SEXUAL IMPOTENCE | Causes and Treatment

SEXUAL IMPOTENCE | Causes and Treatment

Sexual impotence also known as erectile dysfunction , is the inability of man to initiate and / or maintain a penile erection sufficient for sexual intercourse there . In this paper we address the causes , symptoms and treatment of sexual impotence .

Impotence - Introduction

Men are four major groups of sexual problems :

    Erectile dysfunction .
    Premature ejaculation (read : premature ejaculation | Causes and Treatment ) .
    Lack of libido.
    Difficulty ejaculating .

Sexual health is now a major factor in the quality of life of people . Sexual impotence although not a health risk to bring to life , can bring undesirable consequences to the patient's personal life , influencing relationships and self-esteem , and can even lead to depression the patient (read : WHAT IS DEPRESSION ? .)

It is important to note that having any difficulties in erection is not considered as impotence. To be considered erectile dysfunction the man to be unable to get or maintain erections at least 75 % of attempts . Unable to have an erection for satisfactory time or another is completely normal and happens to all men , even the youngest .

It is important to differentiate impotence from lack of libido. In the ED , the man feels sexual desire but is unable to initiate or maintain a satisfactory erection . In the absence of libido , erection does not occur because of lack of sexual interest .

The prevalence of erectile dysfunction increases with age and with the presence of other diseases such as diabetes , hypertension , heart disease , obesities etc ... It is estimated that between 30-40 % of men over age 40 have some degree of erectile dysfunction .

How does the penis erection ?

The male sexual function is controlled by the interaction of the nervous , hormonal , vascular and psychological . Any disturbance in one of these systems can cause erection problems . Knowing how comes erection is important to understand the sexual impotence and how the current treatment , such as the famous Viagra .

PênisAnatomia anatomy of the penis ( click the image to enlarge it . Attention : Image above may be considered offensive to some people )

Roughly speaking , we can summarize the erection as a vascular event , triggered by neurologic signs and facilitated by an appropriate hormonal milieu and psychological . We'll explain .

A penile erection occurs when the corpora cavernosa , two spongy structures in the form of parallel cylinders inside the penis become filled with blood. The penis is filled so that compresses the veins preventing blood return to the rest of the body. The corpus cavernosum is thus full of blood, maintaining the erection until the end of sexual stimulation . When there is an orgasm or when the stimulus for the erection ends, the corpus cavernosum empties , the penis again becomes flaccid .

For the corpora cavernosa fill with blood it takes a signal from the central nervous system , releasing a substance called nitric oxide . This neurotransmitter is who relaxes blood vessels of the corpus cavernosum , facilitating the entrance of blood therein. While there nitric oxide in the corpus cavernosum , the penis will remain full of blood, and therefore erect , when nitric oxide levels fall , the erection ends .

Hormonal and psychological factors , such as changes in levels of testosterone and thyroid hormones , for example , can interfere with this neurological vascular erection .

The nightly erection of the penis is a normal phenomenon that occurs during deep sleep and is not related to the existence of erotic dreams . This type of erection begins in adolescence and persists for much of his life . The presence of normal nocturnal erections in men with erectile dysfunction speaks in favor of psychological causes for the same , while men do not have erections during sleep or usually have some organic problem behind . Men with difficulties in reaching deep sleep stages also may not have that kind of erection.

Risk factors and causes of impotence

Despite his age to be popularly known as the main risk factor for erectile dysfunction , in fact, aging itself is not as guilty as the diseases that come with it . An older person and completely healthy without medication is fully capable of achieving erections satisfactory in most cases . A healthy man of 65 years may have more " power " than a 40 year old man with a history of diabetes and cardiovascular disease .

Among the diseases and problems related to erectile dysfunction are :

- Diabetes mellitus (read : DIABETES MELLITUS | DIAGNOSIS AND SYMPTOMS ) .
- Hypertension (read : HYPERTENSION | Symptoms and Treatment ) .
- Obesity (read : OBESITY AND METABOLIC SYNDROME | Definitions and consequences ) .
- Cardiovascular disease (read : MYOCARDIAL INFARCTION | Causes and prevention) .
- Dyslipidemia (read : GOOD CHOLESTEROL | BAD CHOLESTEROL | TRIGLYCERIDES ) .
- Smoking ( read : HARM THE CIGARETTE | Treatment of smoking ) .
- Alcoholism (read : EFFECTS OF ALCOHOL | Alcoholism ) .
- AVC (read : AVC | STROKE | Symptoms and Treatment ) .
- Chronic renal failure (read : CHRONIC RENAL FAILURE | Symptoms and Treatment ) .
- Diseases of the thyroid (read : DISEASES AND thyroid symptoms ) .

