Every sexually mature man knows what impotence or erectile dysfunction is. It is she who is one of the main fears of men of any age and social status. Today there are many different medicines to restore potency, but almost all of them are aimed only at eliminating symptoms, but do not affect the causes of impotence, which, by the way, can be quite a lot. Therefore, such drugs give only a temporary result, require a gradual increase in the dose and ultimately lose their effectiveness.
Accordingly, in modern andrology and urology, the influence on the causes of the development of erectile dysfunction, which is very different in the mechanism of impotence, is brought to the fore. Only by exerting a direct impact on the causes of the development of potency disorders can the problem be completely solved, and not temporarily restore the ability to have sexual intercourse.
Features of male anatomy
The male reproductive system, that is, the activity of the penis, testicles, appendages, etc. , is controlled by the frontal lobes of the cerebral cortex, the sympathetic and parasympathetic nervous systems. At the same time, endocrine-humoral mechanisms and sex hormones also have a direct impact on its activity.
The frontal lobes, through the involvement of neurohumoral factors, the somatic and autonomic nervous systems, are responsible for the control of sexual behavior. The achievement of an erection is ensured by the activity of the parasympathetic nervous system, while ejaculation is controlled by the sympathetic nervous system.
The parasympathetic nervous system is a part of the autonomic nervous system with centers in the spinal cord and brain, which is responsible for relaxing the muscle fibers of the vessel walls, etc. The sympathetic nervous system is the opposite of the parasympathetic part of the autonomic nervous system, the centers of which are located in the spinal cord and are responsible for contractionmuscle fibers, the transfer of the body to "combat" readiness and, in general, the mobilization of its capabilities.
Expert Opinion of a Doctor
The autonomic nervous system from time to time malfunctions in each person, and, as a result, we have poor general health, contributing to the onset of autonomic dystonia syndrome, autonomic insufficiency and autonomic crises, as well as somatoform disorders, the so-called organ neuroses. All of this is also a trigger for erectile dysfunction. Such neuroses are treated with the help of general massage, physiotherapy and physiotherapy exercises.
During an erection, the walls of the cavernous bodies of the penis relax and the lumen of its blood vessels increases. This process is triggered by the somatic and autonomic nervous systems with the involvement of regulatory centers located in the spinal cord. From it, through the spinal roots branching off at the level of the 3rd lumbar vertebra and further branching into smaller nerves, the nerve impulse is transmitted directly to the walls of the blood vessels and cavernous bodies of the penis. Therefore, changes in the lumbar spine can block this process, which will lead to impotence.
In men, the spinal cord ends at the level of the 1st lumbar vertebra, passing into the large nerve plexus called the cauda equina. It received this name due to its significant external resemblance to the tail of a horse, as it is formed by a large number of nerve fibers that descend vertically down the spinal canal and are excreted in pairs through natural openings in the vertebrae to innervate the corresponding organs.
In addition, sexual function is also controlled by endocrine-humoral mechanisms, i. e. , the testicles-pituitary-hypothalamus system. In this case, the synthesis of seminal fluid and tissue nutrition is determined by the level of sex hormones. The adrenal glands are responsible for their production. They secrete almost 2/3 of androgens and up to 80% of estrogens, which are the precursors of male sex hormones. But the activity of the adrenal glands is in direct relationship with the work of the thyroid gland. Therefore, violations in its functioning, as well as the adrenal glands, and the hypothalamic-pituitary system can lead to persistent impotence.
The hypothalamus is a part of the brain and is both a hormone-secreting gland and a center of autonomic nervous regulation.
As a result, during sexual arousal by activating the synthesis of testosterone by hormones of the hypothalamic-pituitary system and the transmission of nerve impulses in the cells of the walls of the arteries of the penis, nitric oxide begins to be synthesized. It provokes relaxation of the smooth muscle fibers of the vascular wall, which causes their expansion. Therefore, the volume of blood entering the penis increases. It fills the cavernous or cavernous bodies, which ensures an increase in the size of the penis and the acquisition of the firmness necessary for sexual contact. In this case, the venules, through which blood flows from the penis, are reduced. As a result of a decrease in their lumen, the rate of blood outflow decreases, which ensures the maintenance of an erection for the required period of time.
Causes and features of development
Not so long ago, it was believed that up to 90% of all cases of erectile dysfunction development are due to psychological disorders. But the studies carried out made us not only doubt this, but also refute such statements. They showed that 60-80% of impotence cases are due to organic disorders. It is worth noting that we are not talking about a decrease in potency and various degrees of erectile dysfunction, but about impotence, that is, an extreme degree of erectile dysfunction, in which it is not possible to obtain a persistent erection with the achievement of the rigidity, volume and directness of sexual intercourse necessary for sexual intercourse. member.
