Erectile dysfunction often referred to improperly as "impotence," consists of the inability to achieve and maintain an erection strong enough to allow for satisfactory intercourse. It is a prevalent condition, which affects 13% of the male population: this means that about 3 million Italians have an erection deficit. It is more common in men over 45-50. Age, therefore, represents one of the main risk factors, also because, with aging, various characteristics of the erection change: the time necessary to obtain complete rigidity of the penis increases; the phase of maintaining an erection is shortened, which is even more difficult; the refractory period is extended
WHAT ARE THE CAUSES OF ERECTILE DYSFUNCTION
Multiple factors can alter the mechanism of erection. The various causes that can determine the onset of erectile dysfunction are divided into psychogenic, endocrine, neurogenic, vascular and iatrogenic. It is essential to underline that of the various possible causes; some are "non-modifiable" because they are linked to pathological situations, while others are "modifiable" because they are linked to behavioral factors. There are also predisposing conditions which, although not direct causes of the erectile deficit, are capable of exponentially increasing the risk.
The habit of smoke is a significant risk factor for erectile dysfunction; the number of cigarettes smoked per day, and smoking duration is directly related to the onset of the erectile deficit. For example, the risk is higher in diabetic smokers than in non-smoking diabetics.
Psychogenic seemed to be the most common cause of erectile dysfunction; today, epidemiological data indicate that it is often determined or accompanied by organic nature alterations. The mechanisms by which psychological factors can favor the onset of erectile dysfunction are not yet fully understood. A fundamental role is certainly played by the sympathetic nervous system's hyperactivity, which occurs, for example, in conditions of stress. A particular situation is represented by the so-called "performance anxiety," which determines an inhibitory effect on erection and is frequent among young people in the first sexual experiences, is facing a new partner, or after the occurrence of early failure in sexual relations.
Endocrine (hormonal) causes
The endocrine diseases most closely related to the onset of erectile dysfunction are hypogonadism and hyperprolactinemia. In hypogonadism, a reduction in testosterone levels occurs, accompanied by decreased sexual desire and a reduction in erectile activity. In men with hyperprolactinemia, there is instead an increase in prolactin, which causes an erectile deficit associated with a decrease in libido and infertility.
Among the neurological diseases affecting the central nervous system related to erectile dysfunction, multiple sclerosis, Alzheimer's disease, and Parkinson's disease play a leading role. Spinal cord injuries are an infrequent cause of the erectile deficit. The recovery of post-traumatic sexual potency depends on the level and extent of the injury. The peripheral nerves that mediate an erection can also be damaged in numerous pathological situations, especially diabetes.
Locally, the vascular pathologies responsible for erectile dysfunction can be both arterial and venous. In the first case, the erectile deficit is caused by reduced blood flow to the penis, while venous pathologies prevent blood from being trapped inside the cavernous tissue of the penis. L' atherosclerosis indeed represents the most common cause of erectile dysfunction of arterial origin; other causes of vascular damage must be remembered are surgery and the pelvis's radiotherapy. On the systemic level, cardiovascular pathologies represent one of the main predisposing conditions for erectile dysfunction
Causes related to chronic diseases
Among the chronic diseases that can induce erectile dysfunction, diabetes and chronic renal failure have the highest incidence. An erection disorder is observed in a percentage ranging from 35% to 75% of males with diabetes. In diabetic patients undergoing medical treatment erectile dysfunction is more frequent than in patients treated exclusively with dietary restriction. Use to Super P Force, Tadarise 20, Super vidalista
Even chronic liver disease is frequently associated with erectile dysfunction, especially in the liver disease of alcoholic origin. In neoclassic diseases the erectile deficit can be caused by both organic and psychosexual causes.
How an erectile deficit is diagnosed
In the case of erectile dysfunction, the goal of diagnosis is to define the nature of the dysfunction: organic, psychological, or mixed. The first approach in the diagnostic process consists of an interview (anamnesis) and an IIEF questionnaire (International Index of Erectile Function), specific to focus on some aspects of sexual activity and lifestyle habits. Laboratory tests are designed to exclude diabetes or other previously undiagnosed systemic diseases. They include measuring blood glucose, triglyceridemia, and cholesterolemia, and measuring hormones that affect sexual activity. Based on this first screening results, it is decided whether to continue with second level investigations. These are evaluations that allow us to detect venous or arterial alterations and to monitor nighttime erectile activity. The basal and dynamic penile Doppler ultrasound evaluates the correct vascular function of the penis. At the same time, the nocturnal stiffness, indicated above all in young patients with erection problems, allows us to monitor the nocturnal erections, which, in a healthy subject, occur physiologically during the REM sleep phase.