The manifestation of erectile dysfunction subsequent to pelvic irradiation constitutes a plausible complication warranting attention, particularly in instances of radiation therapy applied in the context of prostate carcinoma.
Postsurgical Erectile Dysfunction
Given the advancing progress in vascular surgery and the heightened possibilities afforded by anesthesiologically intensive medical techniques, there is a rising incidence of reconstructive interventions in the domain of the abdominal aorta. Correcting preoperative erectile dysfunction linked to generalized angiosclerosis through surgery remains markedly constrained.
Ailments Affecting the Corpus Cavernosum
Maladies affecting the corpus cavernosum, capable of exerting adverse effects on erection, encompass conditions such as induratio penis plastica, localized enamel body damage post-trauma or ailments lacking discernible origins, in addition to harm resulting from treated or untreated priapism.
Trauma to the External Genitalia
Owing to the relatively secluded position of the genitalia amidst the trunk and the muscular mass of the thighs, injuries in this region are infrequent.
Unbiased assessment of available diagnostic methodologies
The current array of diagnostic instruments has unquestionably enhanced the capacity to document organic pathological findings. Embarking on a trial therapy without commensurate preceding diagnostics now appears archaic, depriving the patient of the opportunity for targeted alleviation of their complaints.
Further methods of investigation
Additional investigative approaches are presently undertaken primarily from a scholarly standpoint. Their pertinence for contemporary application in practical settings remains inconclusive.
Pneumoplethysmography of the Phallus
Pneumoplethysmographic examinations have been categorized as valuable, noninvasive assessments for objectifying an arterial circulatory impairment of the penile vessels.
Monitoring Nocturnal Penile Tumescence (NPT)
Given that physiologically, in healthy men, erections lasting 20 to 50 minutes occur during REM sleep phases, the measurement of nocturnal penile tumescences was initially believed to distinguish between organically and psychogenically induced impotence.
Angiographic imaging of the penile vessels is an invasive, technically intricate radiological diagnostic procedure, the use of which is no longer warranted solely for diagnostic purposes.
Duplex Ultrasound Examinations
Duplex ultrasound devices amalgamate ultrasound cross-sectional imaging (B-scan) with integrated Doppler functionality.
Laboratory diagnostics encompass general assessments as well as endocrinological analyses.
Clinical Andrological Inspection
Classification of the patient as male, female, or eunuchoid is predicated on hair pattern, fat distribution, and constitution.
Medical History – Anamnesis
The anamnesis of a patient with erectile dysfunction is partitioned into two segments: the sexual anamnesis and the general anamnesis. In the initial presentation at the andrology consultation or practice, the patient should first delineate the duration and extent of the erectile dysfunction within the purview of the sexual anamnesis.
Causative Factors of Erectile Dysfunction
Primary determinants influencing erection encompass the functionality of supplying arteries, veins, nerves, and the endocrine system, alongside an erection-favoring psychological disposition.
Physiology of Erection
The process of erection is construed as a neurally regulated, hemodynamic occurrence, influenced by an intact hormonal milieu and an apt mental state. The limbic system, situated in the temporal lobe and functioning as a cerebral sexual center, is deemed of paramount significance.
Structural Configuration of the Phallus
The functionally pivotal components of the phallus are the corpus cavernosum and the corpus spongiosum. The corpus cavernosum arises from paired cavernous bodies stemming from the inferior pubic branches.
Prevalence of Erectile Dysfunction
The escalating focus on sexual openness and enlightenment commencing in the late 1960s, coupled with the concurrent destigmatization of the sexual sphere, amplifies the significance of sexual pathology in contemporary medicine.
Diminished Sexual Desire in Males
Disparities in the intensity of sexual desire among healthy individuals underscore the most underestimated, disregarded, ambiguous, challenging-to-appraise, and vexing sexual disorder—hypoactive desire, afflicting millions worldwide.
Erectile Dysfunction in Diabetes Mellitus as a Behavioral Health Issue
While erectile dysfunction, even among diabetics, was traditionally ascribed primarily to psychogenic origins, exhaustive research and enhanced diagnostic capabilities in the past decade have led to a more comprehensive comprehension of the regulatory mechanisms governing male erection and potential pathological processes.
