Erectile dysfunction can be defined as the inability of a man to achieve or maintain an erection sufficient to introduce a penis into the vagina and perform a satisfactory sexual intercourse. Such common sexual disorders as a decrease in sexual desire, rapid ejaculation and infertility to erectile dysfunction do not apply. Violation of the erection significantly affects the quality of life of most of the men who suffer from it. In accordance with the currently recognized classification of erectile dysfunction, 7 types of impotence are distinguished. Let’s have a closer look at each of them.
The leading pathogenetic link of psychogenic impotence is a decrease in the sensitivity of cavernous tissue to the effects of neurotransmitters of erection as a result of direct inhibitory effects of the cerebral cortex or indirect effects of the cortex through spinal centers and an increase in the level of peripheral catecholamines. These phenomena are based on fatigue, depression, sexual phobias and deviations, religious prejudices, associative psychotraumatic factors, etc. In recent years, with the development of methods of objective diagnosis of erectile dysfunction, psychogenic impotence in pure form is diagnosed much less often.
Organic impotence is the inability of a man to erect and maintain it, which is not associated with psychological and mental factors. The most common causes of organic impotence are vascular pathologies. The cavernous arterial system that supplies the male sexual organ with blood consists of an internal pudendic artery, an artery of the genital organ and cavernous bodies. It has a unique ability to dramatically increase blood flow in response to stimulation of internal pelvic nerves. The rate of normal flow at rest is 10 ml / min and about 60 ml / min at the time of stimulation. Such a sharp inflow of blood along with its neuro-redistribution in cavernous bodies and cause an erection.
It is divided into 2 forms:
- Arteriogenic erectile dysfunction: The age and pathomorphological dynamics of the atherosclerotic lesion of the coronary and penile arteries approximately correspond to each other, which allows to consider erectile dysfunction as a disease of age. Other causes of arteriogenic impotence are trauma, congenital anomalies, smoking, diabetes mellitus, hypertension.
- Venous erectile dysfunction: There are 3 types of venous erectile dysfunction: Primary venous erectile dysfunction occurs with congenital pathological drainage of cavernous bodies through large subcutaneous dorsal veins or enlarged cavernous or leg veins, cavernous-spongy bypass, etc.
The leading cause of hormonal impotence is diabetes mellitus, leading to serious structural changes in the penile vessels and cavernous tissue. The well-known fact that the normal level of testosterone in the blood serum is absolutely necessary to provide normal erections, was questioned, a visually-stimulated erection does not suffer in persons with hypogonadism. In connection with this, it is now believed that the degree of assimilability of testosterone is more important than its serum level. However, hormone replacement therapy for the treatment of erectile dysfunction is considered to be shown in persons with hypogonadism and in men’s menopause.
In a patient population of patients with erectile dysfunction, approximately 10% experience neurogenic erectile dysfunction. The highest percentage of neurogenic erectile dysfunction occurs in diabetic neuropathy and erectile dysfunction after spinal cord injury. Sexual function is affected by neurological disorders with alcoholism, conditions after radical operations on the pelvic organs, spinal cord infections and tumors, syringomyelia, intervertebral disc degeneration, transverse myelitis, multiple sclerosis, as well as tumors and brain trauma and cerebral insufficiency.
Such impotence is caused by a combination of causes of psychogenic and organic erectile dysfunction, for example, a chronic disease in combination with psychological problems. The symptomatology of mixed erectile dysfunction combines the factors of both types.
Drug-induced erectile dysfunction
The older a man, the more likely he is to have chronic diseases that are not directly related to the genital area, but require prolonged (or permanent) medical treatment. A medical erectile dysfunction can be a consequence of the use of drugs from different therapeutic groups, regardless of the patient’s age. For example, treatment with monoamine oxidase inhibitors and tricyclic antidepressants, as well as with benzodiazepines and selective serotonin reuptake inhibitors, can lead to a decrease in libido and ejaculation disorders.
The development of erectile dysfunction can be caused by fibrates (gemfibrozil) and simvastatin. H2-receptor antagonists of histamine (cimetidine, famotidine, ranitidine), cardiac glycosides (digoxin), metoclopramide, as well as anabolic steroids, affect erectile function by suppressing androgen production. Problems may be a consequence of the use of tetracyclines, allopurinol, indomethacin, disulfiram and antihistamines of the first generation.