Category: Male Health

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.

January 12, 2022 / by Kevin Roberts

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.

Results

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.

December 13, 2021 / by Kevin Roberts

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.

November 16, 2021 / by Kevin Roberts

Experience in the use of alpha-lipoic acid in the treatment of erectile disorders in patients with diabetes mellitus

Alpha-lipoic acid in the treatment of erectile: To date, there are more than 250 million patients with diabetes mellitus, a chronic non – communicable disease with a pandemic growth rate, in the world alone. At the same time, about 50% of all patients with diabetes are patients of the most active and working age (40-59 years).

Experts of the International Diabetes Federation predict that the number of such patients will increase by one and a half times by 2025 and reach 380 million, mainly due to type 2 diabetes. Data from control and epidemiological studies conducted by the Endocrinology Research Center from 2002 to 2009 indicate that the real number of patients with diabetes is two to three times higher than the registered one and amounts to about 9 million people.

Alpha-lipoic acid in the treatment of erectile dysfunction

The prevalence of erectile dysfunction – a permanent inability to achieve and maintain an erection sufficient for successful sexual intercourse, among diabetic patients, according to various studies, ranges from 20 to 85%. Having diabetes increases the risk of erectile dysfunction by two to four times compared to healthy men of the same age.

In total, about 75% of men with the disease sooner or later notice erectile dysfunction, while such disorders occur in them much earlier than in healthy men, are more severe and more reduce the quality of life. The age of patients, the duration of the course of diabetes, the severity of metabolic disorders (uncontrolled glycemia, hyperlipidemia), the presence of diabetic neuropathy, retinopathy, nephropathy, macroangiopathy are important risk factors for the development of erectile dysfunction in people with diabetes and no viagra can help here.

The role of alpha-lipoic acid drugs in the treatment of erectile dysfunction

For a long time, various preparations of an endogenous antioxidant – alpha-lipoic acid, which is formed during the oxidative decarboxylation of alpha-keto acids, have been successfully used in practical healthcare in Russia. The antioxidant effect of alpha-lipoic acid is due to the presence of two thiol groups in the molecule, the ability to bind free radicals and free tissue iron and prevent its participation in lipid peroxidation.

The property of normalization of cellular metabolism is realized by direct inactivation of free radicals due to their binding by SH-groups of alpha-lipoic acid. The acid not only has its own antioxidant potential, but also provides powerful support for other antioxidant links in the body. Its protective effect is closely related to homeostasis in the system of glutathione and ubiquinone. Alpha-lipoic acid also enhances the anti-inflammatory effects of glucocorticosteroids. In addition, this acid is similar in pharmacological properties to B vitamins, as a result of which it is able to reduce blood glucose levels (the effect of glucose utilization) and increase the content of glycogen in the liver.

alpha-lipoic acid in the treatment of erectile

Of particular interest are the results of a recent study of the effectiveness of alpha-lipoic acid in patients with type 2 diabetes and erectile dysfunction, conducted at the Research Institute of Urology. Alpha-lipoic acid was administered at a dose of 600 mg / day and the parameters of erectile function, libido, and symptoms of androgen deficiency were evaluated. The study involved 86 men aged 43 to 59 years (mean age 51 years) with compensated (HbA1c < 7%) type 2 diabetes and erectile dysfunction. 52 men of the main group received alpha-lipoic acid. The control group consisted of 34 patients.

The effectiveness of treatment was evaluated 12 weeks after the appointment of alpha-lipoic acid based on the completion of the validated ICEF-5 scale and the questionnaire of age – related symptoms of men (Aging Male Simptoms-AMS). When analyzing the results of the study, the patients of the main group showed a significant increase in the sum of ICEF-5 scores from 18 (13-21) to 22 (20-24) and a decrease in the AMS score from 42 (35-44) to 33 (29-34) compared to the control group, where there were no significant changes in the scores according to the questionnaires.

The researchers believe that taking into account the positive pathogenetic effect of alpha-lipoic acid on the endothelium of the cavernous arteries, as well as on the cavernous nerves, new possibilities for its use in the treatment of erectile dysfunction in patients with DM and other forms of erectile dysfunction, taking into account the general mechanisms of development.