With impotence, men complain of a lack of sexual desire, which is combined with a complete absence of not only desired erections, but also spontaneous ones.
Understanding the relationship and features of the functioning of the male reproductive system, it is not difficult to establish the main reasons for the development of impotence. It:
- spine and pelvic injuries;
- degenerative-dystrophic changes in the intervertebral discs of the lumbar spine (intervertebral hernias, protrusions);
- curvature of the spine (scoliosis, lordosis);
- disturbances in the work of the hypothalamic-pituitary system and hormonal disorders;
- vascular disorders, including strokes, atherosclerosis, hypertension, abnormalities in the structure of the cavernous bodies of the penis and circulatory disorders in the reproductive system as a result of the development of prostatitis or prostate adenoma.
Today, according to official data, impotence is diagnosed in 40-50% of men aged 40 to 50 years, in 50-60% of men in 50-60 years old and in 60-80% of men over 60 years old. At the same time, there is every reason to believe that in fact the situation is even more difficult, since not all men have the courage to go to a doctor with such a delicate problem.
In many respects, such statistics are due to a decrease in the amount of testosterone produced after 40 years and the progression of previously earned pathologies of the spine and blood vessels. At the age of 50-60, there is a natural hormonal change with a decrease in the volume of synthesized testosterone. This leads to a decrease in libido and, accordingly, the need for sexual intercourse. But even men at the age of 60 are able to maintain a normal erection for full sexual intercourse in the absence of other disorders. The only difference is the decrease in their frequency.
One of the most common causes of impotence in men of different ages, including at 40, and sometimes even earlier, are neurological disorders caused by infringement of the spinal roots, which are responsible for the innervation of the vessels of the penis. Their compression or damage occurs as a result of spinal injuries or entrapment by a curved spine, protruding discs, or other structures.
In this case, they talk about the presence of neurogenic impotence. Since the filling of the cavernous bodies of the penis with blood is controlled by the nervous system, in the event of disturbances in the transmission of nerve impulses from the brain to the penis, even when a desire arises, the body is not able to transmit a signal about this and provoke an active blood flow to the cavernous bodies. Most often, this is observed when the nerves passing through the spine at the level of the 3rd vertebra are pinched.
Another common cause of impotence is prostatitis, or inflammation of the prostate. Today, this disease in a chronic form occurs in men even before the age of 40, and after 50 years, it is observed in almost every third person. In this case, impotence is often the only symptom of inflammation of the prostate gland.
Prostatitis, like impotence, can be a consequence of circulatory disorders in the pelvic organs as a result of the development of vascular or neurological disorders.
Prostatitis provokes discomfort and pain in the perineum. In addition, the resulting swelling of the prostate gland leads to compression of blood vessels, which reduces the intensity of blood circulation in the pelvic organs. In addition, cytokines produced in response to inflammation impede the transmission of nerve impulses to the prostate. At the same time, its functioning is disrupted, which contributes to a decrease in the synthesis of testosterone, which is responsible for sexual function. All this in a complex inevitably makes it impossible to fully fill the cavernous bodies with blood and leads to a loss of potency.
Expert Opinion of a Doctor
Prostatitis in the modern world is the result of a careless attitude to one's health. As a rule, this is a consequence of untreated colds, which have become chronic, postural disturbances and physical inactivity. Therefore, it is necessary to sanitize chronic foci of infection, since conditionally pathogenic flora (for example, coccal), which develops in the cavities of the prostate gland, can also be the cause of prostatitis. In addition, you need to change your attitude towards sex life, activating it.
Types and consequences
Based on what is the cause of the development of impotence, the following types are distinguished:
- Neurogenic impotence - occurs very often and is caused by disturbances in the transmission of nerve impulses to the smooth muscle of the penis. It is characterized by a decrease in the sensitivity of the penis and a progressive reduction in the frequency of erections, including spontaneous, morning erections.
- Vascular, dividing into arteriogenic and venogenic. The first is a consequence of a violation of blood flow to the cavernous bodies, which becomes a consequence of changes in the state of the genital and cavernous arteries. The second occurs against the background of the expansion of the veins of the penis, which provokes an excessively active outflow of blood. For vascular impotence, uncontrolled ejaculation is characteristic at the initial stages of formation, as well as a decrease in the resistance of an erection.
- Hormonal - it becomes the result of a hormonal imbalance, which is most often observed against the background of diabetes mellitus and other endocrine pathologies, leading to inhibition of testosterone production and its assimilation.
