Erectile dysfunction and atherosclerosis
Vessels of a person suffering from atherosclerosis become less elastic, their lumen decreases. As a result of such changes, the male organ does not receive the necessary amount of oxygen. Significant risk factors for this are dyslipidemia, diabetes, nicotine addiction. About 60% of those suffering from ED are smokers with experience. Moreover, smokers experience hypercholesterolemia twice as often as people who do not have erectile dysfunction. Approximately 40% of men who have atherosclerotic changes in penile vessels have trouble in the genital area after 50. Various complications of atherosclerosis can develop in parallel. For example, erectile dysfunction is often diagnosed among patients with ischemic heart disease. The fact is the same pathologies are caused by the same risk factor – a disorder of the functioning of penile and coronary vessels. If ultrasound dopplerography recorded a significant reduction in blood flow, before the course of ED therapy it is necessary to make loading ECG samples.
Erectile dysfunction and hypertension
Many researchers note that erectile dysfunction often occurs among patients with high blood pressure. The combination of these two problems affects the quality of life of a man and significantly complicates treatment. Therefore, many hypertensive patients notice a decrease in sexual function when taking medications that lower blood pressure and refuse hypotensive drugs. Especially often, ED is associated with the use of OI-adrenoblockers and thiazide diuretics. However, we cannot claim that all types of drugs for hypertension lead to a high risk of erectile problems. On the contrary, some medications (in particular, angiotensin II antagonists) can enhance the erectile capabilities of men. The positive effect of AA II on the sexual function of men is most likely related to the blocking of angiotensin II receptors, which, as the researchers found, is able to stop spontaneous erections.
Erectile dysfunction and diabetes mellitus
ED statistics in diabetes is disappointing. Among men with diabetes, erectile disorders occur three times more often and begin on average 10-15 years earlier than among those who do not have this diagnosis. According to the latest data, erectile dysfunction affects more than half of men with diabetes. The risk of ED among diabetics is increasing with age and is associated with the duration of the underlying disease. In young men with diabetes (up to 30 years), the prevalence of ED is not higher than 15%. Men from 30 to 60 years are diagnosed with erectile disorders in about half of the cases. As for the older age category (70 years and more), here the vast majority – 95%, suffer from ED. Moreover, most often erectile dysfunction occurs in men with diabetes of the second type. The main cause of ED in diabetes is of an organic nature and is associated with polyneuropathy, micro- and macroangiopathy. In addition, researchers note that in men diagnosed with diabetes, erectile dysfunction correlates with the content of glycosylated hemoglobin, retinopathy, peripheral and autonomic neuropathy.
Erectile dysfunction and hormonal disorders
A significant role in the occurrence of erectile disorders is played by hormonal disorders. Thus, it is noted that up to 35% of patients with ED have a testosterone deficiency. Many metabolic disorders are associated with this: overweight, hypogonadism, etc.
Erectile dysfunction and chronic renal failure
Chronic renal failure (CRF) is another pathology that is commonly associated with ED. More than half of these patients complain of problems in the genital area. In men with renal insufficiency, nocturnal erections were studied, and it turned out that after the dialysis procedure the sexual function improved somewhat, but did not completely return to normal. The most effective solution in this case is the kidney transplant.
Erectile dysfunction and bronchial dysfunction
Also, there is a connection between ED and obstructive pulmonary pathology. More than half of men with obstructive bronchitis and asthma have problems with erection. In addition, patients with duodenal ulcer (especially associated with Helicobacteriosis) are known to have this problem, as well as with urinary infections, steatohepatitis. However, there are still very few studies in these areas.
Erectile dysfunction and stress
The dependence of ED on the mental state of a man is a proven fact. So, the risk factor is depression. In men with moderate depression, the probability of problems with erection is 25%. In the case of severe depression, this figure increases up to 90%. A strong shock (for example, death of a loved one) can also cause ED. Nevertheless, the most common psychogenic factor is the man’s insecurity in his sexual abilities. This phenomenon is known as situational ED. In this case, a man is simply afraid to enter into an intimate relationship, believing that he can “disgrace himself” because of an unsuccessful sexual intercourse.
Another risk factor is aggression. Researchers have found that in men prone to fits of anger, erectile dysfunction occurs quite often. In addition, one should not forget that a combination of organic factors with psychogenic causes is possible. In general, it can be argued that about 80% of all cases of ED have an organic origin and are a complication of a somatic disease (diabetes, AH, CRF, atherosclerosis, etc.). At the heart of ED, there are different mechanisms: vascular, neurogenic, associated with side effects of medical drugs. Also, we should not forget about the dependence of erectile problems on the level of education and lifestyle of a man.
What are the symptoms of erectile dysfunction?
