Erectile dysfunction (ED) and cardiovascular diseases

Numerous studies in recent years have proven the relationship between ED and cardiovascular diseases. They are often caused by atherosclerosis, which is preceded by dyslipidemia. Atherosclerosis of the arteries of the penis, manifested by ED, is often the primary symptom of systemic atherosclerosis. Therefore, the detection of atherosclerosis in the vessels of one localization increases the chance of finding it in the vessels of another localization. Thus, like fever in the prodrome of influenza, ED can serve as a reliable predictor of cardiovascular diseases in general and atherosclerosis in particular.

Therefore, when dyslipidemia is detected, in order to improve the state of erectile function, in addition to PDE-5 inhibitors, the patient should be additionally prescribed hypolipidemic drugs, such as statins. Such combination therapy with regular use significantly increases the effectiveness of treatment with PDE-5 inhibitors. So, against the background of constant intake of atorvastatin (Liprimar), sildenafil increases the International index of erectile function by 50% (without it-25%). In addition, combined therapy with PDE-5 inhibitors and antihypertensive drugs prevents the progression of atherosclerosis.

ED and cardiovascular diseases

The most difficult joint decision has to be made by a urologist and a cardiologist in men of the intermediate risk group, which includes patients with moderate stable angina, who have suffered a myocardial infarction within two to six weeks, as well as having extracardial manifestations of atherosclerosis (consequences of a brain stroke, obliterating atherosclerosis of the lower extremities) and left ventricular dysfunction/chronic heart failure of the second functional class (according to the classification proposed by the New York Association of Cardiologists).

On the one hand, the use of PDE-5 inhibitors, the gold standard in the treatment of ED, is generally quite safe. PDE-5 inhibitors (sildenafil citrate – Viagra) were originally developed as vascular drugs that significantly improve microcirculation by enhancing NO-dependent vasodilation. So, against the background of taking sildenafil citrate in patients with chronic stable angina, the time to a possible pain attack increased more than twice, the time to an attack requiring limited physical activity – more than three times, and the time to a decrease in the ST segment by 1 cm on an electrocardiogram – by more than 30%.

The risk of myocardial infarction with this drug was 0.5–0.8% (placebo – 0.9%), brain stroke – 0.3–0.4% (placebo – 0.9%), and the frequency of serious cardiovascular complications-2.3 – 3.9 (placebo–4.9) per 100 patient – years. On the other hand, in order to safely restore sexual activity, an in-depth cardiological examination and further follow-up by a cardiologist is necessary to determine which risk group (low, high) the patient belongs to. These circumstances once again emphasize the need for close professional contact between a urologist and a cardiologist in an individual solution to the problem of restoring sexual activity of a patient with cardiovascular diseases.

Erectile dysfunction in diseases of the internal organs

There are numerous risk factors that create favorable conditions for the development of erectile dysfunction (ED): atherosclerosis, coronary heart disease, arterial hypertension, kidney and liver failure, nervous (neuroses, multiple sclerosis, Alzheimer’s disease, neuropathies of various origins), mental (depression, astheno-depressive and hypochondriac conditions), endocrine (diabetes mellitus, hypo-and hyperthyroidism, androgen deficiency, hyperprolactinemia, obesity, metabolic syndrome) and urological (for example, chronic prostatitis) diseases. The most common conditions for which ED becomes one of the characteristic and persistent manifestations are age-related testosterone deficiency (18.3%), diabetes mellitus (35%), arterial hypertension (31%), dyslipidemia as a precursor of atherosclerosis (21%). In addition, the cause of ED can be the use of medications: antihypertensive agents (thiazide diuretics, beta-blockers), cardiac glycosides, blood sugar-lowering agents, hormones (estrogens, progestins, glucocorticoids, antiandrogens, gonadotropin-releasing hormone agonists), tranquilizers, nonsteroidal anti-inflammatory drugs, H2-receptor blockers, etc.

Today, phosphodiesterase inhibitors of the fifth type (PDE-5), intracavernous injections and endophalloprosthetics can solve the problem of ED in the vast majority of cases. However, the current effective treatment of ED is not a private task aimed at restoring impaired sexual function. Due to the variety of causes, ED should be considered as a symptom complex that is part of the clinical picture of a number of diseases of internal organs and systems (somatic), which directly depends on them in terms of severity and severity.

