patient.

Erectile dysfunction is a pathology of sexual function in men, in which there is an inability to achieve or maintain an erection sufficient for sexual intercourse. In this case, the duration of violations should be at least 3 months. This type of sexual disorder is one of the most common in the world, as it occurs in 52% of men aged 40-70 years. 20% of men over 30 have erection problems. Among smokers, ED occurs 15-20% more often than among non-smokers. Almost every man during his life at least once had an episode of erectile dysfunction.

predisposing factors.

All men need to remember that there are predisposing risk factors for the development of erectile dysfunction! These include:

• increased weight;
• age;
• smoking and alcohol abuse;
• the use of any drugs;
• frequent depressive states;
• lifestyle with hypodynamia;
• metabolic syndrome and lipid metabolism disorder;
• pronounced avitaminosis;
• a variety of adverse environmental factors (radiation, various types of radiation, etc.).

There are 3 main types of causes of erectile function.

1. Psychogenic - when erectile dysfunction is associated with anxiety, some specific situations, mental disorders, etc.
2. Organic - when sexual dysfunction develops due to some structural changes in the penis as such.

Allocate:

• vascular causes (due to increased blood pressure, atherosclerosis, diabetes mellitus, venous insufficiency, surgical interventions, etc.);
• neurological causes (due to strokes, multiple sclerosis, various neuropathies, tumors, injuries, etc.);
• endocrine causes (due to low testosterone, high prolactin, thyroid dysfunction, etc.);
• structural causes (due to penile trauma, congenital developmental anomalies, Peyronie's disease, curvature, priapism, etc.).

Classification

Erectile dysfunction is usually distinguished by the degree of severity: isolated light; average; moderate and severe degree of erectile function. It is also generally accepted and important classification due to the development of the disease:

• psychogenic - about 40% of cases;
• organic - 30% of cases;
• mixed - 25% of cases;
• without clarified cause - 5% of cases.

Warning symptoms of erectile dysfunction are:

• difficulty in the onset of sexual arousal and its continuation;
• weak erection;
• partial or complete absence of a morning erection.

Other types of sexual disorders in men

There are also disorders of sexual function in men, which are not directly erectile dysfunction, but cause no less a decrease in the quality of life. There are various disorders of ejaculation. The biggest discomfort not only for a man, but also for a woman is delivered by accelerated ejaculation. The inability to conduct sexual intercourse in a quality manner leads to psycho-emotional stress and even unwillingness to have a sexual life at all. Painful and difficult ejaculation are less common, but also drastically reduce the quality of life. With various neurological diseases, anejaculatory syndrome can develop - a complete inability to independently achieve orgasm and ejaculation. After surgery on the prostate gland and taking certain medications, persistent retrograde ejaculation may develop - the reflux of sperm during orgasm into the bladder. One of the most common violations of the sexual sphere is the lack of sexual desire, attraction (libido). A decrease in libido can be caused both by neuro-emotional overstrain, physical fatigue, and by concomitant diseases in the body, a violation of hormonal metabolism. Most of all these deviations are quite successfully and safely treated. Their timely correction is important to prevent the formation of secondary psychological deviations.

Diagnostics

When diagnosing erectile dysfunction, it is very important to determine the degree of their severity. It is also necessary to find out the cause of these disorders, to establish the disease that caused the development of a decrease in erection. It is necessary to determine the presence or absence of other types of sexual disorders (reduced libido, disorders of ejaculation and orgasm).

Psychogenic dysfunction usually occurs suddenly. At the same time, normal morning erections are preserved. With psychogenic disorders, there are often problems in relationships with a partner. Erectile dysfunction in this case occurs only under certain circumstances, and under other conditions - sexual function is normal.

With organic erectile dysfunction, the opposite is true. Problems arise gradually, morning erections are reduced or completely absent. In this case, as a rule, a good sexual desire is maintained. The quality of sexual intercourse suffers almost always, with any partner and in various situations. If the first alarming symptoms occur - lack of sexual desire and weak erection - you need to contact an andrologist.

In order to identify the causes of erectile dysfunction, specialists from the Mother and Child group of companies can conduct a number of studies:

1. Questionnaire - filling in the IIEF-5 questionnaire by the patient, which is generally accepted all over the world.
2. Inspection of the genital organs: testicles, prostate gland, penis.
3. Evaluation of secondary sexual characteristics, androgenic saturation of the body and the timeliness of the onset of puberty.
4. Laboratory analysis of urine and blood.
5. Study of hormone levels.
6. Study of the level of carbohydrate and lipid metabolism.
7. Assessment of the state of the cardiovascular (measurement of pulse, blood pressure and, if necessary, additional diagnostics).
8. Assessment of the state of the nervous system.
9. Monitoring of nocturnal spontaneous erections.
10. Test with intracavernous administration of vasoactive drugs (analog of prostaglandin E1 - alprostadil).
11. Ultrasound dopplerography of the arteries of the penis.
12. Study of bulbocavernosus and cremasteric reflexes.
13. Electromyography of the penis.
14. Angiography of the vessels of the penis.
15. Cavernosometry.
16. Rheofallography.
17. Endourethral thermometry.
18. Ultrasound of the genital organs.

As a rule, it is not necessary to carry out all diagnostic methods. Depending on the specific situation, the doctor will suggest the minimum required set of techniques.

Treatment

Before starting treatment, it is recommended that all patients exclude risk factors for the presence of deviations from erection as much as possible. It is important to normalize the lifestyle and mode of sexual activity. An important step is to resolve the issue of the possibility of canceling or replacing medications taken that can adversely affect erection. Neurological and cardiological problems are eliminated with the help of narrow specialists, in particular a psychotherapist. Doctors recommend that such patients come for a consultation with a sexologist and psychologist together with a partner - this will help to understand each other, relax and trust.

Depending on the cause of the disease, there are also methods of treatment. If a treatable cause of erectile dysfunction is identified, it must be eliminated.

There are stages of conservative treatment of erectile dysfunction

1. At the first stage, if there are appropriate indications, drugs are used to stimulate erection (in particular, phosphodiesterase type 5 inhibitors). In the presence of androgen deficiency - drugs that increase the concentration of testosterone. For androgen replacement therapy, injectable and transdermal forms of testosterone are used. The drug, dose, mode of administration and duration of the course are selected individually. It is necessary to take any medicines of these groups only as directed by a doctor. Otherwise, serious side effects are possible. In the case of psychogenic disorders, an important stage of the first line of treatment is psychosexotherapy.

If it is impossible to prescribe or the patient is unwilling to use drugs, local negative pressure therapy is recommended as a first-line physical remedy. The essence of the method lies in the fact that the penis is placed in a special flask, where negative pressure is created using a vacuum pump. This leads to an increase in blood flow to the penis, which leads to an erection. To maintain an erection, a special compressive ring is placed on the base of the penis, which limits the venous outflow.

2. The second stage of treatment involves intracavernous or intraurethral administration of vasoactive agents. It is used in the absence of the effect of drugs. The effectiveness and quality of erection are quite high. This method of treatment has contraindications and side effects.

Surgery

With the ineffectiveness of conservative therapy, if necessary, surgical treatment of erectile dysfunction is used. Patients with lesions of the arteries of the penis, supplying the pelvic organs, are recommended surgical interventions on the vessels. With the failure of all other methods of treating erectile dysfunction, if the patient insists on a radical solution to his problem, phalloendoprosthetics with semi-rigid prostheses or hydraulic implants that mimic an erection are recommended as a last resort. The number of satisfied patients after penile prosthetics exceeds 80%.

Prevention