The majority of men with erectile dysfunction (ED) on its own initiative does not begin to discuss their sexual problems, fear of falling into the embarrassing situation or fearing to be raised to laughter. In medical practice has become customary to ascertain sexual histories of patients to assess the risk of contracting sexually transmitted diseases, HIV and Hepatitis B and C. As a result, there is a real possibility, looking sexual problems of patients, improve the sexual life of the past.
Doctors leading ambulatory practices must come to an understanding of the importance of such interviews with patients and get rid of the false embarrassment, as these discussions can identify problems with the physical proximity, which, in turn, can be a source of emotional abuses and difficulties in social adaptation. ED - one of the most common, but a treatable sexual dysfunction, the details of which can be obtained only by collecting history. In such a case must decide clinician - or he simply identifies patients with ED and per-determined aetiology disorder, sends it to the appropriate specialist, or self-starting treatment, which will continue to be a doctor-sexual pathologist only in the event of failure "first-line therapy." Regardless of the depth of knowledge of a medical practitioner on the pathogenesis and treatment of ED, it is extremely important to develop the skills of relationships with such patients, without which sometimes is difficult to achieve good results of treatment.
Before the conversation with the patient any doctor must overcome to myself:
(1) embarrassment,
(2) feeling that sexual dysfunction is not a major problem patient
(3) doubted their own power.
The doctor should also know what to do with what the patient information.
Epidemiology ED
ED is defined as the inability to have or maintain erection sufficient for satisfactory sexual activity. "Patients with ED may complain about the failure to have sufficient erection or to maintain its required amount of time, some complained about the loss of full erection.
According to rough estimates, about 10% of the total population of men have problems with erection, but only about 5-10% of that number are treated for this reason a doctor. The prevalence of ED in men aged 40 - 50 years - 39%, ranging in age from 50 to 60 years - 46% and over the age of 70 - almost 70%. There is no doubt that the prevalence of ED increases with age. Some of these men say only a "minimal" ED, defined as "recurrent problems with erection," but they can still have satisfactory sexual relationships. The relative number of people with moderate and severe ED, that is those who are unable to have a satisfying sexual relationship, progressively increasing in the interval from 40 to 70 years. Acceptable Erectile function can be recovered from virtually all of these patients using the currently available treatments. ED, it should be noted, is not an inevitable result of aging. Nearly healthy men often continue to have good erectile function throughout their lives.
Physiology of male erection
The composition of the penis, penis, is composed of three body: pair cavernous, corpus cavernous penis, and the odd spongy, corpus sponginess penis. Name of the bodies due to the fact that they are composed of multiple crossbar, fibrous, elastic taenia, among whom there are dense plexus intervals, caves, lined endothelial and filled with blood. The size of the penis varies depending on the number of blood cells in the cavernous and sponge phone. Blood branches aa. profundity et dorsals penis, passing in conjunctive tissue partitions, fall into thin helicon artery, which opens directly into the cavernous space. Give blood venue cavernous. Thanks to the special structure of blood vessels member of the blood in the cavernous body may be delayed, resulting in compaction with erection. It is understandable that a deficit of arterial blood or excessive venous outflow can cause a lack of erection.
Intact nervous system is also necessary for normal erectile function. Sympathetic nerves to ensure timely ejaculation may be dissection with some operations in this area. Parasympathetic nerve fibers that provide erection can be damaged if radical prostate and other surgeries, as well as radiotherapy of prostate cancer.
ED may be the result of:
(1) reduced libido (endocrine or psychogenic genesis)
(2) disrupted innervation
(3) violations of arterial-venous blood
Diseases that cause ED
Diseases of heart disease( diabetes and hypertension) often cause ED. The combination of these diseases, a number that grows with age, increases the risk of ED in older men. Other hormonal and metabolic violations, including primary and secondary hypothyroidism, chronic kidney and liver failure also negatively affect erection. Anatomical defects of the penis and disease Peyroni abet violations of erectile function. Substance abuse, such as alcohol and other drugs, is one of the most common causes of ED. Smoking, because of its ability to cause vascular occlusion, certainly is not the only factor for ED, and maybe an independent cause. Pathology spinal cord operation in the area of pelvic and prostate, pelvic injury less common causes of ED. Mental illness manifestations of depression, dysprosium and anxiety tend to cause various problems and sex, including erectile dysfunction.
Risk factors for erectile dysfunction
Organic
Vascular Diseases ( diabetes and hypertension)
Renal failure
Liver Diseases
Multiple sclerosis
Damage pursuing ways to spinal cord
The dependence on psychoactive substances (including tobacco)
Reduced production of androgens
Hypothyroidism
Anemia
Anatomical injury or illness penis (illness Peyroni)
Psychogenic
Worrying and depressive disorders
The concern of his sexual failure
Previous negative sexual experience
Certain drugs
Surgical intervention in the pelvis
Operation for prostate
Androgenic ED may be caused by a breach of innervation of the pelvis or in operations to the prostate, violations of hydrocarbon or fatty exchange, blood pressure, as well as many medicines, applied in everyday medical practice. Especially Diuretics and central actions could cause ED, as well as dioxin, some of the new antidepressants and anti testosterone hormones, for example, coprolite Sonapaks. The level of testosterone decreases slightly with age, but ED occurs only among a small number of men who initially suffering from hypochondriac have low levels of hormone.