In this regard, the diagnosis of ED, especially developed against the background of diseases of internal organs, and the appointment of therapy, on the one hand, require the knowledge and participation of such specialists as a general practitioner, therapist, cardiologist, neurologist, nephrologist, and on the other, make it necessary for a urologist, andrologist, and sex therapist to closely study internal medicine – the very somatic diseases that are closely related to ED. In other words, ED, like most men’s health problems, is multidisciplinary. Therefore, men with erectile dysfunction have a chance to undergo a detailed medical examination, and as a result of the complex treatment prescribed in time, to improve not only their sexual life, but also, last but not least, their overall health.

Erectile dysfunction as a manifestation of endothelial dysfunction

There is no doubt that organic ED is based on a violation of the function of the vascular endothelium (endothelial dysfunction), which is aggravated by hypertension, dyslipidemia and diabetes mellitus. These disorders cause oxidative stress with a violation of the balance of pro-and antioxidant systems of the endothelium and the further development of persistent vasoconstriction, leading to the progression of hypertension, atherosclerosis with the development of coronary heart disease, their complications as a result of thrombosis with brain strokes and myocardial infarction, and, significantly, an early predictor in the form of ED. According to one study, 57% of men who underwent coronary artery bypass grafting had already suffered from ED long before the operation, and 64% of men hospitalized for the first acute myocardial infarction noted significant erectile dysfunction.

This is indirectly confirmed by common risk factors for ED and coronary heart disease, which include hypertension, diabetes, dyslipidemia, depression, smoking, inactivity, and obesity. Thus, ED should be considered one of the early symptoms of cardiovascular disease. Sometimes patients with cardiovascular diseases are more concerned about ED than the risk of myocardial infarction on the background of coronary heart disease or brain stroke on the background of arterial hypertension. Causing psychological stress in a man, ED can not only aggravate the course of arterial hypertension and coronary heart disease, but also significantly disrupt the relationship between sexual partners, closing the pathological circle of the pathogenesis of the disease.

Erectile Dysfunction. Androgen-Deficiency

Due to the fact that ED is largely endothelial dysfunction, any drug effects aimed at improving the function of the vascular endothelium are considered favorable. In this regard, it is necessary to mention the well-known drug Impaza, which contains antibodies to human endothelial NO-synthase in ultra-low doses. According to the creators, the drug blocks its own antibodies to endothelial NO-synthase, increasing its activity. In this case, the potentiated antibodies to the endogenous regulator do not suppress its activity, but specifically modify it. In ultra-low doses, they have a specific effect, a safety profile equal to homeopathic drugs, do not cause increased individual sensitivity and, therefore, when administered orally, they can be a component of balanced therapy.

The overall sexual satisfaction of patients taking this drug, according to various studies, reaches 74%. At the same time, in 92.6% of patients with mild and moderate ED, regardless of age and duration of the disease, erectile function improves, in 51.8% – orgasm increases, in 48% – libido increases, in 82% – satisfaction with sexual intercourse increases [9]. The advantages of Impaza include the possibility of using it against the background of constant intake of nitrates, and if necessary, the drug can be combined with PDE-5 inhibitors, which significantly increases the therapeutic effect. For example, the International index of erectile function increases by 11% in monotherapy with Impaza of severe forms of ED, and in combination with Viagra – by 34%.

Erectile dysfunction and hypertension

Arterial hypertension in patients with ED is observed in more than 50% of cases and requires mandatory correction. Recovery of sexual function in hypertension may also have adverse consequences, since during sexual intercourse, systolic blood pressure and heart rate may increase by 50-70%. It has been shown that background antihypertensive therapy not only does not reduce the effectiveness of sildenafil, but also reduces the likelihood of developing undesirable side effects from taking this PDE-5 inhibitor. Thus, the feeling of hot flashes without antihypertensive therapy was observed with a frequency of 15.1%, against the background of taking one antihypertensive drug – 12.6%, two-10.4%, dizziness without therapy-2.8%, and when taking three antihypertensive drugs or more-only 1.7%.


The features of the etiology and pathogenesis of ED in somatic diseases of mature and elderly men determine the need to consider this symptom complex from a multidisciplinary perspective. Urologists need to improve their knowledge of somatic medicine. In addition, a patient with ED needs to consult therapists, cardiologists, and endocrinologists. Only joint efforts can improve the quality of life, as well as the prevention of sexual dysfunction in men of working, active mature and elderly age.

About such things as erectile dysfunction and chronic prostatitis, ED and androgen deficiency, Ed and cardiovascular diseases, we will talk in our next article.

Restoration of potency after transurethral resection

Transurethral resection of the prostate is a minimally invasive and effective operation that is prescribed to patients with benign prostatic hyperplasia. Despite the minimal invasiveness, this method is characterized by some complications, among which there is a violation of potency. This condition is quite a serious problem, especially for young men. Fortunately, the violation of potency can be temporary and with proper, professional treatment disappears after a certain time.

