Viagra – Erectile Dysfunction

The at times called, erectile dysfunction “impotence,” is the incapacity repeatedly to achieve or to maintain an erection it sufficiently sign as to have a sexual relation. The word “impotence” can also be used to describe other problems that interfere with the sexual relation and the reproduction, such as the lack of sexual desire and the problems with the ejaculation or the orgasm. The use of the words erectile dysfunction leaves in clear that those other problems are not implied.

The erectile dysfunction, or OF, can be a total incapacity to achieve an erection, an unstable capacity to do it, or a tendency to have only brief erections. These variations do difficult to define that of and to calculate their incident. The calculations vary since 15 to 30 million, depending on the definition used. According to the survey of National Ambulatory Medical Attention (NAMCS, acronyms in English), by each 1,000 men in the United States, 7.7 visits were done al medical doctor’s office by OF in 1985. In 1999, the frequency almost had trebled to 22.3. The increase was produced gradually, presumedly to the extent that they were put available more extensively the processing such as devices of empty and injectable medicines and began to be accepted the discussion of the erectile dysfunction. It is possible that the most publicized advance was the introduction of the medicine oral citrate of sildenafil (Viagra) in March of 1998. The data of NAMCS on new medicines show a calculation of 2.6 million mentions of Viagra in visits al doctor’s office I medicate in 1999, and a third of those mentions they took place during visits for a diagnosis done not relate to OF.

In the older men, that of generally has a physical cause, like an illness, wound, or secondary effects of medicines. Any inconvenience that cause a wound in the nerves or that deteriorate the flow of blood al grieve can cause OF. The incident enlarges with the age: around 5 percent of the 40-year-old men and between the 15 and the 25 percent of the 65-year-old men they experience OF. But is not an inevitable part of the aging.

That of is treatable to any age, and the knowledge of this fact has gone growing. More men have sought aid and returned to the normal sexual activity due to processing improved and successful of that of. Traditionally the urologists, who they specialize themselves in problems of the urinary ways, they have tried that of; nevertheless, the urologists only are 25 percent heads of the mentions of Viagra in 1999.

How an erection occurs?

The penis contains two cameras called cavernous bodies, which occupy the long one of the organ (see the figure 1). A full spongy weaving the cameras. The cavernous bodies are surrounded by a membrane, call robe albugínea. The spongy weaving contains smooth muscles, fibrous weavings, spaces, veins and arteries. The urethra, that is the channel for urinates and to ejaculate, occupies the long one under the cavernous bodies. Illustration of two penises

It figures 1. The arteries (up) and veins (down) penetrate in the full and long cavities that are located along the penis—the cavernous bodies and the spongy body. The erection occurs when the relaxed muscles permit that the cavernous bodies be filled with blood excessively fed by the arteries, while the drainage of blood through the veins is blocked.

The erection begins with the mental stimulation and of the senses, or both. The impulses of the brain and the local nerves do that the muscles of the cavernous bodies relax, permitting that flow the blood and fill the spaces. The blood creates pressure in the cavernous bodies, doing that the penis be expanded. The robe albugínea helps to trap the blood in the cavernous bodies, with it maintaining the erection. When the muscles of the penis contract to stop the flow of entrance of the blood and to open the flow at the outset of the channels, the erection reverts itself.

What cause that of?

Due to that an erection requires a precise sequence of events, OF can happen when any of the events is interrupted. The sequence includes impulses of the nerves in the brain, the backbone, and the area around the penis, and answers of the muscles, fibrous weavings, veins, and arteries in and near the cavernous bodies.

The most common cause of OF is the damage to the nerves, arteries, smooth muscles and you woven fibrous, often as a consequence of an illness. Illnesses such as the diabetes, enermedades of the kidney, chronic alcoholism, multiple sclerosis, ateroesclerosis, illness vascular and neurological illness—they are responsible for around 70 percent of the cases of OF. Between the 35 and the 50 percent of the men with diabetes they suffer from OF.

Also, the surgery (especially the radical surgery of prostate due to cancer) can injure nerves and arteries near the penis, causing OF. A wound in the penis, the backbone, the prostate, the bladder and the pelvis can carry to to produce wound in the nerves, smooth muscles, arteries and fibrous weavings of the cavernous bodies.

Besides, many common medicines—medicines for the arterial pressure, antihistamínicos, antidepressants, soothing, suppressors of the appetite, and cimetidina (a medicine for the ulcer) —they can cause OF as secondary effect.

