Erectile dysfunction - features, mechanisms of erection, causes, treatment

Erectile dysfunction affects more and more men. As the statistics show

a problem affecting as many as 50 percent. men aged 40 to 70 years. We can talk about violations when the erection of the penis does not allow to properly tighten and it becomes impossible to have sexual intercourse. The causes of erectile dysfunction are associated with insufficient blood supply to the penis. A bad erection also includes the phenomenon of a short-term erection, which disappears even before ejaculation. Regardless of the type of problem, a man cannot experience an orgasm. Why can't half of mature men have satisfactory intercourse? How to treat problems with potency? Details below.

1. What is erectile dysfunction?

Erectile dysfunction, abbreviated ED (Erectile Dysfunction), as defined by the World Health Organization, should be understood as a constant or periodic inability to achieve

and/or the man maintains an erection during intercourse.

In terms of diagnosis, erectile dysfunction is a disorder in which an erection does not occur and occurs in at least 25% of sexual attempts. Erectile dysfunction is sometimes referred to as impotence, although the term is less commonly used nowadays due to

derogatory, often ironic and offensive associations. Much more often, patients may encounter a neutral term called "erectile dysfunction."

Erectile dysfunction should not be confused with the natural age-related change in male sexuality, manifested by a weakening or temporary loss of potency during intercourse. Many men experience this during times of stress, drug use, or other health issues. Sexual problems can also arise from certain emotional or relationship difficulties.

Although the frequency of erectile dysfunction increases with age, advanced age does not significantly affect the development of the disease. Thus, a man in his 60s may have fewer erections and reach orgasm more slowly, but his sex life is not disturbed - he just starts to move at a different pace.

2. Mechanisms of erection

2.1. Vascular factors

The cavernous bodies of the penis, located on the dorsal side of the penis and formed by numerous cavities (vascular formations), play the main and most important role in the mechanism of erection.

erection of the penis (erectio penis) is due to the fact that the cavities are filled with blood, tighten the whitish membrane and, increasing their volume, compress the veins, preventing the outflow of blood.

The pits receive blood mainly from the deep artery and to a lesser extent from the dorsal artery of the penis, which branch out along their course. In the flaccid member, the pits are almost completely empty, their walls are depressed.

The vessels that directly supply them with blood are serpentine (cochlear arteries) and have a narrowed lumen. Blood flows in a slightly different way, bypassing the pits, through the so-called arteriovenous anastomoses.

When an erection occurs under the influence of a nerve stimulus, the anastomoses close, the deep arteries of the penis and their branches expand, and blood begins to flow into the pits.

The penis is richly innervated by sensory, sympathetic and parasympathetic fibers. The endings of sensory nerves are located in the epithelium of the glans penis, foreskin and urethra. They perceive tactile stimuli and mechanical stimuli.

The impulses are then conducted along the nerves of the vulva to the erectile center located in the spinal cord at the S2-S4 level. From this center, the parasympathetic nerves receive stimulation that causes an erection of the penis.

Stimulation of parasympathetic fibers that control erection causes relaxation of the muscular membrane and expansion of the deep vessels of the penis (blood flow into the cavity) and narrowing of the drainage veins.

The mechanism of erection is possible due to the presence of specific neurotransmitters, i.e. compounds released by nerve endings. Acetylcholine, secreted by nerve fibers, increases the concentration of nitric oxide, which relaxes vascular smooth muscle.

2.2. Sympathetic system

The role of the sympathetic nervous system in erection is not fully understood. However, it is known to play a significant role in the ejaculatory process by contracting the smooth muscles of the seminal vesicles and vas deferens.

In the resting state of the penis, there is a predominance of the activity of sympathetic fibers, which, through the secreted norepinephrine, reduce the trabeculae of the cavernous bodies and the smooth muscles of the vessels (prevent blood flow to the cavity). It works by stimulating alpha-1 adrenergic receptors.

During rest, erections are also suppressed by increased activity of serotonergic (i.e., serotonin-containing) neurons. So we can say that norepinephrine and serotonin inhibit erection.

Hormonal factors play a very important role in erection. Testosterone is considered an important hormone for human sexual function, but its role is still not fully explained.

However, it is known that hormonal disorders in the hypothalamus-pituitary-testes system lead to impotence. Diseases of other endocrine glands can also have a negative effect. When the penis is already in the erection phase and is additionally stimulated by external stimuli, the so-called surge occurs.

Emission is the first phase of ejaculation, during which, under the influence of the sympathetic nervous system, the smooth muscles of the epididymis, vas deferens, seminal vesicles and prostate contract. This transports the sperm components to the back of the urethra.