Why is potency disturbed after surgery

According to the results of numerous studies, it was found that up to 40% of patients who underwent transurethral resection of the prostate gland face erectile dysfunction of various degrees of severity. The exact causes of this complication have not yet been established, but scientists have several assumptions. The psychological factor is also not ignored. The experiences of a man before surgery on an important organ for him have a negative effect on the erection. This is also facilitated by the painful sensations after transurethral resection – some men noted that because of the postoperative pain when urinating, they are afraid to enter into an intimate relationship. However, after 3-6 months, when the pain went away, they had a complete recovery of the erection.

What should I do if potency has disappeared after transurethral resection?

First of all, you need to contact a competent specialist. Self-medication, the use of traditional medicine and other methods can significantly worsen the patient’s condition. Before you start to restore potency, you need to be diagnosed and determine the cause of its violation. To do this, you will need to go through several stages:

  1. Interview with a doctor, analyze complaints, collect anamnesis, study the details of the operation.
  2. Laboratory tests. The doctor may prescribe the determination of the level of hormones in the blood, etc.
  3. Instrumental examination. It may include such methods as transrectal ultrasound of the prostate gland, Dopplerography of the vessels of the penis.

Experts emphasize that a decrease in the quality of sexual life is quite common, especially in elderly patients who have undergone any manipulations on the prostate gland. Do not hesitate to visit the doctor and try to solve the problem yourself. This approach can only make the situation worse.

transurethral resection

How to restore an erection after transurethral resection of the prostate gland

Modern medicine can offer several ways to help restore potency. Treatment can be complex, or limited to only one method. The exact plan is always developed individually and may include:

  • LOD-therapy. This method allows you to increase blood circulation in the vessels of the penis, restore the destroyed nerve connections and reflex mechanisms that are involved in the occurrence and maintenance of potency, due to local negative pressure. The treatment is relatively simple, but requires a certain amount of time to achieve the result.
  • Shock-wave therapy. The efficiency of the method is about 70%. The procedure helps restore blood circulation in the cavernous bodies, accelerates tissue regeneration after surgery, and relieves inflammation and pain. Of course, all these processes have a positive effect on potency.
  • Drug therapy. It includes the appointment of special drugs in tablet form, as well as injections into the penis. The latter method is considered the most effective, although not the most pleasant.
  • Related procedures. The recovery process can be affected by the patient’s exercise and lifestyle. In particular, it is recommended to give up smoking and other bad habits, it is necessary to eat properly, to be in the fresh air more often, to lead a mobile lifestyle.

In exceptional cases, when conservative treatment does not bring the desired result, penile prosthetic surgery (phalloprosthesis) may be prescribed. It should be approached very carefully, especially in elderly patients.

Thus, there are various ways to restore potency after transurethral resection of the prostate. Initially, it is important to determine the cause of this problem and find out the individual characteristics of the patient. It is impossible to get such information on your own, so if you develop erectile dysfunction, you should contact a urologist-andrologist. The doctor will conduct an examination, prescribe the necessary diagnosis and select the optimal treatment plan, which will need to be strictly followed. Only if all these conditions are met, you can achieve the maximum chance of recovery.

How to replace Viagra – effective natural substitutes

Replace Viagra with natural aphrodisiacs

Natural aphrodisiacs affect erectile function and increase sexual activity, but they can not be considered a full-fledged substitute for Viagra. Yes, they increase sexual arousal, but they do not affect the state of the enzymes, and also do not suppress the premature release of seminal fluid.

The most effective natural aphrodisiacs are:

  • shellfish;
  • greenery;
  • nuts;
  • honey;
  • coffee;
  • dark chocolate;
  • cayenne pepper.

how to replace viagra

Natural Viagra for Men

You can take organic supplements, the action of which is aimed at restoring the process of blood circulation in the pelvis. These preparations may contain ginseng extract, deer antler (we do not trust this), walnut and other additives.

Such drugs stimulate the work of the reproductive system, improve the overall well-being and the state of the nervous system, restore the production of sperm. Home-made Viagra is called ginseng tincture. To prepare it, you need to put 100 grams of ginseng in a glass dish, pour 500 milligrams of vodka, and insist for a month. Take the product 30 drops once a day for one month.

What drugs can be taken instead of Viagra

There are a lot of such drugs, we will present two of them, this is Cialis Soft – an effective drug that provides a long-term stimulating effect. In the composition of the drug contains Tadalafil. The substance increases the quality of erection and blocks the process of early ejaculation. The effect of the product lasts at least 24 hours. And Levitra, which contains the inhibitor Vardenafil, which, like the main component of Viagra, suppresses premature ejaculation by reducing the production of the enzyme PDE-5. The action of the product lasts eight to ten hours.