Conclusion

Erectile dysfunction is an urgent problem for patients with diabetes – a widespread worldwide disease with a high growth rate. Pathogenetic therapy of erectile dysfunction in patients of this category necessarily implies compensation for DM and a decrease in the severity of symptoms of peripheral diabetic polyneuropathy.

For a long time, for the treatment of diabetic neuropathy, the administration of various alpha-lipoic acid drugs has been successfully practiced, which reduce the manifestations of oxidative stress – the leading factor in the pathogenesis of diabetes and its complications. The possibility of effective administration of alpha-lipoic acid in erectile dysfunction in patients with DM determines the relevance and prospects of its clinical use.

October 21, 2021 / by Kevin Roberts

Pharmacotherapy of erectile dysfunction

Pharmacotherapy of erectile dysfunction: Erectile disorders are often the cause of reactive states, lead to loss of interest in life and even suicidal attempts, socially maladapt the personality. In 30-70% of cases, erectile dysfunction is the cause of depression.

Erectile disorders are not just a male problem. The “side effects” of this condition are also reflected in sexual partners. Among the women surveyed whose partners had erectile disorders, 60% reported a decrease in interest in sex compared to 29% of those with partners who did not have erectile disorders, 44% had problems with lubrication compared to 11% whose husbands did not have sexual problems, and 52% reported difficulties in achieving orgasm compared to 20% of women with partners without any sexual disorders.

The relevance of the problem of erectile disorders is undoubtedly related to the prevalence of this condition, which is clearly demonstrated by epidemiological and social studies conducted around the world.

50% of men worldwide over the age of 40 suffer from erectile disorders of varying severity: 30 million men in the United States, 31 million in Europe, 7-8 million in Russia, although the data is very understated. By 2025, the WHO predicts that 900 million men will suffer from erectile dysfunction. The largest increase is expected in developed countries, large industrial centers.

Back in 1940, Stekel wrote, warning that “impotence is a disease associated with modern civilization”, and the famous psychiatrist Ouden described our century as “an era of anxiety”. The widespread and steady growth of erectile disorders in the population has led the WHO to classify erectile dysfunction (ED) as one of the most important problems of our time. Moreover, in 2000, the WHO set of documents legally spelled out the “fundamental rights of citizens to sexual health”.

The progressive growth of erectile disorders is primarily due to the demographic situation in developed countries – the global aging of humanity, the increase in life expectancy in Europe and North America. Someone solves the problem with an erection with the help of Viagra, someone is not treated at all.

Also, the key points of this process are the growth rates of risk factors, the main of which are cardiovascular diseases and diabetes mellitus. According to a number of researchers, a steady increase by 2025. ED of up to 900 million people will be associated with a similar increase in the incidence of diabetes. The increase in the frequency of ED is also associated with population growth, mainly due to third world countries. The socio-economic factor is also key.

Trends in the growth of erectile disorders vary in different countries of the world, which is explained by the peculiarities of national and cultural traditions, the degree of development of the information base and a number of other factors.

Pharmacotherapy of erectile dysfunction: Therapy

Modern oral therapy is more than 40 years old. Pharmaceuticals differ in the target point and are divided into drugs of central and peripheral action. The mechanisms of action of non-hormonal drugs are different and are based on the blockade of a-adrenergic receptors (phentolamine, iohimbine), serotonergic receptors (trazodone), stimulation of dopaminergic receptors (apomorphine) and blockade of phosphodiesterases (Viagra, Levitra, Cialis). These groups of drugs can be used as a course of monotherapy or for the purpose of sexual adaptation (pharmacoprosthesis).

pharmacotherapy of erectile dysfunction

Despite the certain effectiveness of central-acting drugs, the prevalence of side effects over therapeutic, as well as the systemic effect at the central nervous system level, in our opinion, are a limiting factor for the widespread use of this group of drugs in the correction of ED.

The accumulated clinical experience currently allows specialists to take a more detailed approach not only to solving the problem of erectile disorders, but also to qualitatively change the sexual life of the patient as a whole, taking into account his needs and desires.

September 27, 2021 / by Kevin Roberts