The discussion of sexual issues with patients
Patients may complain of erectile dysfunction or have certain risk factors. Because men have the risk of ED with age, it is reasonable to conduct screening of all male patients over 40 years at the ED. The reason for the treatment of male doctor with vague somatic complaints may, in fact, a sexual dysfunction. Since men often avoid routine visits to the doctor, sexual behavior can be as motivated and the actual cause of the visit. Partner patient may be a primary source of information about ED, so a lot of men troubled themselves to start a conversation on this subject.
Start the conversation
There are several ways to start a conversation, and often helpful to use several of them.
When asked about sexuality
1. After perhaps the main complaint: "Doctor, I do not feel changes for the better in recent times"
2. At any time of the interview: "As your disease affects your sex life?"
3. After questions like: "Many men and women ask questions related to sexuality. What matters is you?
4. During a physical examination: "What are some problems with erection, ejaculation? Experiencing pain during sexual intercourse? Problems with lubrication?"
During the interview you must create an environment that would allow patients to discuss their sexual problems without the feelings of discomfort. For specific medical practices are best to establish a pattern of conduct that would be useful to most patients. Worth immediately inform the patient about their confidential information. Often you can achieve better results if the collection of sexual history in the context of the history of life of the patient or during somatic examination. At the beginning of the conversation, use the general questions like: "What can you say about his sex life?", Or simply: "How does your sexual life?". Encourage the patient to be more frank, to this end, tell it that you acknowledge the importance of sexual health for men, or that you will not be surprised if a patient will report on their sexual problem. For example, patients with diabetes can be said: "Many of my patients with diabetes complain of a problem with erection, you do not have something similar?" This will enable the patient to respond calmly, without a sense of what a doctor would be unpleasantly surprised or shocked by his response. Useful use encouraging gestures in the form of approval nods head, to keep the patient a good visual contact, as well as summarize aloud at the end of the conversation obtained the information.
A standardized questionnaire sexual health for men
Sexual health - an important part of good physical and emotional life. Erectile dysfunction, also known as impotence is a common disorder of sexual health. Fortunately, there are enough different methods of treatment of this pathology. This questionnaire is designed to help you and your doctor determine the existence or extent of the problems you experienced in the sexual sphere. If the results do not match your responses suggest, you can discuss the possibility of treatment with your doctor.
Each question has several possible answers. Select the answer that best meets your own situation. Please make sure you choose one and only one answer for each question.
Over the past 6 months:
1. How can you assess their ability to obtain and maintain erection?
1. Very bad
2. Poor
3. Satisfactory
4. Ok
5. Very good
2. When you were in a state of sexual initiation with the erection, how often has your erection sufficient to penetrate your partner?
0. There was no sexual activity
1. Almost never or never
2. Several times (much less than half the cases)
3. Sometimes (about half the cases)
4. Most times (much more than half of the cases)
5. Almost always or always
3. During sex, how often you can support your erection after you have entered your partner?
0. Do not attempt to sex act
1. Almost never or never
2. Several times (much less than half the cases)
3. Sometimes (about half the cases)
4. Most times (much more than half of the cases)
In analyzing disorders phase excitation / erection need to ask: "Do you have any difficulties with achieving or maintaining erection or reaching or maintaining only sufficient intensity of erection, or all together?" If the patient recognizes the difficulties with erection, it is necessary to clarify their duration, frequency and intensity of expression, Tire tried treatment, the relationship with psycho traumatize events. The most easy to distinguish psychogenic ED caused by organic obtaining answers to three questions: (1) "Do you often wake up in the morning erection?", (2) "If you touch yourself when your partner does not close, you can get erection?" ( 3) "If you can not always reach a state of erection, then maybe you can get the erection of any certain time of day and night, during some form of sexual activity with certain (even imaginary) partner?" A positive answer to these questions indicate that the ED was psychogenic aetiology.
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Recommendations for a healthy life for patients with ED
-Waiver of smoking and / or other psychoactive substances (including alcohol)
-Compliance with the diets of low-fatty acids and cholesterol
-Exercise
-Regular admission drugs needed if disease cardiovascular and diabetes patient
-The exclusion of stress
-Optimism in the early normalization of erectile function due to treatment
Should be replaced by drugs that adversely affect erectile function, but only if the patient's clinical condition allows it. Sometimes success can be achieved by replacing the beta-blockers adrenal-type propranolol (anaprilin) for calcium antagonists type veroshpiron (verapamil) or simply lowering the dosage of dioxin. Selection of the drug carried out strictly individually depending on clinical evidence. And it is important to remember that it is not necessary to postpone the visit to the doctor, because only a good specialist can recommend the correct treatment and a healthy drug.
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