Derectile dysfunction is defined as the persistent inability to achieve and maintain an erection that is firm enough to allow satisfactory sexual performance.
The normal physiology of the penis can be assessed by the report that the patient has a nighttime erection or wakes up with a morning erection. In this way, its penile vascular and neurological integrity is verified.
Stages of erection and penile swelling:
- Excitement - tachycardia, increased blood pressure, penile erection, testicular retraction and sexual arousal may occur
- Plateau - Tachycardia occurs, blood pressure increases, muscle contraction increases sexual arousal
- Orgasm - Contractions of the pelvic muscles, ejaculation, pleasure or intense satisfaction
- Resolution - Loss of penile erection, decreased heart rate and blood pressure, decreased sexual arousal, refractory period
Many men do not understand what is considered a normal erection for their age. Consequently, the loss of erectile quality occurs naturally with aging. In this way, they begin to believe that they have erectile dysfunction. In the same way, the libido is changing, and may become less stimulated, either by visual, auditory and sensitive sensations of eroticism.
Certain drugs, like 5-alpha reductase, hypogonadism (drop in testosterone), serotonin inhibitors and alcoholism can cause decreased libido. The normality of the refractory period continues with age and men are not able to return to a new full erection quickly. Thus, the average ejaculatory latency in healthy heterosexual men is about 5-6 minutes, and therefore there is a variance normally distributed around these values. However,early jaculation is one that occurs in less than 1 minute of penetration.
Symptoms of Erectile Dysfunction
When the erectile dysfunction it occurs suddenly, due to a sudden erection failure, it probably has a psychogenic cause (depression, performance anxiety with the partner). On the other hand, those who have difficulty sustaining an erection have an indication of anxiety, which occurs due to the release of adrenergic substances that inhibit the erection or by venous leakage.
If the man is subjected to radical prostatectomy occurs acute inflammatory damage to the neurovascular band. In this way, the erectile dysfunction it occurs in an average of 6 to 9 months. For this reason, the erection usually restores slowly, with progressive improvement in the quality of the erection.
Clinical studies at this stage have shown that erection-facilitating drugs should be used early and daily. However, recovery can only return to the previous level where the patient was at the pre-surgery moment. Therefore, patients with more significant deficits, who already use drugs to improve erection, are more likely to progress with erectile dysfunction.
Doctors should direct masturbation to stimulate erection to bring irrigation to the corpora cavernosa. In this way, free radicals are removed from them and for that reason, penile tumescence occurs several times a day in healthy men.
In younger men, less than 60 years old, erection can return in less than 1 month, in surgery performed without damage to neurovasculature bandr. However, in patients with partial unilateral or bilateral neurovascular band injury, the erection can be progressively recovered within 2-3 years after RP.
Our organism can recover partial vascular and neurological lesions of the neurovascular band. However, if severe bilateral lesion of the neurovascular band occurs, the erection is not able to be restored, regardless of the postoperative time.
The use of certain drugs, due to their side effects, can be the cause of erectile dysfunction. There is depression due to the decrease in erectile function and the consequent decrease in self-esteem. However, when there is complete loss of nighttime erection, the suspicion of erectile dysfunction falls on vascular or neurological diseases.
Diagnosis of Erectile Dysfunction
Initial assessment of the man complaining of erectile dysfunction includes clinical history with an emphasis on the sexual and psychosocial spheres. In addition, laboratory tests identify comorbidities that may predispose to erectile dysfunction. Therefore, certain therapies can be contraindicated for their known side effects.
The clinical history can reveal causes or comorbidities, such as cardiovascular diseases (including hypertension, coronary disease, atherosclerosis or hyperlipidemia), diabetes mellitus, depression and alcoholism. Most of these diseases increase in prevalence with age. Furthermore, there are dysfunctions related to premature ejaculation, increased latency time associated with age and psychosexual relationship problems.
Other risk factors include smoking, pelvic or perineal trauma, penile surgery, neurological disease, endocrinopathy, obesity, pelvic radiotherapy, Peyronie's disease or use of drugs used to treat systemic diseases. Despite this, other elements are changes in sexual desire, ejaculation and orgasm, presence of genital pain and lifestyle, sexual orientation in childhood and adolescence and quality of the relationship with the partner. Finally, a history of the partner's sexual function may be the key to unraveling the cause that predisposes ED.
The desire precedes sexual arousal and can be spontaneous or in response to erotic stimuli. It is followed by the phases: plateau, orgasm and resolution. Men experience a refractory period after the resolution phase. In view of this, during the refractory period it is not possible to stimulate the penis back to the erectile state. It is typically shorter in young men, but becomes progressively longer with age.
Physical examination basically examines the femoral and tibial pulses (vascular disease), penile plaques in the albuginea (Peyronie's disease), gynecomastia. Furthermore, small testicles (hypogonadism), cremasteric reflex (evaluates the integrity of the thoraco-lumbar erectogenic centers), change in the visual field (pituitary tumor).
The initial treatment is based on the suspected diagnosis and its possible associations. Sometimes, the most important measures fall on the treatment of hypertension, diabetes, metabolic syndrome, dyslipidemia, obesity, smoking. In addition, anxiety, lifestyle stress (psychogenic, associated or not with psychoactive drugs) and hypogonadism.
Men with low Testosterone be treated as one of the main causes of libido and physical and mental vigor. From time to time, creating a free weekend, away from the daily anguish and agitation, can be the key to erection recovery.
In general, initial medical treatment with 5-phosphodiesterase inhibitors can be instituted, evaluating their efficacy and side effects. However, nThey should not be used in men who use nitrates and used with caution and endorsement by the cardiologist, those who use beta-adrenergic blockers.
As drugs used intra-cavernous, in the body of the penis, initially under medical guidance and then self-injected by the patient are considered second line.
Initially, patients should be compensated for all possible clinical changes in medical control prior to indication for penile prosthesis implantation. Diabetics must be compensated before surgery. In this case, the risk of postoperative complications increases substantially when still decompensated.
Finally, the third line of treat it is offered by surgeries that will support the corpora cavernosa, either by malleable or inflatable prostheses. The pros and cons of each prosthesis must be presented to the patient. One is not better than the other, what counts is what the patient wants from the result of the prosthesis.
Furthermore, the best functional results are obtained in patients who maintain a certain penile erection, because there is still penile blood flow, which may still swell the penis with blood supply during sexual intercourse.
Nobody is born knowing everything. In view of this, many things are learned in life every day and we even need to know the secrets of how to have sex.
Prevention of erectile dysfunction
A prevention is based on the clear rules of good living, knowing how to live with joy and willingness to overcome the inherent difficulties of life. Recognizing mistakes and correcting them is an art. It's never too late to start over.. Thus, we must have professional guidance and not lose focus to achieve the proposed goals that must be achieved.
Nothing is impossible. Comfort doesn't help us at all. If obese, lose weight; if dyslipidemic, correct with diet, medication and exercise; if hypertensive, controlling pressure is basic; if diabetic, diet and medication; if you have night apnea, make all changes recommended by specialists. In this way, a readjustment of medications can control pressure and improve penile circulatory performance; etc.
Therefore, medical guidance, discussing progress and difficulties, at each moment of treatment can illuminate your path and give you strength to reach your goal. Therefore, do not forget that aging exists and rest assured that all of us, if we live long enough, will one day present erectile dysfunction.