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¿What is erectile dysfunction?

Erectile dysfunction, sometimes called "impotence," is the repeated inability to achieve or maintain an erection firm enough to have a sexual relationship. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. The use of the words erectile dysfunction makes it clear that those other problems are not involved.

The erectile dysfunction, or DE, can be a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to have only brief erections. These variations make it difficult to define the Education Department and calculate their impact. Estimates range from 15 to 30 million, depending on the definition used. According to the survey from the National Ambulatory Medical Care (NAMCS acronym in English), for every 1000 men in the United States, there were 7.7 visits to the doctor by FROM in 1985. In 1999, the frequency had nearly tripled to 22.3. The increase occurred gradually, presumably as they were made available more widely treatments such as vacuum devices and injectable medicines and began to accept the discussion of erectile dysfunction. Perhaps the most publicized advance was the introduction of the oral drug sildenafil citrate (Viagra) in March 1998. Data from NAMCS on new drugs show an estimate of 2.6 million mentions of Viagra in physician office visits in 1999, and one-third of those mentions occurred during visits for a diagnosis unrelated to DE.

In older men, usually has a cause of physics, as an illness, injury or side effects of drugs. Any disorder that causes injury to the nerves or impair blood flow to the penis can cause DE. The incidence rises with age: about 5 percent of men 40 years of age and between 15 and 25 percent of men over 65 years of age experience OF. But it is not an inevitable part of aging.

The DE is treatable at any age, and awareness of this fact has been growing. More men have sought help and returned to normal sexual activity because of improved treatments and successful were included. Traditionally urólogos, who specialize in problems of the urinary tract, have treated the OF, however urólogos are only responsible for 25 percent of the mentions of Viagra in 1999.

How an erection occurs?

The penis contains two chambers called corpus cavernosum, which occupy the length of the body (see figure 1). A spongy tissue fills the chambers. The corpus cavernosum are surrounded by a membrane, called robe albugínea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins and arteries. The urethra, which is the channel for urinating and eyacular, took the long short of the corpus cavernosum.

Figura 1.The arteries and veins (above) (below) penetrate the long and filled cavities that are located along the pene-los corpus cavernosum and body fluffy. Erection occurs when the muscles relaxed allow the corpus cavernosum are filled with excess blood fed by the arteries, while it blocks the drainage of blood through the veins.

The erection begins with the mental and stimulation of the senses, or both. The impulses from the brain and local nerves cause the muscles of the corpus cavernosum to relax, allowing blood to flow and fill the spaces. The blood creates pressure in the corpus cavernosum, causing the penis to expand. The robe albugínea helps trap the blood in the corpus cavernosum, thereby sustaining erection. When the muscles of the penis contract to stop the flow of blood from the entrance and open outflow from the channels, erection is reversed.

What causes DE?

Due to an erection requires a precise sequence of events, ED may happen when any of the events is interrupted. The sequence includes nerve impulses in the brain, spine, and the area around the penis, and responses of the muscles, fibrous tissues, veins and arteries in and around the corpus cavernosum.

The most common cause of the damage to nerves, arteries, smooth muscles and fibrous tissues, often as the result of an illness. Diseases such as diabetes, enermedades kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and illness neurológica-son responsible for about 70 per cent of cases of DE. Between 35 and 50 percent of men with diabetes suffer from DE.

Also, surgery (especially radical prostate surgery due to cancer) can damage nerves and arteries near the penis, causing OF. An injury to the penis, spinal cord, prostate, bladder and pelvis can lead to injury in place of nerves, smooth muscles, arteries, and fibrous tissues of the corpus cavernosum.

In addition, many drugs comunes-medicamentos for blood pressure, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer medication) -pueden cause of as a side effect.

Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem and fear of failure on sex cause 10 to 20 percent of cases of DE. Men with a physical cause of OF often experience the same kind of psychological reactions (stress, anxiety, guilt, depression).

Other possible causes are smoking, which affects blood flow in veins and arteries, abnormalities in hormones, such as insufficient testosterone.

How was diagnosed DE?

Background patient.

The medical history and sexual help define the extent and nature of the DE. A medical history can reveal diseases leading to the DE, while a simple story of sexual activity can distinguish between problems with sexual desire, erection, ejaculation or orgasm.

The use of certain illegal drugs or prescription drugs may suggest a cause chemistry, and that the effects of drugs are responsible for 25 percent of cases of DE. Use less or replace certain medications often can alleviate the problem.

Physical examination.

A physical examination may provide clues about systemic problems. For example, if the penis is not sensitive to the touch, it could be a problem in the nervous system. Abnormal secondary sex characteristics, such as the distribution of hair can bring hormonal problems, which would mean that the endocrine system is involved. The examiner could discover a circulatory problem if observed pulses decreased in the wrist or ankles. And unusual features of the penis itself might suggest the origin of problema-por example, a penis to bend or curve when it is erect could be the result of Peyronie's disease.

Test laboratory.

Several laboratory tests can help diagnose included. Tests for systemic diseases include blood, urine, and lipid profile measurements of creatinine and liver enzymes. The measurement of the amount of testosterone in the blood can give information about problems with the endocrine system and is especially useful in patients with decreased sexual desire.