Outside of the ejection phase, ejaculation also includes proper ejaculation and bladder neck closure. The rhythmicity of the flow of sperm is due to the correct nervous excitation.

It is the sympathetic fibers mentioned above that are responsible for stimulating the contraction of the muscles that remove sperm and cause contraction of the muscles of the urogenital diaphragm.

In addition, closing the bladder outlet prevents the flow of semen back into the bladder.

3. Erectile dysfunctions and their causes

It is almost impossible to diagnose a single cause of erection problems because it is the result of several factors, both physical and mental. The physical background of erectile dysfunction is more typical for older men, while in younger men, the psychogenic background is the source of dysfunction. Some of the most common causes of erectile dysfunction include:

• circulatory diseases,
• anomalies and damage to the vessels and cavernous bodies of the penis,
• neurological diseases,
• spinal cord and spine injuries,
• atherosclerosis,
• kidney problems,
• type 1 diabetes
• type 2 diabetes
• multiple sclerosis,
• hypertension,
• surgical interventions on the prostate gland,
• smoking,
• alcohol abuse,
• drug abuse,
• use of certain pharmaceutical drugs (high blood pressure medicines, sedative antidepressants, medicines called diuretics)
• hormonal disorders,
• neurological disorders.

Sometimes a man has erection problems only in certain situations. This means that the main cause of the disorder is psychological, and poor erection is psychogenic. The most common psychogenic causes include:

• low self-esteem,
• past traumas,
• fear that the sexual partner will not be satisfied with sexual intercourse,
• coldness towards / from the partner,
• cheating
• guilt,
• unpleasant sexual experiences
• inadequate reactions from the partner,
• penis size complex,
• religious beliefs,
• sexual rigorism,
• educational discipline,
• lack of confidence in their own gender identity,
• unconscious homosexual tendencies,
• purposeful approach to sexual intercourse,
• anxiety disorders,
• depression
• fear of pregnancy
• fear of sexually transmitted diseases (for example, syphilis, gonorrhea),
• negative erotic fantasies,
• deviant preferences.

4. Erectile dysfunction and partner's attitude

Poor erection can cause deep complexes when it comes to sexual intercourse. The discovery of reduced sexual activity has a devastating effect on men's self-esteem and begins to restrict them from free sexual activity. Fear of not keeping up with the pace of a partner during love raptures and a growing sense of guilt hinder their normal functioning.

An unsuccessful sex life sometimes leads to the collapse of relationships. Over time, such problems can lead to the fact that the erection disappears completely. A person's stress will continue to worsen and lead to serious health problems.

One of the conditions for recovery is the correct attitude of the sexual partner, characterized by patience and understanding. Sometimes more intense and prolonged stimuli are enough.

If partner support is not working, the man should start treatment with a specialist. Therapy should start with causes of erection problems.

After excluding organic diseases, a mental block should be considered. Then the man should start psychotherapy. There he will learn to control stress and anxiety, and also learn to cope with complexes.

Unfortunately, as statistics show, many men do not start treatment for erectile dysfunction. The fear of visiting a specialist is too great. Underestimating the problem is the worst possible scenario. This can lead to permanent erection problems and very serious mental problems.

According to statistics, just 2 years after the detection of ED, every fourth man seeks medical help, every third man begins to independently use drugs for potency, and half of the men do not go to the doctor at all and do not respond to their symptoms. anyway.

5. How is erectile dysfunction treated?

How is erectile dysfunction treated? In this case, it is extremely important to recognize the cause of the violations. The doctor who diagnoses the patient must first determine whether the erection problem is caused by mental or physical factors.

Treatment of mental erectile dysfunction requires the use of psychotherapy, training methods with a partner, the use of relaxation techniques, hypnosis, the use of pharmacological agents. Specialists often prescribe sedatives to patients. In many cases, injections into the cavernous body of the penis are also recommended.

If erectile dysfunction is associated with organic factors

it is recommended to take appropriate medications orally (the most famous remedy is Viagra). Vacuum pump and physiotherapy also help in the treatment of sexual disorders. In some cases, injections into the cavernous body of the penis may also be helpful. It happens that the patient needs surgery or prosthetics of the penis.

Lifestyle changes, exercise, weight control, and avoiding cigarettes, drugs, and alcohol can also help treat sexual problems in men. It is also recommended to engage in sexual activity to constantly stimulate the penis.

Erectile dysfunction is not a life-threatening disease, but can sometimes be a harbinger of other serious diseases: atherosclerosis, diabetes mellitus or arterial hypertension. Prolonged and untreated erection problems can lead to severe depression.

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