We also recommend Dapoxetine – an effective tool for prolonging sexual intercourse. The drug has an inhibitory property, without reducing the sensitivity of the nerve endings. The effect lasts four hours, but dapoxetine is intended only for episodic use. It is effective for serious erectile dysfunction and does not cause any addiction.

How does hirudotherapy help in matters of potency?

Hirudotherapy: The use of leeches for medical therapy. From hirudin, the active principle in the salivary secretion of leeches that acts as a potent anticoagulant (blood thinner).

hirudotherapy or viagra

Would you be able to treat yourself with leeches? Well, who’s brave?

Hirudotherapy within the framework of urology is becoming more popular year by year. More and more doctors are talking about the effectiveness of this type of treatment.

In urology, the indications for hirudotherapy are:

However, this is not all that such seemingly ordinary leeches help to cope with.

They solve such problems as pyelonephritis, cystitis, renal colic, low libido, hydronephrosis.

By the way, in the treatment of priapism and elephantiasis of the scrotum, leeches are almost the only treatment.

Well, where is it without potency! This is one of the main topics for men, and leeches and really well solve this issue. Why is this happening?

With the help of hirudotherapy, you can well improve blood circulation in the pelvic area. Blood completely fills the cavernous bodies of the sexual organ and there are no difficulties with potency. The effect of this procedure is visible almost immediately. Almost like after Viagra.

Chronic prostatitis and erectile dysfunction

Prostatitis and erectile dysfunction-at all times, men have faced these problems. There is no” age ” in this insidious disease, it can appear even in young men. It is known that one of the causes of erectile dysfunction is chronic prostatitis. Therefore, due to such a close relationship between the two diseases, the approach to the treatment of erectile dysfunction should be comprehensive.

What is erectile dysfunction?

Normal erectile function in a man includes the ability to get an erection hard enough to penetrate a woman’s vagina, and maintain that erection long enough to complete sexual intercourse.

Erectile dysfunction is the inability to obtain and / or maintain a penile erection sufficient for adequate sexual relations. Early signs are loss of a morning erection, premature ejaculation, and lack of interest in sexual activity. It is known that smoking, drug use, and alcohol abuse play an important role in this issue. The risk of developing erectile dysfunction increases with concomitant conditions such as type II diabetes, obesity, cardiovascular disease, hypertension, and dyslipidemia. However, the most common cause of erectile dysfunction is infectious diseases, with prostatitis in the first place.

What is prostatitis?

Prostatitis is an inflammatory disease of the prostate gland. It can affect all men: those who are in monogamous or polygamous relationships, and even virgins. Prostatitis is a very common pathology of the genitourinary system. Among the serious consequences of this disease can be called erectile dysfunction – many men mistakenly associate “failures” in sexual life with stress at work, fatigue and lack of sleep. But modern research has shown that infectious diseases, such as prostatitis, are most often the cause of problems in sexual relations.

To get rid of prostatitis, as well as to avoid serious complications (for example, impotence and infertility), it is necessary to seek qualified medical help from a urologist-andrologist when the first symptoms appear.

The main symptoms of prostatitis

  • Frequent urination.
  • Feeling of incomplete emptying of the bladder.
  • Pulling pains and discomfort in the lower back, lower abdomen and perineum.
  • Whitish or greenish discharge from the urethra.
  • Pain and heaviness in the anus.
  • Decreased libido and potency.

Prostatitis and erectile dysfunction, what is the connection?

If the endothelium of the vessels of the penis is damaged by exposure to chronic diseases and toxins, this leads to a decrease in erection.

However, there is another version: most doctors believe that sexual disorders in prostatitis are usually psychological in nature. Constant and exhausting pain causes depression and increased anxiety, unpleasant symptoms and chronic pain syndrome affect not only the general well-being, but also the mood of the man, brings him stress and discomfort. However, most modern urologists are of the same opinion: the cause of erectile dysfunction lies in organic damage to internal organs.

The importance of the prostate gland in the process of erection

Erection from the point of view of normal physiology is caused by complex neurovascular mechanisms, with several central and peripheral neurological mechanisms involved in addition to molecular, vascular, psychological and endocrinological factors, and the balance between them is what ultimately determines the functionality of the penis.

