erectile dysfunction
Introduction
Introduction to erectile dysfunction In the past, mens sexual incompetence was generally referred to as impotence, and its scientific definition was inaccurate and discriminatory. Until 1992, the National Institutes of Health discussed with experts, decided to replace impotence with the word erectiledysfunction (ED), and defined penile erectile dysfunction as: penis continued to reach and/or maintain Enough erection to get a satisfactory sex life (intercourse). basic knowledge The proportion of illness: 1% Susceptible people: good for adult males Mode of infection: non-infectious Complications: impotence
Cause
Causes of erectile dysfunction
(1) Causes of the disease
With the development of science and social progress, people's understanding of ED is deepening. For example, as early as the 15th century, ED was considered to be the devil's possession. In the 18th century, it was considered to be masturbation. In the early 19th century, ED was considered to be a psychological disease. It was considered a behavioral disease after 1950. It was still considered to be related to the reduction of androgen levels before 1970. Natural ageing and psychological factors are related. Due to the lack of common sense of understanding ED, many ED patients have heavy burdens. Ideological burdens affect normal family life, and often become unsociable and prone to violent, thus affecting interpersonal relationships. After 1970, due to the progress of erectile physiology and pathology research, people realized that psychological factors can certainly cause ED, but In most men, ED is associated with many diseases (hypertension, diabetes, cardiovascular disease), drugs, trauma and surgery, because the erectile mechanism is smooth muscle relaxation of the corpus cavernosum, dilatation of the penile artery, increased blood flow and blocked venous return. A complete hemodynamic process in which any dysfunction or any defect in the structure of the penis can cause and cause Erectile dysfunction, so the cause of erectile dysfunction can be divided into:
Psychological ED (30%):
Refers to erectile dysfunction caused by mental and psychological factors such as stress, stress, depression, anxiety and marital disharmony.
Organic ED (35%):
(1) Vascular causes: including any diseases that may lead to decreased blood flow to the cavernosal arteries, such as atherosclerosis, arterial injury, arterial stenosis, pudendal artery shunt and abnormal cardiac function, or hinder the venous return closure mechanism. Penile leucorrhea, penile venous leakage caused by a decrease in smooth muscle in the cavernous sinus of the penis.
(2) Neurological causes: Central, peripheral nerve diseases or injuries can cause erectile dysfunction.
(3) surgery and trauma: large blood vessel surgery, radical prostatectomy, abdominal perineal rectal cancer radical surgery and other pelvic fractures, lumbar compression fractures or riding a cross injury, can cause penile erection-related blood vessels and nerve damage, leading to erection disfunction.
(4) Endocrine disorders, chronic diseases and long-term use of certain drugs can also cause erectile dysfunction.
(5) Penile disease itself: such as penile induration (inclusion of penis), penile curvature deformity, severe phimosis and foreskin balanitis.
Mixed ED (25%):
Refers to the erectile dysfunction caused by mental and psychological factors and organic causes. In addition, due to the lack of timely treatment of organic ED, the patient's psychological stress is aggravated, fear of sexual intercourse failure, making ED treatment more complicated, 628 cases in domestic group Studies on the etiology classification of ED patients showed that psychology accounted for 39%, organic quality was 15.8%, and mixedness accounted for 45.2%.
Pathogenesis
1. Classification according to ED pathophysiological mechanisms can be divided into 6 categories:
(1) psychological erectile dysfunction: about 50% of ED patients, the main reasons are anxiety, depression, nervousness, marital disharmony or lack of sexual attraction of spouses, poor childhood and so on.
(2) Endocrine erectile dysfunction: such as low gonadotropin hypogonadism, high gonadotropin hypogonadism, hyperprolactinemia, Klinefelter syndrome, testicular trauma, thyroid dysfunction.
(3) Neurological erectile dysfunction: Parasympathetic or somatic nerve damage caused by the medulla can cause partial or complete erectile dysfunction. In addition, neurological diseases caused by certain diseases can also cause erectile dysfunction, such as diabetes. Chronic alcoholism.
(4) arterial erectile dysfunction: such as atherosclerosis of the corpus cavernosum artery can cause stenosis of the lumen, radical prostate cancer, pelvic fracture and other penile artery injury, resulting in decreased blood perfusion pressure and blood flow reduction, in addition to smoking High blood pressure, diabetes can cause arterial disease.
