Erectile dysfunction 

Erectile dysfunction

Erectile dysfunction (ED) is the most common type of male sexual disorder. The penis fails to achieve or maintain a sufficient erection during sexual intercourse for more than three months.

In the past, men’s “sexual incompetence” was generally referred to as “impotence”, and its scientific definition was inaccurate and discriminatory. In 1992, medical experts decided to replace “impotence” with the term erectile dysfunction (ED).

What are the causes of erectile dysfunction?

Psychological causes

  • It refers to erectile dysfunction caused by mental and psychological factors such as stress, depression, anxiety and marital disharmony. Other factors such as lack of sexual knowledge, poor experience, financial stress, misunderstanding of media propaganda are the principal causes of erectile dysfunction in male.
  • Psychological disorders and environmental factors caused by fear of disease and the medicinal drug also contribute to erectile dysfunction. Mental illness is also one of the common causes of ED. The severity of symptoms of mental illness positively correlated with dysfunction.

Biological Causes

1. Vascular causes 

Vascular lesions are the common cause of erectile dysfunction, accounting for nearly 50% of ED cases.
It includes any diseases that may lead to decreased blood flow to the corpus cavernosum, such as atherosclerosis, arterial injury, arterial stenosis, and abnormal cardiac function, or penile venous leakage caused by the reduction of smooth muscle in the penis.

Almost all risk factors that cause high blood pressure, such as smoking, hyperlipidemia, obesity, etc., can increase the risk of erectile dysfunction.

2. Neurological causes

Peripheral nerve injury, Parkinson’s disease, myelopathy, lumbar disc disease, multiple sclerosis, multiple atrophy can result in erectile dysfunctions.

3. Endocrine disorders, chronic diseases and long-term use of certain drugs used for the treatment of hypogonadism, thyroid disease, acromegaly, and other diseases that cause testosterone levels to decrease, change the function of the hypothalamic-pituitary-gonadal axis. Drugs, such as Hypertensive drugs (diuretics and beta-blockers), antidepressants, antipsychotics, antiandrogens, antihistamines, drugs (heroin, cocaine, and methadone) can cause erectile dysfunction.

4. The penile disease such as penile sclerosis, small penis, penile curvature deformity, severe phimosis and foreskin balanitis are all comes under erectile dysfunction category.

Erectile dysfunction Symptoms

  • The penis fails to achieve or maintain a sufficient erection during sexual intercourse for more than three months.
  • Lack of sexual desire

Erectile dysfunction Treatment

1. Psychotherapy

  • Because most patients with erectile dysfunction have psychological factors, psychotherapy is very necessary. It is best for both husband and wife to participate in sexual psychotherapy. Sex concentration training is currently the most important treatment for psychological causes of erectile dysfunction. It is suitable for the treatment of almost all sexual dysfunction.
  • Its purpose is to relieve anxiety, promote communication between husband and wife, and improve the skills from language communication to non-verbal communication.
  • Psychotherapy improves the relationship between husband and wife and sexual function. The improvement rate of this method of treating erectile dysfunction is 20% to 81%.

2. Drug treatment

  • Oral medication is the simplest and most acceptable treatment method for erectile dysfunction.

Non-hormonal drugs 

  • Oral drug acting on the central system: such as Adrenergic antagonist, Dopamine drugs, Serotonin Receptor Antagonists.
  • Peripheral oral drugs: PDE5 inhibitors (such as sildenafil, tadalafil, vardenafil, etc.) are specific phosphodiesterase inhibitors that inhibit Cyclic guanosine monophosphate (cGMP degradation, increase cGMP concentration, and thus smooth muscle relaxation, causing the penis to erect.
  • These drugs are currently the best choice for the treatment of ED, with a total effective rate of more than 70%. 

Hormone drugs 

  • Androgen replacement therapy mainly used for the treatment of endocrine erectile dysfunction, including ED caused by primary and secondary hypogonadism.
  • Primary hypogonadism: a testicular tumour, Klinefelter syndrome, trauma, surgery and other diseases can lead to decreased testosterone levels in the body, increased levels of FSH and LH, for such patients, testosterone replacement therapy is the best. 
  • Secondary hypogonadism: After supplementation with gonadotropin or gonadotropin-releasing hormone, it can improve libido and improve erectile function. Androgens used in the treatment of ED are mainly testosterone undecanoate capsules, injections and patches. For patients with prostate cancer or suspected prostate cancer, androgen replacement therapy is contraindicated.

3. Cavernous Injection Therapy (ICI)

  • The intracavernous drug injection is to inject the vasodilator into the corpus cavernosum so that the corpus cavernosum is congested to achieve the purpose of penile erection.
  • At present, the most commonly used drugs for the treatment of erectile dysfunction in the clinic are papaverine, phentolamine and prostaglandin E1.
  • With the widespread use of oral drugs, the method is invasive, causing side effects such as pain, bleeding, abnormal penile erection and penile fibrosis, and is less clinically applied.

4. Surgical treatment

  • With the advent of new drugs for erectile dysfunction, surgical treatment is gradually reduced. But there are still some patients with ED who need surgery to solve, usually by other various treatments. 
  • Surgical treatment includes prosthesis implantation, arterial revascularization, and venous ligation.

 

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