An erection is not a mechanical act that can be used as a hydraulic jack to lift at any time. It is a subtle physiological process that begins with a stimulus perceived by the brain, and that comes from visual perception, smell, sensation, or touch.

prostatitis and erectile dysfunction

A person’s sensitivity to this sexual stimulus largely depends not only on their level of the hormone testosterone, but mainly on its conversion to the active metabolite dihydrotestosterone, which is formed inside a healthy prostate under the influence of an enzyme called alpha-reductase. And if there are problems with the prostate gland, respectively, problems will appear with the metabolite, which will lead to difficulties during sexual intercourse.

Restoration of potency and treatment of prostate damage

If erectile dysfunction occurred against the background of infection, then no Viagra will help: it is necessary to remove the main cause.

Bacterial prostatitis, like any infection, is treated with antibiotics. However, to create the necessary concentration of drugs in the prostate, in the focus of infection, antibiotics are very difficult, and sometimes impossible. This is due to the fact that as a result of inflammation and swelling in the prostate, blood supply is significantly reduced. Only complex treatment will be effective – a combination of medications and physiotherapy that improves blood supply to the prostate gland, relieves its swelling. The doctor may prescribe such courses as extracorporeal magnetic stimulation, vibromagnetolaser massage, sinusoidal modulated currents, shock wave therapy, ozone therapy.

If the doctor prescribed the correct treatment and the man followed all the prescriptions and recommendations, then with the elimination of inflammation in the prostate, violations in sexual life disappear without a trace.

Prostatitis and erectile dysfunction: prevention

  • Regular sex life (this is a purely individual issue, but up to 30 years of age, the frequency of sexual contact 2-3 times a week is considered the norm).
  • Hygiene during sexual intercourse.
  • Healthy lifestyle.
  • Exclusion of injuries and hypothermia.
  • Regular urological examination (at least once a year for men over 40 years of age).

A person’s recommended lifestyle should include regular exercise, adequate sleep, smoking cessation, a balanced diet with an emphasis on Mediterranean food, and moderate alcohol consumption.

In order to feel masculine strength for as long as possible and maintain a high quality of life, when the first unpleasant symptoms appear, do not delay a visit to a qualified urologist-andrologist. Complete a comprehensive urological examination, get an accurate diagnosis and effective treatment.

Sexual dysfunction and social adaptation

Sexual dysfunction: The concept of “violation of sexual function” traditionally includes a whole range of problems: these are violations of sexual desire, sexual arousal and orgasm, as well as pain during sexual intercourse caused by both medical and psychological problems of a person. Usually, even one of these problems leads to the inability or unwillingness to lead a sexual life, which seriously affects the social role of a person. And believe me, no viagra will help here.

Lack of sexual activity is a serious problem in people’s relationships. According to studies conducted in America in the 70s, 35% of women and 15% of men under the age of 50 say that they do not want to have sex with their spouse, and among young (under 30) unmarried people, 8% complain about the lack of sexual life in the presence of a partner.

Sexual dysfunction: Reasons

Doctors identify many reasons for the lack of sexual activity in couples. Traditionally, they are divided into psychological and organic.

Psychological factors include factors that are tied to a person’s perception of the surrounding reality. Among the most common are::

  • self-doubt;
  • fear of contracting a sexually transmitted disease;
  • overwork;
  • constant voltage;
  • insomnia.

But in addition to this, the cause can be child psychological trauma, temperament properties, difficulties in relationships with people, and much more.

Organic factors are associated with innate or acquired features due to diseases. They are associated with the physical inability to perform sexual intercourse. These can be:

It is worth noting that organic and psychological factors cannot be completely separated from each other. In about 5% of cases, they are closely interrelated.


Due to the lack of sexual life in a couple, there are usually serious problems in the relationship. Usually they are accompanied by depression, irritation, isolation. A man who is faced with impotence may not go to the doctor for a long time because of embarrassment, instead poisoning his body with numerous folk remedies and pills, which can then adversely affect his health as a whole.

sexual dysfunction

The main sign of the weakening of potency is a decrease in interest in sex, thoughts and fantasies on this topic disappear. The morning erection characteristic of a man’s body disappears or becomes irregular, and it also does not occur during sexual caresses. An erection can also disappear right during sexual intercourse. Sometimes a man may not attach importance to these “bells”, as this does not happen simultaneously.

Due to the huge number of reasons that can lead to violations of sexual function, the diagnosis can only be prescribed by the attending physician after the examination and collection of anamnesis. A few simple rules will help to prevent violations of sexual function.

Signs of impotence. Prevention and diagnosis of the disease

Modern medicine uses a term such as “erectile dysfunction” (ED) to refer to disorders associated with the partial or complete loss of a man’s ability to perform sexual intercourse (signs of impotence). Previously, this sexual impotence was called “impotence”, it was usually attributed to the natural age-related (along with this psychological and physiological) changes in the body.