Any chronic disease can increase the risk of impotence , and to worsen , many of the drugs used in the treatment of these diseases also help for erectile dysfunction . It is estimated that up to 1/4 of cases of impotence are caused by these drugs . Antidepressants (read : Antidepressants | Escitalopram , Fluoxetine , Sertraline ... ) and medications for hypertension ( all classes ) are the main villains .

There are other causes for erectile dysfunction , including , pelvic trauma , chemotherapy , radiotherapy in pelvic surgery for prostate cancer (read : PROSTATE CANCER | Benign prostatic hyperplasia ) , surgery in the pelvic region and cycling for too long ( professional cyclists ) .

Most of these diseases cause disturbances in one of the two main systems of erection :

- Prevent a good vascularization of the penis
- Snag the production and release of nitric oxide

Impotence of psychological origin

Not all erectile dysfunction is related to some organic disease , psychological factors may also be responsible. Stresses of everyday life can cause loss of concentration and decrease in libido , interfering in male performance . Professional problems , financial or marriage are the most common causes .

In addition to the daily stressors , anxiety for the sexual act is also a common cause of impotence . The obligation that society imposes on the man always have to be ready to meet the woman , turning a failure into something shameful , ends up being a lot of pressure for some people . The anxiety about the performance ends up growing up the man has ever experienced erectile difficulties before. In some cases the concern to have and maintain erection ends up becoming the main focus , making the sexual act itself becomes secondary . This nervousness turns into a snowball , causing new episodes of impotence , which in turn leads to more anxiety .

Depression is another cause of erectile dysfunction . As anxiety, this process can self - feed . Many men do not accept that your sexual performance will decrease over the years , and in some cases , episodes of inability to maintain an erection can lead to depression .

Treatment of Impotence

For many years to treat sexual impotence as a natural consequence of aging , as older people were not entitled to an active sex life . Until a few years older persons did not seek medical help because of impotence , erectile dysfunction accepting as something unavoidable .

As explained above, in most cases of erectile dysfunction , there is an organic cause behind . When there is no known chronic disease , the dosage blood thyroid hormones , testosterone and prolactin are needed to determine if there is a hormonal environment adequate for erection .

Better control of chronic diseases , the hormonal environment and suspension, when possible , drugs that might be disturbing , are important in the treatment of erectile dysfunction .

Phosphodiesterase type 5 inhibitors

In the late 1990s there was a revolution in the treatment of sexual impotence with the advent of drugs that inhibit Phosphodiesterase type 5 ( PDE5 inhibitors ) . The main drugs of this class are :

    Sildenafil ( Viagra ® )
    Vardenafil ( Levitra ® )
    Tadalafil ( Cialis ® )

The phosphodiesterase type 5 ( PDE5) which is a substance that acts removing nitric oxide from the bloodstream , causing decrease the amount of blood in the corpus cavernosum. Therefore , drugs that inhibit the action of PDE5 , increase the residence time of nitric oxide , thus facilitating erection.

These drugs should not be used without medical evaluation , not only the risks of adverse effects , but also because , without a thorough assessment , they may be ineffective . If the patient has , for example , testosterone deficiency , Viagra will not only solve your problem. In diabetic patients , only 50% are responsive to the tablets . If the problem is vascular order , not always increase nitric oxide will result .

1. Sildenafil ( Viagra ® ) - was the first drug of this class to be launched . Should be taken 1 hour before relations and their action begins after 30 minutes and lasts about 4 hours.

2 . Vardenafil ( Levitra ® ) - is a drug similar to sildenafil , with more or less the same efficacy , duration of action and side effects .

3 - Tadalafil ( Cialis ® ) - Displays the main differential fact of drug action started with just 15 minutes and can last for up to 36 hours. This does not mean that the patient will have an erection that lasts 36 hours , but that within a span of 36 hours this will be easier to have erections when there is sexual stimulation .

In the end , the three drugs have similar efficacy , left to the discretion of the patient to choose the one that best fits it , taking into account the price and dosage .

PDE5 inhibitors can cause drop in blood pressure and should never be taken by patients who use nitrates . Patients with heart disease or treated with drugs for prostate hyperplasia should also be careful with this medication . To know more details about Viagra , Cialis and Levitra , read : REMEDIES FOR IMPOTENCE | Viagra , Cialis and Levitra

PDE5 inhibitors are currently the first choice in the treatment of erectile dysfunction and have efficacy rate above 70 % . When there is no answer or when the patient can not take these drugs , there are other options for treating impotence , among them we can mention the administration of drugs with intra penile urethral or intra . There are also some devices that act creating vacuum , promoting blood circulation to the penis .

The implantation of a penile prosthesis is a treatment currently in 3rd line and is indicated only when the treatments described above do not have success.