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.
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%.
Conclusion
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.