Empirical Management of Erectile Dysfunction Through the Ages
Hippocrates, the ancient Greek physician and revered father of medicine, attributed erectile dysfunction to a man’s professional preoccupations and the perceived unattractiveness of the female. Moralists in the 18th and 19th centuries contended that it stemmed from excessive sexual activities like masturbation, prostitution, and promiscuity.
Behavioral Therapy for Diabetes Mellitus
Impotence emerges as one of the most prevalent complications in men with diabetes. The manifestation of potency issues correlates notably with metabolic control quality, the presence of other risk factors, diabetes duration, and age.
Androgen Replacement for Erectile Dysfunction
The interconnection between male sexuality and a sound testicular function has been acknowledged since ancient times and has manifested practically through aphrodisiacs containing, for instance, animal testicular extract.
The phallus, dubbed “the barometer of a man’s health,” rightfully earns this moniker, as any anomaly in its anatomy, physiology, or functionality may signify an underlying ailment. Furthermore, the phallus symbolizes virility, power, manhood, strength, and authority.
Physiological Foundation of Erection
A prerequisite for treating erectile dysfunction is a comprehension of the anatomical structures and physiological processes crucial for erection development, maintenance, and decline.
Impacts of Sexual Dysfunction on Men and Their Partners
Sex constitutes an integral facet of an intimate relationship, forming the bedrock of shared love and respect for couples. However, many individuals struggle to fully relish these pleasures. A man grappling with sexual dysfunction may lack the desire or self-assurance to engage in sexual activity.
Sexual Counseling and Therapy for Erectile Dysfunction
In instances of erectile dysfunctions primarily or wholly rooted in psychological and/or relational factors, sexual psychotherapy emerges as the preferred treatment modality. It stands as one of the few causal therapeutic options available for psychogenic erectile dysfunction within the domain of erectile dysfunction.
Physical Triggers of Erectile Dysfunction
Recognizing erectile dysfunction (ED) and comprehending its causes necessitates an awareness that penile erection is an uninterrupted neurovascular phenomenon subject to psychological control. A proper hormonal milieu is imperative for its successful realization.
Practice of Sex Therapy for Erectile Dysfunction
The subsequent insights aim to furnish practical guidance on the sex therapy approach to erectile dysfunction.
A Bedroom Tragedy: Sexual Dysfunction
Erection hinges on robust vascular and neurologic tissue and genital organs, along with an appropriate male hormonal environment. A myriad of factors spanning the brain, spinal cord, nerves, blood vessels, smooth muscles, and hormones is pivotal to a man’s optimal sexual expression and pleasure.
Psychological Origins of Erectile Dysfunction
The groundbreaking work of Masters and Johnson in the 1970s shed illuminating new perspectives on potential causes of sexual dysfunction. Their publications underscored the impact of religious orthodoxy, fear of failure, homosexuality, and maternal influence as contributors to erectile dysfunction (ED).
Manifestations of Erectile Dysfunction
The display and manifestation of erectile dysfunction by afflicted men, as per our observations, delineate a distinctive dichotomy.
Oral Pharmacological Treatment Choices for Erectile Dysfunction
As per reports in the literature and our patient encounters, oral medication emerges as the preferred treatment modality for erectile dysfunction in the majority of cases.
Rise and Descent: The Erection Process
The phases of the male sexual response exhibit distinctive physiologic characteristics, encompassing the continuous series of neurovascular events constituting the erectile process. These unfold within a normal hormonal milieu, primarily characterized by an appropriate level of serum testosterone, and with an intact psychological setup.
Sildenafil (Viagra) for Male Erectile Dysfunction: A Meta-analysis of Clinical Trials
Meta-analyses inclusive of otherwise undisclosed randomized trials are rare but valuable in situations where information is contradictory.
Clinical Safety of Oral Sildenafil Citrate (VIAGRA™) in Treating Erectile Dysfunction
The effectiveness of sildenafil citrate in a broad spectrum of patients with erectile dysfunction has been demonstrated, leading to its approval in the United States for this indication. The comprehensive clinical safety of oral sildenafil, a potent phosphodiesterase type 5 inhibitor, in treating erectile dysfunction was assessed in more than 3700 patients.