There are several other types of impotence, for example, anatomical, genetic, etc. , but they are much less common than those described above.
Whatever type of impotence is, it is always a serious problem for a man. First of all, the inability to have sexual intercourse leads to difficulties in personal life, loss of self-confidence and psychological problems. Often, impotence causes an increase in aggressiveness and the development of severe depression in men of any age, especially when it develops in fairly young years - in 40-50 years. This cannot pass without a trace, as a result, relations with close people and colleagues are heating up, conflicts often flare up, which can lead to the loss of a job and an aggravation of the psychological state up to the appearance of suicidal or, on the contrary, antisocial thoughts.
But, in addition to psychological difficulties, impotence has an extremely negative effect on the health of a man. Constant stress provokes the aggravation of existing chronic diseases, and also negatively affects the state of immunity. Therefore, a man becomes more susceptible to the development of various infectious diseases. Also, constant psychological stress often causes disturbances in the functioning of the digestive tract, heart, and lungs. Therefore, often against the background of impotence develop or worsen:
- gastritis and peptic ulcer of the stomach and duodenum;
- Ischemic heart disease, angina pectoris;
- bronchitis, etc.
Therefore, it is extremely important not to ignore the problem of impotence, writing it off to age and resigning to the situation, but to start acting, looking for the causes of sexual dysfunction and ways to solve it. This is true not only at 40, but also at 50 and 60 years old. Comprehensive diagnostics and targeted treatment of the detected disorders will help not only restore normal potency and return the man to a full sexual life, and at the same time psychological comfort, but also eliminate diseases that, if untreated, can lead to severe and sometimes life-threatening complications. as well as disability.
In the absence of potency or the initial stages of erectile dysfunction, a man needs to contact an andrologist, and in the absence of such a specialist in the city, a urologist. During the initial consultation, the doctor will listen to the patient's complaints, assess his psychological state and examine the groin area for signs of genital diseases. In the absence of such, the doctor prescribes a set of diagnostic procedures, the main purpose of which is to detect pathologies of other organs and systems that provoked the development of impotence. It:
- UAC and OAM;
- analysis of the level of sex hormones, thyroid hormones, etc. ;
- blood sugar test;
- determination of the level of blood pressure;
- PCR for the presence of sexually transmitted diseases;
- Genital ultrasound;
- palpation of the prostate gland to assess its condition.
If these studies do not show visible deviations from the norm, the patient will be advised to consult a neurologist, since it is neurogenic impotence that is quite common today. At the consultation, a neurologist will examine the patient, and first of all he will be interested in reflexes, the condition of the spine and the completeness of limb movements. To determine the presence of changes in the state of the spine, the doctor uses the method of palpation and conducts functional tests. Already on the basis of the results obtained, he can establish the presence of changes in the state of the spine. But to confirm the diagnosis, as well as to accurately determine the degree and nature of the pathology, instrumental research methods are necessarily carried out:
- X-ray or CT are the main methods for diagnosing abnormalities in the state of the bone structures of the spine, therefore they are often used to detect scoliosis, lordosis, etc. ;
- MRI is the best method for detecting changes in the state of soft tissue structures, including intervertebral discs, spinal cord, etc . ;
- myelography is a method that allows to assess the quality of transmission of nerve impulses to muscles, which provides information about the degree of neurological deficit caused by compression of the spinal roots.
Features and nuances
In general, the treatment of impotence can be divided into symptomatic and etiotropic. In the first case, all efforts are aimed directly at achieving adequate potency, and in the second, at eliminating the causes of its loss. The first way involves getting the result here and now, the second is more complicated and allows you to eliminate problems with potency completely, but gradually. Therefore, today, symptomatic and etiotropic therapy is usually combined, which provides the patient with a quick recovery of psychological comfort, as well as an improvement in his health in general.
Therefore, treatment for impotence usually includes:
- drug therapy aimed at restoring potency and treating diseases that caused impotence;
- manual therapy, which allows to improve the quality of blood circulation in the pelvic organs, as well as to eliminate pathologies of the spine and restore the normal transmission of nerve impulses to the smooth muscle fibers of the penis;
- kinesiotherapy, which consists in training the pelvic floor muscles, as well as the back and abdominal muscles, which consolidates the results of manual therapy and is extremely important for neurogenic impotence.
All patients are recommended to:
- quit smoking, alcohol and drugs;
- increase the level of physical activity, especially when leading a sedentary lifestyle, sedentary work, etc. ;
- make adjustments to the diet, bringing it as close as possible to a healthy diet;
- to reduce weight in the presence of signs of obesity, especially abdominal;
- avoid stressful situations.