The diagnosis of “erectile dysfunction” (“impotence”) can be made only to those men who have more than 25% of sexual acts were unsuccessful. Often, in the presence of physical abnormalities, the libido in these patients persists, which creates additional psychological problems. Modern medicine has reached a level of its development, thanks to which the diagnosis allows you to detect erectile dysfunction (impotence) in the early stages and select an adequate prevention. This gives a high chance of restoring a man’s sexual abilities after undergoing special therapy.

Symptoms of erectile dysfunction

The initial manifestations of the disease can be observed in more than 30% of the stronger sex at the age of 18-59 years. The first signs of impotence in men are expressed in the following symptoms of sexual disorders.

signs of impotence

Lack of erection. The first sign of impotence (erectile dysfunction) may be the absence of not only adequate, but also spontaneous morning and night erections. In cases where there is no adequate erection, but at the same time there is a spontaneous one, it is more likely that impotence is psychological in nature. With a simultaneous violation of both adequate and spontaneous erectile function, specialists diagnose the disease of an organic form.

Weak erection. One of the most important symptoms of impotence is a decrease in rigidity and the frequency of erections. This group also includes the lack of firmness of the penis during sexual intercourse. In this case, impotence can be a sign of vascular, neurogenic, hormonal and other organic disorders, somewhat less often it appears due to psychological problems.

Inability to maintain an erection. One of the first manifestations of erectile dysfunction (impotence) is premature ejaculation – an uncontrolled release of seminal fluid that occurs immediately at the very beginning of sexual intercourse or even before it. The cause of this sexual dysfunction is organic in nature and, as a rule, this symptom is associated with vascular disorders. Premature ejaculation in psychogenic impotence is quite rare.

Despite the widespread prevalence of organic causes of impotence, experts have found that in 9 out of 10 cases, sexual disorders appear against the background of unfavorable psychological factors. If a man notices at least one of the above manifestations, he should consult a doctor as soon as possible, identify the causes of the disease and choose methods of treatment and prevention of erectile dysfunction.

Stages of diagnosis of erectile dysfunction

If there are signs of impotence in men, it is necessary to promptly conduct a diagnosis and a number of therapeutic measures. In this case, it is necessary to develop a system of prevention of impotence together with a specialist. Diagnosis of erectile dysfunction can be carried out in several stages.

Determination of patient complaints. At the first appointment, the doctor should ask the patient about problems in their sexual life. Symptoms of impotence (erectile dysfunction) are detected after filling out a special questionnaire – the International Index of Erectile Function (ICEF-5). The survey form includes 5 simple questions. The answers to them allow the specialist to assess the degree of impotence, choose prevention and treatment.

Psychosocial examination. Great importance in the diagnosis of sexual disorders is given to the analysis of the psychological state of the patient. The doctor needs to find out what kind of relationship the patient has with a sexual partner, what kind of reaction they both show to erectile dysfunction. Effective treatment and prevention can not be prescribed without determining the presence or absence of a man’s anxiety and depressive states. In these cases, the most effective treatment is not medication for erectile dysfunction, but a consultation with a neurologist or psychotherapist.
Collection of medical history. In about 21% of cases, the causes of organic forms of impotence are regular medication or surgery. The collection of a medical history is necessary to identify these actions and their impact on the body of a man. Also, in the anamnesis, information should be collected about bad habits, systemic and chronic diseases, taking medications and narcotic drugs, conducting radiation therapy on the pelvic organs, etc.

Physical examination. During the examination, the doctor evaluates the patient’s physique, special attention is paid to the severity of secondary sexual characteristics in the man. One of the main tasks of the examination is to identify problems associated with the improper functioning of the thyroid gland. This includes physical examination, changes in pulse rate, skin problems, etc. A medical examination of the external genitals shows the condition of the scrotum, possible changes in the shape of the penis (congenital or with Peyronie’s disease). Prostate diagnosis (to determine inflammation) is performed rectally. Physical examination allows you to determine the causes and degree of erectile dysfunction. For example, if a weak sensitivity of the penis is detected, then the cause of impotence may be a lesion of the nervous system. In the case when the patient is diagnosed with an increase in the mammary glands, a small size of the testes, slow growth of facial hair, these are signs of problems with low testosterone levels in the blood.

Laboratory tests. Diagnosis of erectile dysfunction involves measuring the blood pressure in the vessels of the penis, conducting ultrasound and radioisotope scanning. The most effective method for detecting signs of impotence is to monitor spontaneous nocturnal erections. Normally, their duration is at least 20% of the total sleep time. This percentage of erections with reduced rigidity increases significantly with age.