The experts think that psychological factors as stress, anxiety, fault, depression, low self-esteem and fear of failure in the sex cause 10 to 20 percent of the cases of OF. The men with a physical cause of OF often experience the same type of psychological reactions (stress, anxiety, fault, depression).

Other possible causes are to smoke, that affects the blood flow in the veins and arteries, and abnormalities in the hormones, as insufficient quantity of testosterone.

How it is diagnosed that of? Antecedents of the patient

The sexual and medical antecedents help to define the degree and the nature of that of. A medical record can reveal illnesses that carry to that of, while a simple story of the sexual activity can distinguish among problems with sexual desire, erection, ejaculation or orgasm.

The use of certain illegal drugs or medicines recetados can suggest a chemical cause, since the effects by medicines are 25 percent heads of the cases of OF. Utilizing less or to substitute certain medicines often can alleviate the problem. Physical exam

A physical exam can give trails on problems sistémicos. For example, if the penis is not sensitive al touch, the cause can be a problem in the nervous system. Characteristics of abnormal secondary sex, such as the distribution of the hair, they can indicate hormonal problems, what would signify that the endocrine system is implied. The examiner would be able to discover a circulatory problem if observed pulses diminished in the wrist or the ankles. And characteristic unusual of the same penis they would be able to suggest the origin of the problem—for example, a penis that doubles or curve when is erect could be the result of the illness of Peyronie. You test of laboratory

Diverse tests of laboratory can help to diagnose that of. The tests for illnesses sistémicas include recounts of blood, analysis of urine, profile of lipids and measurements of creatinina and enzymes of the liver. The measurement of the quantity of testosterone in the blood can give information about problems with the endocrine system and is especially indicated in patients with sexual desire diminished. Other tests

The monitoring of the erections that occur during the dream (tumescencia peniana nocturnal) can help to rule out certain psychological causes of that of. The healthy men have involuntary erections during the dream. If did not there were nocturnal erections, then is possible that that of having a not psychological and physical cause. Nevertheless, the tests of the nocturnal erections are not completely dependable. The scientists have not normalized such tests and they have not determined when should they be taken to obtain better results. Exam psicosocial

An exam psicosocial, that utilizes an interview and a questionnaire, reveals factors psicosociales. Also it can be interviewed the sexual couple of a man to determine the expectations and perceptions during the sexual relation.

How treats that of?

The majority of the doctors suggests that the processing be carried out of less to more invasive. It is considered first to reduce any medicine that have damaging secondary effects. For example, the medicines for the high arterial pressure function of different ways. If you think that a medicine particularly is causing problems with the erection, avísele to its doctor and consult if can test a different class from medicine for the arterial pressure.

If they are indicated, the modifications of the conduct are considered subsequently and the psicoterapia in select patients, you followed by medicines orally or injected locally, devices of empty, and devices established surgically. In rare cases, would be able to be considered the surgery in veins or arteries. Psicoterapia

Often the experts treat that of with psychological base using techniques that diminish the associated anxiety with the sexual relation. The couple of the patient can help with the techniques, that include the gradual development of the intimacy and the stimulation. Such techniques can also help to alleviate the anxiety when treats that of by physical causes.

Therapy with medicines

The medicines to treat that of can be taken for mouth, they can be injected directly in the penis, or to be inserted in the urethra by the tip of the penis. In March of 1998, the Administration of Food and Medicines approved Viagra, the first pill to try. It taken an hour before the sexual activity, Viagra functions enlarging the effects of the nitric oxide, a chemical agent that relaxes the smooth muscles of the penis during the sexual stimulation and permits an increase of the blood flow.

In spite of the fact that Viagra improvement the answer to the sexual stimulation, does not unchain an automatic erection as the injections do it. The dose recommended is of 50 mg, the doctor can adjust this dose to 100 mg or 25 mg, depending on the patient. The medicine should not be used more than one time al day. The men that take based on medicines nitrates such as the nitroglycerine for problems of the heart should not use Viagra since the combination can cause a sudden fall of the arterial pressure.

Is possible that soon have additional oral medicines to treat that of. They are being tested Vardenafil and Cialis by their security and efficacy. Both medicines function like the Viagra enlarging the blood flow toward the penis. A third medicine to test, Uprima, functions in the brain and the nervous system to unchain an erection.

