Pathology to multiple relational and psychological implications, male impotence is a real disease whose mechanisms are becoming better known and for which new treatments are currently available or under evaluation.
The words to say
Impotence is by definition impossible to maintain an erection sufficient for sexual intercourse. Attention should not be confused with the erection ejaculation and orgasm, which are three specific elements that can be found during sex.Impotence on erection. At rest, we say that the penis is "flaccid". Flaccidity is not impotence.
How "it" works?
The penis consists of erectile bodies, the corpora cavernosa, located on the sides. These erectile bodies work like sponges that are gorged with blood under the control of nerve stimulation. Multiple small sphincters are arranged around the blood vessels of the erectile bodies, causing an opening or closing of these vessels allowing cavernosa to increase volume or to empty. However, the erectile function can not be commanded, it is a neurological reflex independent of the will influenced by hormonal and psychological phenomena. To prove the existence of erections occurring thing in the morning without any sexual stimulation occurs.
Am I impotent?
Immediately to reassure the male (or worry, it depends), we must know that there are between two and three million French people who experience sexual failures to different degrees, occasionally (39% of French) or once in two (11% of the French), the latter being the criterion for defining a true helplessness.
The causes of impotence
Given the complexity of the mechanisms responsible for erection, one can easily imagine the many possible causes. First, we must distinguish two types of impotence: the impotence of psychological origin and the impotence of organic origin.
Psychological factors are the most frequent episodes of depression, loss of self-confidence and relationship problems with partner. To highlight a psychological cause, ie the absence of organic cause, we practice a recording of nocturnal erections, which normally occur during REM sleep phases and are not influenced by psychological factors. If the existence of these erections is demonstrated in the patient, it is indeed a psychological cause. We can then refer the patient to a specialist in psychology or psychiatry.
Otherwise, or if the condition is obvious, we are moving towards an organic cause. However, in most cases, the organic and psychological reasons are associated. Organic causes of impotence are numerous and the balance will depend on the impotence clinic focus towards one or other of these causes:
· Hormone, it is a deficiency in secretion of male hormones (androgens) or an excess of pituitary hormone (prolactin);
• The diabetes is the most common cause of organic impotence. It can cause impaired vascular, neurological dysfunction of the corpora cavernosa, a decline in general health. Diabetes can also be involved through the anti-diabetic drugs or psychological problems associated;
General evolutionary · Diseases (heart attack, cancer ...)
° The causes are numerous drug. An Internet address end of the article gives a very complete list of drug substances that can disrupt the erection. In general, the recurrence of erections after stopping the offending drug is proof;
· Causes surgery: Some surgeries can cause erectile dysfunction mainly by nerve damage (cancer of the rectum, bladder, prostate ...);
· Neuropathy, by achieving a level of the nervous axis allowing the erection of the spinal cord to the penis;
· Causes arteries due to decreased blood flow to the penis and corpus cavernosum. This case is not unusual in view of the frequency in our country, cardiovascular diseases (arteritis ...). This is the way that smoking can be a source of organic impotence;
· The alcohol is somewhat unusual because it involves phenomena "toxic" and psychological phenomena.
Psychological factors are the most frequent episodes of depression, loss of self-confidence and relationship problems with partner. To highlight a psychological cause, ie the absence of organic cause, we practice a recording of nocturnal erections, which normally occur during REM sleep phases and are not influenced by psychological factors. If the existence of these erections is demonstrated in the patient, it is indeed a psychological cause. We can then refer the patient to a specialist in psychology or psychiatry.
Otherwise, or if the condition is obvious, we are moving towards an organic cause. However, in most cases, the organic and psychological reasons are associated. Organic causes of impotence are numerous and the balance will depend on the impotence clinic focus towards one or other of these causes:
· Hormone, it is a deficiency in secretion of male hormones (androgens) or an excess of pituitary hormone (prolactin);
• The diabetes is the most common cause of organic impotence. It can cause impaired vascular, neurological dysfunction of the corpora cavernosa, a decline in general health. Diabetes can also be involved through the anti-diabetic drugs or psychological problems associated;
General evolutionary · Diseases (heart attack, cancer ...)
° The causes are numerous drug. An Internet address end of the article gives a very complete list of drug substances that can disrupt the erection. In general, the recurrence of erections after stopping the offending drug is proof;
· Causes surgery: Some surgeries can cause erectile dysfunction mainly by nerve damage (cancer of the rectum, bladder, prostate ...);
· Neuropathy, by achieving a level of the nervous axis allowing the erection of the spinal cord to the penis;
· Causes arteries due to decreased blood flow to the penis and corpus cavernosum. This case is not unusual in view of the frequency in our country, cardiovascular diseases (arteritis ...). This is the way that smoking can be a source of organic impotence;
· The alcohol is somewhat unusual because it involves phenomena "toxic" and psychological phenomena.
What solutions?
Basically, common sense requires that we treat the organic cause psychological or suspected to cause erectile dysfunction, but there are also solutions that directly support the erection penile prostheses outside providing the necessary rigidity but are reserved for severe cases and when the patient is requesting.Most of these treatments act on the vascular phenomena of erection (erectile bodies fill). Direct injection into a corpus cavernosum of prostaglandin E1 is effective in all types of erection and consistently. The disadvantage is that this technique is aggressive and may cause error if dosing is too prolonged erections (priapism) can lead to lesions of the penis. The other injection system not yet available in France, the system Muse, is the direct injection of prostaglandin into the urethra through a catheter. Still in treatment with a direct local action may signal the mechanical system Vacuum pump that allows an erection once achieved, to maintain it with a rubber band placed around the base of the penis.As for drugs taken systemically, they are represented mainly by Viagra, which acts by promoting the erection when sexual stimulation, but that should be taken one hour before intercourse, and especially, who may have consequences serious cardiac patients treated with nitrates. Currently, some are being marketed as phentolamine (Vasomax), which would have fewer cardiac effects than Viagra, and apomorphine, which would be effective in cases of psychogenic impotence, but that would cause nausea and dizziness.
Warning
One can find, especially on the Internet, a large number of advertisements for drugs to treat impotence. Most have no efficacy in the best case, and some are even dangerous to health. Moreover, Viagra can be bought without a prescription on the Internet but this is strongly discouraged because of potential serious heart risks. So in cases of impotence assumed or feared, it is best to talk to his doctor or a urologist.
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