Other test.

Monitoring erections that occur during sleep (tumescencia penile evening) can help rule out certain causes of psychological included. The able-bodied men have involuntary erections during sleep. If there were no nocturnal erections, then you may have a cause of the physical and not psychological. However, the evidence of nocturnal erections are not completely reliable. Scientists have not standardized tests and have not determined when they need to be taken to achieve better results.

Review psychosocial.

A psychosocial examination, which uses a questionnaire and interview, reveals psychosocial factors. You can also meet the sexual partner of a man to determine expectations and perceptions during sexual intercourse.

How is the DE?

Most doctors suggest that treatments are carried out in less than invasive. It is considered the first reduce any medicine that has harmful side effects. For example, medication for high blood pressure works in different ways. If you think that a particular drug is causing problems with erection, avísele your doctor and see if you can try a different class of medication for blood pressure.

If they are identified, are considered below the behaviors and psychotherapy in selected patients, followed by medication by mouth or injected locally, vacuum devices, and surgically implanted devices. In rare cases, surgery may be considered in veins or arteries.

Psychotherapy

Often the experts dealing with the basis of using psychological techniques to decrease the anxiety associated with sexual intercourse. The couple patient can help with the techniques, which include the gradual development of intimacy and stimulation. These techniques can also help relieve anxiety when it comes DE by the physical causes.

Therapy with medication.

The drugs to treat OF can be taken by mouth, can be injected directly into the penis or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved Viagra, the first pill to treat OF. Taken an hour before sexual activity, Viagra works by increasing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

Despite that Viagra improves the response to sexual stimulation, not automatically triggers an erection as do the injections. The recommended dose is 50 mg, the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The drug should not be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use Viagra because the combination can cause a sudden drop in blood pressure.

It may soon be available to treat additional oral medications were included. Vardenafil is being tested and Cialis for their safety and effectiveness. Both drugs such as Viagra works by increasing blood flow to the penis. A third drug test, Uprima, works on the brain and nervous system to trigger an erection.

The oral testosterone can reduce some of the men with low levels of testosterone naturally, but often is not effective and can cause damage in the liver. Patients have also claimed that other medicines orales-que include hydrochloride yohimbina, dopamine agonists and serotonin, and trazodona-son effective, but the results of scientific studies substancien these claims have been inconsistent. The improvements observed after use of these medicines can be examples of the placebo effect, that is a change that is simply because the patient is going to happen creates an improvement.

Many men are able to have erections stronger inject drugs into the penis, causing swell with blood. Medicines such as papaverine hydrochloride, fentolamina and alprostadil (marketed as Caverject) widen the blood vessels. However, these drugs can create unwanted side effects, which include a persistent erection (known as priapism), and scars. The nitroglycerin, a muscle relaxant, can sometimes raise an erection when it is rubbed on the penis.

A system for inserting a pellet into the urethra of alprostadil is marketed as Muse. The system uses an applicator prellenado to deposit the pellet about one inch into the urethra. Start an erection in 8 to 10 minutes and can last from 30 to 60 minutes. The most common side effects are pain in the penis, testicles and the area between the penis and rectum; feeling of warmth or burning in the urethra; redness due to increased blood flow to the penis and mild urethral bleeding and spotting.

The investigation of medicines to treat OF is expanding rapidly. Patients should consult with their doctor about the latest advances.

Devices empty.

The devices cause mechanical vacuum erection by creating a partial vacuum, which carries blood to the penis, hinchándolo and expandiéndolo. The devices have three components: a plastic cylinder, which puts the penis, a pump, which draws air out of the cylinder and a rubber band, which is placed around the base of the penis to maintain the erection after withdrawing the cylinder and during sexual intercourse by preventing blood flow back to the body (see Figure 2).

Figure 2. An instrument vacuum constrictor cause an erection by creating a partial vacuum around the penis, which sends blood to the corpus cavernosum. Here are the necessary components: (a) a plastic cylinder, which covers the penis, (b) a pump, which draws air out of the cylinder, and (c) an elastic ring, which, when adjusted on the basis of penis traps the blood and maintains erection after withdrawing the cylinder.

A variation of the vacuum device involves a semi-rigid rubber sheath, which is placed in the penis and stays there after that is accomplished and the erection during sexual intercourse.

Surgery

The surgery generally has one of three goals:

Introducing a device that can cause the penis becomes erect



Rebuilding the arteries to increase blood flow to the penis



Block veins that allow blood out of the penile tissues.

• Warning:
  
  The information you will find in this article is not intended to replace the necessary medical advice or the need for a professional medical treatment for a condition or transtorno on their health.
  
  You should always consult a doctor before any doubts about your health and before starting a new treatment with medication, diet or exercise program

  El uso de estos fármacos: Viagra(impotencia),Cialis(impotencia),Levitra(impotencia), Propecia(alopecia),Xenical,acomplia,reductil(adelgazar),Valium,Prozac (stress)Zyban,(dejar de fumar),deben ser aprobados y revisado su uso por médicos, no juegue con su vida, póngase en manos de su médico.
  

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