The oral testosterone can reduce that of in some men with low levels of natural testosterone, but often is not efficient and can cause damage in the liver. The patients have also demanded that other oral medicines—that include the hydrochlorate of yohimbina, the agonistas of the dopamine and the serotonin, and trazodona—they are efficient, but the results of scientific studies that substancien these claims have been unstable. The improvements observed after the use of these medicines can be examples of the effect placebo, this is, a change that results simply because the patient creates that is going to occur an improvement.

Many men manage to have stronger erections being injected medicines in the penis, doing that is stuffed with blood. Medicines as the hydrochlorate of papaverina, fentolamina and alprostadil (marketed as Caverject) they widen the blood vessels. Nevertheless, these medicines can create secondary effects done not desire, that include a persistent erection (known as priapismo) and scars. The nitroglycerine, a relajante muscular, at times can enlarge an erection when rubs itself it on the penis.

A system to insert a granule of alprostadil in the urethra markets itself as Muse. The system uses an applicator prellenado to place the granule around an inch inside the urethra. Will begin an erection in 8 to 10 minutes and can last from 30 to 60 minutes. The most common secondary effects are pain in the penis, testicles and area among the penis and the straight one; sensation of heat or ardor in the urethra; reddening owed al increase of the blood flow toward the penis; and light bled or you stain uretrales.

The investigation of medicines to treat that of is being expanded quickly. The patients should consult with their doctor about the last advances.

Devices of empty

The devices of empty mechanics cause erection creating an empty partial one, that carries blood toward the penis, swelling it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a bomb, that extracts air out of the cylinder and an elastic band, that is placed around the base of the penis to maintain the erection after be withdrawn the cylinder and during the sexual relation avoiding that the blood flow of return al body (to see the figure 2).

A variation of the device of empty involves a sheath of semirigid rubber that is placed in the penis and remains there after the erection is achieved and during the sexual relation. Surgery

The surgery generally has one of three goals:

* to establish a device that can cause that the penis return erect

* to reconstruct the arteries to enlarge the flow of blood al grieve

* to block the veins that permit that the blood leave the weavings of the penis

The devices established, known like prosthesis, they can return the erection to many men with OF. The possible problems with the implants include mechanical break and infection, although the mechanical problems have diminished in recent years due to the technological advances.

The malleable implants generally consist of a pair of rods, that are inserted surgically in the cavernous bodies. The user adjusts by hand the position of the penis and therefore, the rods. The adjustment does not affect the wide or long of the penis.

The inflatable implants consist of a pair of cylinders, that are inserted surgically inside the penis and they can be expanded using liquid to pressure (to see the figure 3). Some pipes connect the cylinders to a deposit of liquid and to a bomb, also established surgically. The patient inflates the cylinders pressing a small bomb, located under the skin in the scrotum. The inflatable implants can expand something the long one and the wide one of the penis. Also they leave al penis in a more natural state when is not inflated.

The surgery to repair arteries can reduce that of caused by obstructions that block the blood flow. The better candidates for said surgery are young men with a discreet blockade of an artery due to a wound in the crutch or the fracture of the pelvis. The procedure is less successful in older men with a blockade extended.

The surgery in the veins to permit that the blood leave the penis generally implies the procedure opposed—intentional blockade. The blockade of the veins (ligature) can reduce the loss of blood that diminishes the inflexibility of the penis during the erection. Nevertheless, the experts have been questioned about the long-term efficacy of this procedure, and rarely time is done. [Up] Hopes through the investigation

The advances in supositorios, injectable medicines, implants and devices of empty have expanded the options for the men that seek processing for that of. These advances have also helped to enlarge the number of men that seek processing. The therapy with genes is being tested for OF in various centers, which can offer a lasting therapeutic focus for that of.

The National Institute of the Diabetes and Renal and Digestive Illnesses (NIDDK, acronyms in English) sponsors programs directed to understand the causes of the erectile dysfunction and to find processing to revert its effects. The Division NIDDK of Renal Illnesses, Urológicas and Hematológicas supported the investigators that developed Viagra and continues supporting the basic investigation of the mechanisms of the erection and the illnesses that deteriorate the normal function in the cell and molecular levels, including diabetes and high arterial pressure. [Up] Points to recall

* The erectile dysfunction (OF) is the incapacity repeatedly to achieve or to maintain an erection it sufficiently sign as to have a sexual relation.

* OF it affects from 15 to 30 million American men.

* OF has generally a physical cause.

* OF is treatable in all the ages.

* The processing includes psicoterapia, therapy with medicines, devices of empty and surgery.