What is Erectile Dysfunction?
It must be distinguished from other sexual problems, such as
lack of desire, ejaculation disorders (premature ejaculation, delayed
ejaculation, and absence of ejaculation) or orgasm disorders.
Manuel Giron de Francisco, from the Urology Service of the
University Hospital La Paz , in Madrid, points out that, in the absence of a
psychogenic cause, it is "a symptom of an involvement of vessels and
nerves responsible for erection, whether due to smoking, diabetes, aging
hypertension with age, sedentary lifestyle, overweight and obesity, etc. "
In fact, he emphasizes, " cardiovascular diseases are an important cause
of erectile dysfunction."
This is a frequent problem that, if left untreated, can
affect relationships with the couple, the family and the work and social
environment.
Causes
Impotence or erectile dysfunction can be caused by:
Psychological causes
In these cases, the penis does not present any physical
alteration, however, diseases such as anxiety (frequently caused by the fear of
not getting an erection or disappointing the woman), depression, problems with
the partner and even stress They can affect the sexual act.
Also, the excessive preoccupation by the labor, social or
familiar problems implies that the necessary attention is not dedicated to the
sexual act. Fatigue, lack of appetite, lack of exercise, insomnia or work
failure also unbalance sexual reflexes.
Vascular causes
This guy is very usual. The penis cannot accumulate the
blood necessary for an erection to occur, usually because it does not arrive in
sufficient quantity. Smoking, high blood pressure, diabetes, some heart
disease, and increased blood cholesterol levels can cause vascular disorders
that make erection difficult.
Neurological causes
In these cases, there is an interruption in the transfer of
messages from the brain to the penis because there is an injury to the nerves
involved. This occurs with spinal cord injuries, multiple sclerosis or after
some surgical interventions in the pelvis.
Hormonal causes
They are rare. They are usually due to a lack of male sex
hormones.
Pharmacological causes
There are several medications that have as a side effect
decrease the ability to have an erection. Among them, there are some drugs to
treat hypertension, heart disease, and psychiatric disorders.
Symptom
The main symptom of erectile dysfunction is a change in the
quality of the erection, both in terms of stiffness, and in the ability to
maintain an erection.
If impotence is caused by physical causes, one of the main
indicators in the inability to have or maintain an erection upon waking up in
the morning.
On the other hand, if it is caused by psychological causes,
impotence usually occurs during a specific period of time (while the stress
situation lasts, for example). If it persists for more than three months, the
patient should seek a urologist specialized in andrology.
Prevention
The main measure that men should take into account to avoid
the onset of erectile dysfunction is the modification of lifestyle to avoid any
habit that negatively impacts arteries and veins, such as smoking, alcohol
consumption, and saturated fats, Sedentary life and stress.
Types
At present, some experts establish the following
classification to distinguish the different types of erectile dysfunction:
- Leve.
- Moderate.
- Serious.
- Diagnosis
For the elaboration of a correct diagnosis, it is necessary
that the patient undergoes medical examinations that allow establishing a good
clinical history.
An interview with the affected person may reveal
psychological factors involved in the erection disorder. The scale for Beck's
depression and the Yesavage geriatric depression scale in the elderly are
simple and easy to perform.
Personal relationships should also be analyzed to determine
if there are conflicts or communication difficulties with the couple. An
interview with the sexual partner of the affected can reveal very important
data.
On the other hand,
there are currently several tests that help establish the diagnosis of
erectile dysfunction. SHIM (Sexual Health Index for Men), a reduced variant of
the IIEF that consists of 5 questions and presents high sensitivity and
specificity. A score less than or equal to 21 shows signs of erectile
dysfunction.
The general medical assessment should include a history of
intake of drugs, alcohol, smoking, diabetes, hypertension, and atherosclerosis,
an exploration of the external genitalia to rule out the presence of fibrous
bands and an assessment of the signs of vascular, hormonal or neurological
diseases.
Specialists recommend measuring testosterone levels,
especially if impotence is associated with lack of desire.
Laboratory tests should include the assessment of thyroid
function. It may also be useful to determine the lutein hormone since it is
difficult to diagnose hypogonadism based on testosterone values alone.
In the case of young patients with specific problems, it may
be necessary to perform more complex tests in addition to the physical
examination, such as a measurement-monitoring of the penis at night, the
injection of medications into the penis, or an echo-Doppler.
Determining vascular indexes is especially beneficial for a
correct diagnosis, such as the penile pressure-brachial pressure index that
indicates a risk of other more serious vascular disorders, even in asymptomatic
patients.
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