Erectile dysfunction (impotence) is a treatable sexual disorder. In 95% of cases, if the course of therapy was started in a timely manner, the patient comes to a full recovery. Prevention of impotence includes a number of simple actions: maintaining a healthy lifestyle, limiting alcohol intake, complete abstinence from smoking and taking drugs, maintaining a regular sexual life (without frequent changes of partners, sexual excesses and prolonged abstinence). Before taking any medications for impotence, you should first consult with a specialist. If a man has undergone surgery on the pelvic organs or has had an injury, he will need the help of a urologist.

Evaluation of the informative value of diagnostic methods in determining the etiology of ED

Diagnostic ED: A large number of research papers on the physiology of erection and the pathophysiology of erectile dysfunction have been published, which have revealed the problem of studying the informativeness of diagnostic methods aimed at identifying the etiology of ED.

Currently, due to the wide choice of laboratory and instrumental diagnostic methods, the question arises about their irrational use, since some of them have insufficient information content and do not have diagnostic significance, and therefore do not play a special role in determining the further tactics of managing patients with erectile dysfunction. At the same time, it should be noted that the strategy for treating ED depends on the effectiveness and timeliness of diagnostic measures, and the delay in finding the causes of erectile disorders negatively affects the effectiveness of therapy.

To establish the etiopathogenetic mechanism of ED development, a comprehensive integrative approach is used, which implies step-by-step laboratory and instrumental studies. However, this does not always make it possible to obtain reliably significant information necessary for making a decision on the further plan of therapeutic and diagnostic measures.

The determination of diagnostic parameters that are highly specific and sensitive in determining the etiology of ED will reduce the frequency of unnecessary diagnostic measures and increase the accuracy of the really necessary diagnostic methods, which means that the optimal therapeutic tactics will be chosen.

Purpose of the study: To evaluate the informativeness of the diagnostic parameters used in determining the etiology of ED.

Materials and methods diagnostic ED

The study involved 465 men who complained about the inability to achieve and maintain an erection sufficient for sexual intercourse. The median age of the patients was 39 (30-49 years). The study did not include patients with cancer, autoimmune, or mental illnesses identified during the examination.

All participants underwent a step-by-step comprehensive diagnosis, including a clinical and anamnestic examination, a questionnaire (according to the questionnaire of the international index of erectile function 15), a physical and laboratory-instrumental examination. The results of a biochemical blood test (total protein, total bilirubin, creatinine, urea, alanine aminotransferase, aspartate aminotransferase, glucose) were evaluated with the determination of lipid (total cholesterol, high-and low-density lipoprotein cholesterol, triglycerides) and hormonal (total testosterone, sex hormone-binding globulin, estradiol, prolactin, and thyroid-stimulating hormone) profiles.

All patients underwent pharmacodopplerographic examination of the vessels of the penis using intracavernous injections of prostaglandin E1 (none of the patients had contraindications to this procedure). Diagnostic parameters such as the peak systolic blood flow rate in the cavernous arteries (Vmax a. cavernosa), the final diastolic blood flow rate in the cavernous arteries (Vend a. cavernosa), the index of resistance of the cavernous arteries, as well as the maximum speed and time of preservation of blood flow in the deep dorsal vein were evaluated.

diagnostic ED

All patients also underwent a non-invasive examination of the endothelial system function using a special EndoPat hardware complex with the determination of the value of the reactive hyperemia index, which allows us to assess the presence or absence of endothelial dysfunction.

Based on the results of the examination, the patients were divided into two groups for a consistent statistical analysis. The first group included 319 (68.6%) men with diagnosed organic forms of ED, the median age was 44 years. The second group included 146 (31.4%) men who had confirmed ED that was not associated with organic factors, the median age was 30 years.


According to the results of the study, diagnostic parameters that are sufficiently informative make it possible to timely identify risk factors and pathological conditions underlying the etiology of ED, avoiding overdiagnosis. Diagnostic parameters that have unsatisfactory information content can be conditionally considered as additional if appropriate clinical data are available.

Through the consistent use of informative diagnostic parameters, it is possible to establish risk factors, as well as concomitant somatic diseases that are associated with the development of organic forms of ED, in order to determine further therapeutic and diagnostic tactics.

