Impotence / erectile dysfunction, inability to maintain erection for satisfying sexual activity, affects many men sometime during life.
Epidemiological data indicate that 5 to 20% of all men exhibit moderate to severe erectile dysfunction. Other studies have pointed out that approximately 50% of all men over 40 years of age report different degrees of erectile dysfunction. The symptoms often adversely affect the quality of life as well as physical and psychosocial health – both for the patient and for his family. The risk factors are often the same as for cardiovascular disease: inactivity, obesity, smoking, hyperkolesterolemia and metabolic syndrome. Other risk factors are radiotherapy against prostate or passage prostatectomy. Erectile dysfunction may be an early sign of general vascular insufficiency.
SYMPTOM AND CLINICAL FUNNY
Erectile dysfunction is divided into four main groups:
- Endocrine disorders;
- Vascular insufficiency;
- Neurological dysfunction;
- Psychogenic impotence.
Some medicines (cardiovascular vessels) may also cause impotence. However, most patients are observant and register themselves if erectile failure occurs in connection with drug insertion. Antidepressants and neuroleptics can cause erectile and erectile dysfunction.
Normally, the lower limit of S-testosterone is set to 11 nmol / l. Even patients above this value may in some cases be valued by testosterone substitution (at values above 15 nmol / l, however, do not pay for substitution). However, prior to substitution, hypogonadism (insufficient production of testosterone in the primary or secondary cause test) should be ruled out.
Blood flow to the penis must increase approximately 25 times in order for a useful erection to occur. This places great demands on the vascular system.
Three out of four men with suspected somatic impotence have some type of vascular disease. Most commonly, arteriosclerosis with impaired blood flow to the penis. Many of these patients are diabetic or smokers.
Trauma to the small pelvis can cause vascular injury with erectile dysfunction as a consequence – even in young men. Surgical revascularization may in these cases have a good effect.
Pathological leakage via the venous system is a common cause of erectile dysfunction. Patients with venous leakage usually respond poorly to normal treatment. Operational intervention is usually necessary. Investigations are conducted by urologist with so-called kaososometry.
In younger patients, leakage may be due to anatomical malformation in the form of a pathological vessel that drains corpora cavernosa.
In elderly patients, a defect in tunica albuginea may cause inadequate compression of drainage veins.
Patients with spinal cord injury usually do not have normal erectile dysfunction (depending on the location and extent of the injury). Nowadays these patients can often be treated successfully by urologists.
Patients who have lost the ability to erect after major surgical procedures in the small pelvis can also be treated successfully by oral or intracorporeal injections.
Patients with juvenile diabetes often suffer from erectile dysfunction at the age of 40.
Patients with neurodegenerative diseases (eg MS) are often affected by impotence.
In addition, a concurrent psychogenic component occurs in erectile dysfunction. Suspicion of a purely psychogenic impotence is enhanced by the patient’s youth, giving varying sexual ability and maintaining a night / morning reaction. Often there is performance anxiety in the picture, ie the patient is afraid of “failing”. These patients can usually be managed by a general practitioner.
- Medical history;
- Alcohol and smoking;
- sexual History.
Morgonerektioner. A potent man has 2-5 erections during the REM sleep every night. The absence of nocturnal erections can now be diagnosed with sophisticated apparatus such as Rigiscan. Patients with pure psychogenic impotence have normal nocturnal erections:
- Relationship to partner;
- S testosterone;
- IIEF Questionnaire (IIEF = International Index of Erectile Function);
- cardiac Investigation.
May be motivated as erectile dysfunction may be an early sign of vascular pathology – small penile arteries previously reach a critical diameter reduction compared to larger vessels similar to coronary arteries. Studies have shown that patients with erectile dysfunction have a 45 percent increased risk of heart disease within a five-year period.
Hormonal insufficiency is an unusual cause of impotence that is easy to treat.
Treatment options consist of injection (Nebido) was 3 months, testosterone in gel form which is applied once daily (TESTOGEL Tostran or Testim) or tablet (undestor testokaps) morning and evening. Testosterone values are monitored for possible dose adjustment. These patients should be referred to an orrologist or urologist.