Male impotence is manifested by such signs:
- problems with achieving / maintaining an erection;
- weak erection;
- ability to maintain an erection only through conscious effort;
- morning erection weakens and happens less often.
Such problems are usually attributed to the personal sphere and kept secret from others. That is why most men with ED are slow to share their problem with specialists and remain without treatment. In addition, many of them are sure that modern medicine cannot fix anything. However, this is not true, erectile dysfunction is successfully cured nowadays. According to statistics, treatment helps in nine out of ten cases. Earlier it was mentioned that ED is not an independent diagnosis, but a manifestation of another disease. Therefore, therapeutic courses are prescribed taking into account the underlying disease. The treatment can be both medicamental and psychological.
What are peculiarities of diagnosis of erectile disorders?
Complex diagnostics of erectile disorders involves examination of the patient, study of anamnesis, laboratory tests. For effective collection of necessary information, patients are given special questionnaires. The questionnaire has two important advantages: it saves the doctor’s time and helps the patient to avoid the awkwardness which is inevitable in a personal conversation.
Mandatory are the tests for the level of testosterone and glucose in the blood. The level of prolactin, lipids, and PSA can also be measured.
Further surveys are recommended for men with primary erectile dysfunction, in order to eliminate the organic nature of the disorder. They will also be necessary if there is an injury in the pelvic or perineal region.
The next method of diagnosis is monitoring of spontaneous nocturnal erections. It is a well-known fact that a healthy man has up to six erections in the fast sleep phase. Each episode of erection lasts 10-15 minutes. The total time of nocturnal erections reaches one and a half hours, which is 20% of the duration of a night’s sleep. In the case of ED, both the quality and the number of spontaneous erections at night decrease. This makes it possible to use monitoring for the purpose of differential diagnosis of mentally conditioned and organic forms of erectile disorders. If the erection lasted less than 10 minutes, and its stiffness was only 60%, we can talk about sexual dysfunction. Today the study of spontaneous nocturnal erections is considered to be the most reliable method of qualitative and quantitative evaluation of a male’s erectile capacity.
Another informative diagnostic method in this case is ultrasound dopplerography of male organ vessels. This procedure gives a good picture of blood microcirculation. And if implemented in the B-mode, it is possible to detect changes caused by Peyronie’s disease and cavernous fibrosis. However, the separate use of the two modes does not give exact results. Therefore, a duplex method of examination is used quite frequently. In addition, the effectiveness of the procedure largely depends on the technical level of medical equipment. Examination of the arteries of the penis is performed twice: at rest and during erection, which is achieved by visual stimulation (erotic video) or with a drug stimulating the erection. Then the results are compared.
The quantitative parameters of the study are the peak systolic velocity and the final diastolic velocity (PSV and EDV). Using standard formulas, relative values are calculated on the basis of absolute indices: the resistance index, the pulsation index (RI and PI).
For diagnostic purposes, the Viagra test can be combined with video stimulation, while monitoring erection and tracking hemodynamics in the penis with ultrasound. The main advantage of such a survey is that it is non-invasive and does not carry the threat of priapism. Nevertheless, the method has a significant disadvantage. The fact is that visual stimulation does not allow full standardization of the technique, because different patients require different stimuli to get excited.
Vasculogenic erectile disorders are detected using a special test, which involves intracavernous injection of vasoactive substances (most often alprostadil). If a full erection appears within ten minutes and lasts at least half an hour, it means that arterial and veno-occlusive hemodynamics are normal.
Several other studies are being conducted on a number of indications. These include cavernometry. The purpose of this method is to estimate the elasticity of a sinusoidal system and to determine its closing ability. For this, physiological saline is injected into the cavernous bodies, and its volumetric rate necessary for the appearance of an erection is established.
Cavernography. The method consists of examining the vessels through which blood is discharged from the cavernous bodies.
Radioisotope phalloscintigraphy. This test gives a complete picture of hemodynamics in the cavernous bodies of the male organ.
Treatment methods for erectile dysfunction
Unfortunately, many patients with erectile dysfunction are pessimistic. They do not believe that modern medicine can help them return to a full sexual life. Moreover, some doctors believe that the extinction of sexual function with age is natural, and this is an irreversible process. Nevertheless, studies show that accurate diagnosis and adequate therapy help improve sexual function of 95% of patients.
Treatment scheme and impotence correction is determined by a specialists and should depend on the results of diagnosis and the available somatic diseases associated with ED. For example, men with a diagnosis of diabetes require safe hypoglycemic therapy. Patience with hypertension should take antihypertensive drugs. In chronic obstructive pulmonary disease (COPD) adrenomimetics and theophylline are canceled, anti-inflammatory inhalation treatment is indicated. Patients with CRF need to strengthen dialysis and prescribe a course of anemia treatment. Patients with gastric ulcer H2-histamine blockers are substituted for proton pump inhibitors.