(5) Venous erectile dysfunction: Sometimes, despite adequate perfusion of the penile artery, excessive venous leakage can cause erectile dysfunction, such as leukorrhea defect, abnormal function of cavernosal smooth muscle.
(6) Others: Drug-induced drugs that often interfere with penile erection of the central nervous system-endocrine function or affect local neurovascular regulation are susceptible to erectile dysfunction, such as antihypertensive drugs, antidepressants, anticholinergics, and estrogens.
(2) to (5) are generally referred to as organic erectile dysfunction.
2. The indexing ED is light, medium and heavy, and the erectile function international questionnaire (IIEF) can quantify ED symptoms objectively.
(1) Severe ED: IIEF table score 5 to 7 points.
(2) Moderate ED: IIEF table scores 8 to 11 points.
(3) Mild ED: IIEF table score 12 to 21 points.
(4) No ED: IIEF table integral 22 points.
Prevention
Erectile dysfunction prevention
prevention:
(1) Do not succumb to indulgence and greed.
(2) Universal knowledge education, correctly treat the natural physiological functions of sexuality, reduce anxiety about sexual intercourse, eliminate unnecessary ideological concerns, and avoid the occurrence of mental impotence.
(3) Avoid taking or stopping taking the medicine that may cause (or verify that it can cause) impotence.
(4) Avoid all kinds of sexual stimuli, stop sexual life for a period of time, to ensure that the sexual center and sexual organs can be adjusted and rested, which is conducive to the regulation of the will and the recovery of the disease.
(5) Actively treat various diseases that may cause impotence. Both husband and wife have responsibilities, the woman should be considerate, understand the man, must not blame or despise the man, so that patients on the basis of understanding, understanding to enhance confidence, to benefit the spirit, can promote the blood circulation of the sponge.
(6) When impotence occurs, the doctor should be introduced to all diseases and their development and changes to help early treatment and avoid concealing the condition.
(7) Emotions should be cheerful, clear-minded, pay attention to life adjustment, strengthen physical exercise, enhance physical fitness and improve disease resistance. Once the impotence occurs, both men and women should treat it correctly, carefully identify the cause and actively treat it.
Complication
Erectile dysfunction complications Complications
1. Affect male fertility. Most genital patients with genital dysfunction are difficult to erect normally, unable to perform normal sexual life, and can not let sperm lose to the cervix of women, obviously can not give birth to the next generation.
2. Initiate related mental illnesses. A large number of clinical cases show that male impotence is easy to cause depression. Many patients suffer from anxiety, inferiority, and marijuana loss due to impotence, which can lead to depression; in addition, depression and many treatments of yao can cause impotence.
Symptom
Erectile dysfunction symptoms common symptoms penis short penis injury penis abnormal penis hard pain penile erection
1. Detailed medical history analysis should include the following contents: gradual development or sudden occurrence, intermittent or continuous occurrence; nighttime penile erection; whether there has been a major mental attack; marital status should understand the relationship with the spouse, childbirth, seek medical attention For the purpose, you should also ask what kind of medicine has been used, whether there is history of trauma, whether there is diabetes or other chronic diseases, whether there is masturbation habit and alcohol and tobacco habits, whether prostatectomy, sterilization or lower abdominal surgery have been performed, with or without Chronic prostatitis or seminal vesiculitis.
2. Physical examination: should pay attention to systemic performance, blood pressure, nutritional status, secondary sexual development, male breast development and milk, pay attention to surgical scars, inguinal hernia, etc., should focus on the external genitalia, such as the penis Size and morphology, with or without phimosis, with or without induration or penile curvature, such as suspected neurogenic erectile dysfunction, should be measured for the expansion of the bulbosus muscle reflex time and urodynamic examination, check the anal sphincter tension.
Examine
Erectile dysfunction check
1. Blood, urine routine, fasting blood sugar, high and low density lipoprotein and liver and kidney function.
2. Hormone determination includes serum testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL). If suspected testosterone secretion is low, testosterone levels should be determined twice.
3. Perform a chromosome check if necessary.
4. Night nocturnal penile tumescence (NPT)
(1) Paper tape or Snap-Gauge test: Three test rings with different tension bands are fixed on the penis before going to sleep at night, and the tension of the tension band is checked on the morning of the second day, and it is judged whether there is no night. Penile erection and firmness of erection.
