Causes of impotence
Urology / / August 12, 2017
Erectile dysfunction - is the absence (or the failure) increase penis seal initiation or difficulty, the lack of stability of the above-described process - making it difficult or impossible to conduct a sexual act.
erectile dysfunction are the primary and secondary.Primary erectile dysfunction observed at the beginning of sexual activity, usually disorders progress over time.Secondary erectile dysfunction occur after a period of normal sexual life.Secondary and primary erectile dysfunction can be both functional and organic etiology.
factors involved in the violation
erection etiological factors involved in erectile dysfunction can be divided into two categories: functional and organic disorders (Somatogenic factors)
1 Weak libido.
A) Subjective lack of interest in sex before 50 years.
B) Reduction of interest in sex in old age after 50 years.
2 Typical personality traits that lead to a decrease in sexual interest and behavior of defects in sexual situations.
A) is disturbing-hypochondriac type - suffers persistence (traditional Puritan views, a sense of inferiority)
B) phlegmatic type of men with a strong interior defense to suppress their sexual desires.
B) anxiety-depressive type of men - a shy, diffident man.
3 Homosexual inclinations may prevent the normal heterosexual erectile response.
4 Manifestation transsexual symptoms that may also interfere with normal erection with a partner of the opposite sex.
5 Factors - based on life experience
A) Puritan upbringing - antisexual education, leading to sexual inhibition and a strong sense of guilt.
B) The religious restrictions.
B) Broken family relationships (can be a wide variety of options, such as the loss of a parent with a secondary neuroticism, the Oedipus complex and the like
d) violation lifestyle: erection difficulties associated with hard work, workat night, the change of time zones, the problems of acclimatization to the new location, stressful situations at work, at home.
D) Specific trauma: a variety of events throughout life, affecting an individual's sexual response.For example: rape, sexual abuse of a patient in puberty, observation unfaithful partner.
6. Problems in interpersonal relationships.
A) Neurosis expectations erectile dysfunction as a result of anxiety - waiting for failures.
B) Loss of partner (divorce, death) - causes depression, neurotic personality changes.
D) problems in the relationship between the partners - the rejection of a partner open or veiled;specific sexual incompatibility - frigid woman is not capable of stimulating positive responses in sexual partner, or high sexual demands from women form neurosis expectations of men.
D) Heterophobia - lack of specific skills male courtship, sex games, leading to neurosis expectations.
E) Habituation, attraction loss partner.
F) Specific problems in the partner - vaginismus, an aversion to sex.
Organic (Somatogenic factors)
1 genital diseases:
A) Anatomical and morphological changes after injuries genitals.
B) Plastic induration of the penis.
D) Inflammation of the genitals (balanoposthitis, prostatitis, urethritis, etc.)
2 Neurological diseases that lead to a violation of the innervation of the genitals, as well as hormonal disorders (lumbar damage-krestsovyh spinal cord, multiple sclerosis, tumors of the hypothalamic-pituitary region)
3 Endocrine disorders (low testosterone, hyperprolactinemia)
4 vascular disorders - stenosis, atherosclerosis vessels supplying the penis cavernous body.Increased venous shunt blood corpus cavernosum of the penis during erection.
5 Diabetes - emerge as microangiopathy vessels of the penis, so polyneuropathy corresponding nerve conductors.
6 toxic effects (chronic alcoholism, chronic renal failure).
7 Iatrogenic causes of erectile dysfunction (long-term use of certain estrogen medications, drugs anticholinergic action, some antidepressants with serotonergic pronounced).
8 Surgical complications.
To get good results in the treatment of erectile dysfunction important to carefully differential diagnosis of organic and functional disorders, and combinations thereof.
main symptoms, talking about the prevalence of functional factors in erectile dysfunction:
1 of erection during sleep (developed many simple methods of registration of an erection during sleep, but are considered to be the most reliable check using special devices).
2 Availability erections during masturbation, or in conditions other than the usual patient (eg, the other sexual partner).
3 Communication erectile dysfunction with certain situations, or partners.The frequency of functional disorders according to different authors varies from 95% to 80%.Most functional disorders and organic erectile dysfunction is accompanied by depression, anxiety and phobic states, which dictates the need for antidepressants, anxiolytics.
From experience it is known that antidepressants can cause erectile dysfunction.Erectile dysfunction in this case is associated with serotonergic antidepressants, the only drug in this group, which has a weak serotonergic effects, trazodone - is the drug of choice for such violations.Since the drug has an alpha-adrenoceptor blocking action (such action has yohimbine), it contributes to a normal erection in men suffering from erectile dysfunction.The drug may be used as monotherapy in men with erectile functional disorders associated with phobias, obsessions, anxiety.
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in anesthetized rabbits intracavernosal injection of trazodone and its main metabolite m-hlorfenilpiperazina in experimental animals resulted in completeerection.The introduction of alpha-adrenoceptor agonists caused a complete removal of an erection that arose with the introduction trazadona.Monitoring was conducted by introducing an isotonic solution, which did not have such an effect.
trazadona Action on the sexual function of men divided into two functions:
1 Effect on sexual motivation, rastormazhivaya subcortical centers.It removes the fear, anxiety, depression.
2 Effect on genital reflexes in the form of strengthening and prolonging erections.
Clinically trazadon led to the prolongation of erections, improve erectile function up to the development of priapism in men with normal erection.