It is not uncommon to find recommendations to use vacuum pumps or pumps for the treatment of impotence. But this method does not have any therapeutic effect and does not always provoke the onset of an erection. However, it is associated with the risk of pain during ejaculation, bruising and pain or numbness in the penis itself, therefore it is not recommended by urologists.
The first step after establishing the causes of impotence development is the appointment of the appropriate drug therapy. It consists in prescribing means to restore potency and eliminate diseases that provoked problems with it.
Symptomatic therapy of impotence mainly consists in the use of drugs to stimulate an erection, that is, PDE-5 inhibitors. In some cases, the introduction of vasodilators is prescribed, temporarily activating the blood flow to the cavernous bodies of the penis. But they also do not have a therapeutic effect and allow only a short time to solve the problem of impotence.
Etiotropic therapy or aimed at eliminating the causes of the development of erectile dysfunction is more complex and complex. Moreover, its nature directly depends on the causes of impotence:
- with pathologies of the thyroid gland, diabetes mellitus, hormonal drugs and / or antihyperglycemic drugs are prescribed, which should be taken on an ongoing basis to maintain normal hormonal balance;
- with prostatitis, antibiotics, α1-blockers, homeopathic remedies are indicated, and therapy is selected individually depending on the causes of inflammation of the prostate gland;
- in case of vascular pathologies, the administration of drugs that normalize blood pressure, lower blood cholesterol levels, manual therapy is shown;
- for spinal pathologies that cause compression of the spinal roots, drugs are used to restore altered intervertebral discs, B vitamins, muscle relaxants, NSAIDs and some others.
Inhibitors of phosphodiesterase-5 or PDE-5 are a group of drugs well known to most men for solving the problem of erectile dysfunction. They are based on active substances that inhibit the production of a special enzyme phosphodiesterase-5. It is responsible for the suppression of cyclic guanosine monophosphate (cGMP), which is a product of biochemical transformations triggered by nitric oxide. cGMP leads to a decrease in the tone of smooth muscles, and hence the expansion of the cavernous bodies of the penis, i. e. , the occurrence of an erection. Therefore, PDE-5 inhibitors, by reducing the activity of phosphodiesterase-5, "prolong the life" of cGMP, thereby providing a long-lasting and stable erection even against the background of natural age-related changes.
All PDE-5 inhibitors work only on demand, that is, sexual arousal is required to get the effect.
PDE-5 inhibitors include:
- Sildenafil is the first drug to appear on the pharmaceutical market to increase potency. It has the shortest duration of action - up to 4 hours, and begins to act 45-50 minutes after ingestion. But sildenafil is not compatible with alcohol, and also often provokes the development of side effects (redness of the face, nasal congestion, headaches, discomfort in the heart).
- Tadalafil - has the longest duration of action - up to 36 hours, and the effect occurs 15-20 minutes after ingestion. Tadalifil is usually well tolerated and rarely provokes the development of unwanted effects.
- Vardenafil is a drug that works for 5-12 hours with the onset of the effect 30-45 minutes after administration. One of the advantages is compatibility with alcohol, but its use should still be avoided, as it negatively affects the condition of the blood vessels.
The drugs in this group are available in different dosages. In most cases, the urologist recommends starting with the minimum dose and increasing it only if there is no effect. FED-5 inhibitors should be taken no earlier than an hour after a meal. This will ensure the fastest absorption of the active substance and the possibility of obtaining an effect. If you take the drug with food, the speed of the onset of the effect decreases.
It is important not to take more than the recommended dose during the day. This increases the likelihood of side effects and can adversely affect the functioning of the cardiovascular system.
At the same time, it is important to consult a doctor before using such medicines, since they have a number of contraindications:
- severe cardiovascular diseases, in particular angina pectoris and coronary artery disease;
- anomalies in the structure of the penis;
- cases of priapism (prolonged painful erection) in the past;
- optic neuropathy;
- suffering a stroke or heart attack during the last six months.
It is not recommended to combine PDE-5 inhibitors with α-blockers, nitrite-based drugs. These combinations can cause serious complications.
PDE-5 inhibitors make it possible to obtain adequate potency in almost all cases. But with their uncontrolled use, the organism initially develops addiction, which necessitates an increase in the dose to obtain the same result.
Thus, impotence is not a sentence today. Every man at almost any age can face it, especially representatives of "sedentary" professions and those associated with excessive physical exertion. But when such a delicate problem arises, it is important not to be shy and self-medicate, but to see a doctor. Moreover, the sooner a man seeks medical help, the faster it will be possible to get rid of the problem of impotence, and further reduce the risk of developing other complications that can provoke diseases that lead to erectile dysfunction.