Tadalafil in the treating of erectile dysfunction

Erectile dysfunction (ED) is the inability to achieve or maintain an erection that allows for coitus. In more than 67% of men, the deterioration in the quality of sexual life occurs due to erectile dysfunction. The prevalence of the disease correlates with age. ED is detected in 40% of men aged 40-50 years, in 57% – at the age of 50-60 years and in 70% – over 60 years. It is expected that by 2025, more than 300 million men will suffer from erectile dysfunction. When determining the treatment strategy, it should be taken into account that 31.5-44% of the male population remain sexually active until the age of 80. Consider the treating of erectile dysfunction on the example of tadalafil.

To date, the first-line drugs for ED therapy are phosphodiesterase type 5 inhibitors (PDE-5), which have been used for the treatment of erectile dysfunction since 1998.

During sexual stimulation, the parasympathetic nervous system is first activated, after which a relaxing factor – nitric oxide-is released from the vascular endothelium, which leads to the accumulation of cyclic guanosine monophosphate in the cavernous tissue and relaxation of the walls of the fetal arteries and cavernous bodies. The result of the active filling of the cavernous bodies of the penis with arterial blood is the compression of the venules, which allows you to block the outflow of blood, thereby provoking the appearance of an erection. It is important to note that when the intracellular activity of PDE-5 is suppressed, even a slight activation of guanylate cyclase can cause a sharp increase in the concentration of cyclic guanosine monophosphate inside the cell. As a result, the tone of the smooth muscle framework of blood vessels decreases with a further drop in blood pressure. That is why the use of nitrates is contraindicated in the appointment of PDE-5 inhibitors.

There are currently four PDE-5 inhibitors on the market: sildenafil, tadalafil, vardenafil, and udenafil. Speaking about the pharmacodynamic properties of these drugs, it is necessary to note the selectivity of their effect on PDE. Thus, sildenafil and vardenafil have similar selectivity for PDE-5. In addition, they have a weak depressing effect on PDE-1 and 6. It is known that blocking PDE-6 can provoke color perception disorders. Exposure to PDE-1 leads to side effects from the cardiovascular system. In contrast to other drugs of the discussed group, the affinity of tadalafil for PDE-1 is significantly weaker. It has been proven that this drug, which is highly selective against PDE-5, inhibits PDE-6 to a lesser extent, which minimizes the likelihood of side effects, in particular from the side of vision.

At the same time, the tadalafil molecule has a high affinity for PDE-11, which is found in muscle tissue. For this reason, patients taking tadalafil are more likely to have myalgia and back pain. However, daily intake of tadalafil in low doses (2.5–5 mg) can reduce the frequency and severity of headache, nausea, dizziness, myalgia, and redness of the face by three to five times compared to its on – demand intake at a dose of 10-20 mg. The low level of side effects of tadalafil is due to the long half-life of the drug, which allows it to be used in low doses. A number of studies have revealed the absence of serious side effects on the background of daily intake of tadalafil. In addition, it was found that against the background of long-term use of tadalafil, the frequency of side effects significantly decreased over time.

S. McMahon and co-authors analyzed the results of treating of erectile dysfunction. Of the 70 men who took taladafil (20 mg) on demand, 73% gave responses indicating a significant improvement in the quality of an erection. According to D. Hatzichristou and co-authors, patients suffering from diabetes mellitus also noted an improvement in erectile function against the background of daily tadalafil intake without pronounced changes in the level of glycated hemoglobin.

treating of erectile dysfunction

In addition to the advantages characteristic of the entire class of PDE-5 inhibitors, tadalafil has a number of unique properties. Its half-life is 17.5 hours, which provides more than 36 hours of drug action. This duration is especially relevant for young patients with high sexual activity. Daily intake of tadalafil (5 mg) allows you to maintain the therapeutic level of the drug in the body of a man, sufficient to preserve the spontaneity of sexual life and does not require prior planning of sexual intercourse. It was found that 79.2% of women preferred their partner to take tadalafil rather than sildenafil, citing a more comfortable approach to sexual contact and intimacy. Thus, the spontaneity of sexual life against the background of daily therapy with tadalafil is an important and attractive factor for most partners of men suffering from erectile disorders. In another study, it was shown that the constant intake of tadalafil 5 mg / day as an effective method of treating ED satisfied both men and their sexual partners.

Treating of erectile dysfunction – Conclusion

Thus, tadalafil in comparison with other representatives of the group of PDE-5 inhibitors has a number of undeniable advantages. First of all, this is due to the duration of its action, due to the long half-life of the drug. The constant concentration of the drug in the blood allows you to maintain the spontaneity of sexual contacts, which, of course, has a positive impact on the quality of life of both patients and their partners. In addition, tadalafil is presented in various dosages, which makes it possible to use the drug daily, increases adherence to treatment with a reduced likelihood of side effects.