(2) Penis hardness tester: It is the only non-invasive test that can measure the nighttime expansion of the penis and reflect the hardness of the penis. Normal parameters: night erection frequency 3 to 6 times, each erection time lasts 5 to 10 minutes, and the hardness exceeds 70%. , expansion > 2 ~ 3 cm.
5. Penile brachial index (PBI) The Doppler ultrasound stethoscope was used to measure the systolic pressure of the radial artery and penile dorsal artery respectively. The ratio of systolic pressure of the penile dorsal artery to the systolic pressure of the radial artery was the penile artery blood pressure index. PBI>0.75 is normal; <0.6 is insufficient blood supply to the penis.
6. Intracavernous injection (ICI) Intracavernous injection (ICI) directly injects vasoactive substances into the corpus cavernosum, induces erection, determines the blood flow supply of the penis from the time of erection induced, hardness, erection angle, and duration. In the case of venous reflux, commonly used drugs are: papaverine 30mg plus phentolamine 0.5 ~ 1mg; or prostaglandin El 10 ~ 40g.
7. The corpus cavernosum is suitable for those who are suspected of having venous fistula. The vasoactive substance is injected first to induce penile erection. Then, 30% diatrizoate 30-100ml is injected into the cavernous body immediately, and the penis is positive and the lateral X-ray film is taken. There are significant changes in those with venous fistula.
8. Selective penile angiography Angiography is the main method for assessing the localization and characterization of penile blood supply abnormalities. It is an invasive examination and is contraindicated for patients with severe hypertension, diabetes, myocardial infarction and vasculitis.
9. Neurological examination
(1) Autonomic nerve detection: There is currently no direct examination method, which only indirectly through the organs involved in autonomic neuropathy, the functional status and neural distribution of the system and their relationship with autonomic nerves, and evaluates their neurological functions. : Heart rate control test, cardiovascular reflex test, sympathetic skin reaction, cavernous EMG, temperature domain test, urinary anal reflex.
(2) Somatic nervous system examination: including penile biological threshold measurement test, sacral nerve stimulation reaction, vaginal nerve conduction velocity, somatosensory nerve evoked potential.
10. Color duplex ultrusonography (CDU) is a non-invasive test. The high-frequency probe can observe the pathological changes of the penis. The 4.5 MHz pulse ranging probe can perform blood flow analysis and measure the blood flow rate. In combination with ICI, observe the blood flow of the penis before and after injection, and understand the blood supply and venous closure mechanism of the penile artery. The main parameters are: maximum systolic blood flow rate (PSV)>25cm/s for penile artery blood supply, end-diastolic blood. The flow rate (EDV) <5 cm/s is normal for the closure of the dorsal vein of the penis, and the mean value of the resistant index (RI) is 0.99.
1. Cavernometry (CM) is an effective method for diagnosing venous erectile dysfunction. The perfusion flow rate (MF) of maintaining erection is directly related to venous fistula. MF>10ml/min may consider venous closure.
Diagnosis
Diagnosis and identification of erectile dysfunction
The diagnosis of ED is subjective. The questionnaire method relies on the patient's self-perception to evaluate the erectile function. There are many kinds of questionnaires, including MMAS, IIEF, IIEF5 and BMSFI. The most commonly used is IIEF5, MMAS ED epidemic. The investigation is the most standardized and credible.
1. Psychological erectile dysfunction is also manifested as erectile dysfunction, but patients often have trauma, homosexuality, marital discomfort or mental anxiety, depression and other medical history, and in certain circumstances such as masturbation, sleep or Another partner can have a normal erection when they are together, the erection of the penis is normal at night, and the blood flow of the penis is normal.
2. Neurological erectile dysfunction refers to erectile dysfunction that occurs when the structural and functional integrity of the pudendal nerve pathway is disrupted. When the peripheral nerve injury occurs, the anal finger reflex can be found in the physical examination, and the cavernosal muscle reflex is weakened or disappeared; Sexual penile erection weakens and disappears, and can also be differentially diagnosed by neurophysiological tests.
3. Arterial erectile dysfunction refers to erectile dysfunction caused by lesions or abnormalities of the penile artery. The diameter of the cavernous artery, the maximum systolic velocity and the blood flow acceleration can be understood by the drug-induced penile dual-function ultrasound (PPDU). .
4. Venous erectile dysfunction refers to erectile dysfunction caused by lesions or abnormalities in the penile vein. The use of cavernosal pressure and cavernous angiography can be used to understand the presence or absence of venous fistula.
