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Erectile dysfunction

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**Group 1: Erectile Dysfunction Overview**

– Erectile dysfunction (ED) is characterized by the persistent inability to achieve or maintain a penile erection for satisfactory sexual activity for at least 3 months.
– It often affects the emotional well-being of males and their partners, with about 75% of diagnosed cases remaining untreated.
– Causes of ED include diets high in saturated fat, prescription drugs, neurogenic disorders, cavernosal disorders, hyperprolactinemia, psychological factors, surgery, aging, kidney disease, lifestyle habits, COVID-19, surgical interventions, bicycling, and pornography use.
– The pathophysiology involves the management of penile erection by reflex and psychogenic mechanisms, with nitric oxide secretion leading to smooth muscle relaxation.
– Diagnosis is based on symptoms history, physical examination, and laboratory investigations to rule out serious causes, with the distinction between physiological and psychological ED being crucial.

**Group 2: Diagnostic Methods for Erectile Dysfunction**

– Diagnostic methods for ED include penile ultrasonography with Doppler to examine blood flow, bulbocavernosus reflex test to check nerve sensation, and nocturnal penile tumescence to measure penile rigidity during sleep.
– Other methods like penile biothesiometry, dynamic infusion cavernosometry, and corpus cavernosometry are used to evaluate sensitivity, nerve function, vascular pressure during erection, and venous leakage.
– These tests help in distinguishing between organic and psychogenic causes of ED and guide treatment decisions.

**Group 3: Treatment Options for Erectile Dysfunction**

– Treatment for ED depends on the underlying cause and may include exercise, counseling, medications like PDE5 inhibitors (sildenafil, vardenafil, tadalafil), alprostadil cream, penile injections, suppositories, and testosterone supplementation.
– Vacuum erection devices, focused shockwave therapy, and surgical options like penile implants or vascular reconstructive surgeries are available.
– Alternative therapies lack FDA recommendation and products claiming to be herbal Viagra may contain adulterants, while surgical interventions are considered as a last resort.

**Group 4: Impact of Lifestyle and Medical Factors on Erectile Dysfunction**

– Factors like aging, smoking, vascular risk factors, diabetes, and the use of sex aids can impact erectile function.
– Research shows a link between dietary patterns, plant-based diets, and specific medications with ED.
– COVID-19 has also been studied for its potential impact on male reproductive health.

**Group 5: Pornography and Sexual Dysfunction**

– Studies have explored the association between pornography use and erectile dysfunction, with conflicting evidence on the prevalence and impact.
– Factors like pornography addiction, internet use, and post-finasteride syndrome have been linked to sexual dysfunctions.
– Vibrators have been found effective for ED, and research continues to investigate the relationship between pornography consumption and sexual dysfunction.

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.

Erectile dysfunction
Other namesImpotence
SpecialtyUrology, sexual medicine, andrology
SymptomsInability to gain or maintain an erection
CausesLow testosterone levels, certain prescription drugs, neurogenic disorders
Risk factorsCardiovascular disease, diabetes, smoking, stress, mental disorders, ageing, high saturated fat diet, kidney disease
Diagnostic methodDepends if psychological or physiological; absence of involuntary erections suggests physiological
Differential diagnosisHypogonadism, prolactinoma
PreventionAdequate exercise
TreatmentPenis pump, counseling (psychological treatment)

The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease, diabetes mellitus, high blood pressure, obesity, abnormal lipid levels in the blood, hypogonadism, smoking, depression, and medication use. Approximately 10% of cases are linked to psychosocial factors, encompassing conditions like depression, stress, and problems within relationships.

The term erectile dysfunction does not encompass other erection-related disorders, such as priapism.

Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues. In many instances, medication-based therapies are used, specifically PDE5 inhibitors like sildenafil. These drugs function by dilating blood vessels, facilitating increased blood flow into the spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra, the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants, the use of penis pumps, and vascular surgery.

ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75.

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