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Erectile dysfunction or Impotence

Erectile dysfunction ( ED), also known as impotence, is a form of sexual dysfunction characterized by the inability during sexual activity to produce or sustain a penile erection. ED can have psychological implications, as it can be related to problems in relationships and self-image. For around 80 per cent of cases, a physical cause can be found. That include cardiovascular disease, diabetes mellitus, neurological complications such as prostatectomy follow-up, hypogonadism and side effects of the drug. Psychological impotence is when, due to thoughts or emotions, erection or penetration fails; this is much less common, around 10 percent of cases. There is a good response to placebo-treatment in psychological impotence. The term erectile dysfunction does not refer to other erection conditions, such as priapism. Treatment involves treating the root factors, changing the lifestyle and solving psychosocial issues. A trial of pharmacological therapy with an inhibitor of PDE5, such as silde...
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Symptoms

ED is defined by the frequent or persistent failure to obtain or sustain adequate rigidity erection to perform sexual activity. It is described as the "persistent or recurring inability to achieve and maintain sufficient rigidity in a penile erection to allow for satisfactory sexual activity for at least 3 months."  Psychological influence  Sometimes ED affects both men and their partners' emotional well-being. Many people do not seek treatment because they feel ashamed. Around 75% of diagnosed ED cases go untreated.
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Causes

Causes of or contributors to ED shall include:  Prescription medications (e.g. SSRIs, beta blockers, agonists of adrenergic receptors alpha-2, thiazides, hormone modulators, and 5α-reductase inhibitors) Neurogenic disorders (for example, diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis , Parkinson 's disease, multiple system atrophy)  Cavernosal (e.g. Peyronie 's disease) disorders  Hyperprolactinemia (for example, with a prolactinoma)  Psychological causes: anxiety over success, stress and mental disorders  Surgery (for instance radical prostatectomy)  Aging: In men aged 60s it is four times more common than in men of their 40s.  Kidney insufficiency  Lifestyle habits, particularly smoking, which is a key risk factor for ED as it causes narrowing of the arteries. Surgical intervention may remove anatomical structures necessary to install, damage nerves or interrupt blood supply for a variety of conditions. ED is a common complicati...
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Pathophysiology

Penile erection is controlled by two mechanisms: the reflex erection achieved by rubbing the penile shaft directly, and the psychogenic erection achieved by sexual or emotional stimulation. The former includes the peripheral nerves and the lower portions of the spinal cord, while the latter contains the brain's limbic network. In both cases a successful and complete erection requires an intact neural system. Stimulation of the penile shaft by the nervous system contributes to nitric oxide (NO) secretion, which induces relaxation of the smooth muscles of the corpora cavernosa (the penis' main erectile tissue), and consequently penile erection. Furthermore, the maintenance of a healthy erectile system requires sufficient amounts of testosterone (producted by the testes) and an intact pituitary gland. Impotence can develop due to hormonal dysfunction, neural system disorders, lack of sufficient supply of penile blood or psychological issues, as can be seen from the mechanisms of a...
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Diagnosis

The diagnosis can be made in many cases based on the history of symptoms in the person. In other cases, to rule out more serious causes such as hypogonadism or prolactinoma, a physical examination and laboratory investigations are done. Differentiating between physiological and psychological ED is one of the first steps. Determining whether there are involuntary erections is important in removing the possibility of psychogenic causes for ED. Occasionally having full erections, such as nocturnal penile tumescence while asleep (that is, while mental and psychological problems, if any, are less present), appears to indicate that the physical systems are functioning functionally. Similarly, manual-stimulated performance and any performance anxiety or acute situational ED can suggest a psychogenic component to ED. Certain factors contributing to ED are diabetes mellitus, which is a well-known cause of neuropathy).ED is often correlated with generally poor physical health, poor eating habits...
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Treatments

Treatment is a result of the underlying cause. Overall, exercise, particularly of the aerobic form, is effective in preventing ED during midlife. 18–19 Counseling can be used where the root cause is psychological, including how to alleviate the sex-related stress or anxiety. Mouth and vacuum erection systems are first-line interventions, 20, 24 followed by injections of medications into the penis, as well as penile implants. Reconstructive vascular surgery is useful in certain communities. Treatments, rather than surgery, do not fix the underlying physiological issue but are used prior to sex as needed. Medications The sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) antagonists of PDE5 are prescription medications that are taken by mouth. Sildenafil is available without a prescription in the UK as from 2018. In addition, a cream that combines alprostadil with the DDAIP permeation enhancer has been approved as a first line treatment for ED in Canada. At the other hand,...
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History

ED treatment attempts dating back to over 1,000 years. People of Ancient Rome and Greece wore rooster and goat genitalia talismans in the 8th century, claiming these talismans would double as aphrodisiacs and encourage sexual function. Albertus Magnus advocated consumption of roasted wolf penis as a cure for impotence during the 13th century.  Male impotence was considered a felony in France during the late 16th and 17th centuries, as were legal reasons for a divorce. The custom, which included court expert examination of the claimants, was ruled obscene in 1677. Vincent Marie Mondat invented the first efficient vacuum erection apparatus, or penis pump, in the early 1800s. In the 1970s Geddings Osbon, a Pentecostal preacher, created a more sophisticated system, built on a bicycle pump. He got FDA clearance in 1982 to market the drug as the ErecAid ®.  In the 1920s and 1930s, John R. Brinkley launched a boom in US male impotence remedies. His radio programmes, including operati...
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