Sexual disfunction in men -Things You Should Know
Sexual disfunction in men – Erectile dysfunction (ED) has been attributed to several risk factors including low testosterone levels, an unhealthy lifestyle, smoking, and obesity, and some individuals are predisposed to the condition.
Excessive androgen production is the primary contributor to ED, but this may also occur in situations in which levels are normal. But the role of sex hormones in the development of ED is controversial. Not all experts agree that the role of sex hormones in ED is unequivocally relevant to diagnosis. Common medications used to treat ED include levonorgestrel, clomiphene, prucalopride, and dydrogesterone.
Botox is another medication that is known to be effective in treating ED. Erectile dysfunction is a medical condition with multiple different clinical presentations. It can result from the direct physical effects of some disease processes, such as high blood pressure, diabetes, or hypertension, but can also be a symptom of other, related medical problems, such as cancer. According to one study of men with ED, 30.6% had a previous history of cardiovascular disease.
Cardiovascular disease, in particular atherosclerosis, affects blood flow to the penis, reducing the ability to stimulate an erection, and can lead to ED. Pulmonary arterial hypertension (PAH) affects blood flow to the penis, leading to reduced semen production, and is a leading cause of erectile dysfunction.
Sex hormone-binding globulin (SHBG) is a key regulator of vascular tone. In men, the ratio of SHBG to testosterone is significantly lower in men with erectile dysfunction compared to control men, and a reduction in SHBG has been shown to produce ED in animal models. Erectile dysfunction and coronary artery disease are associated with an impaired blood supply to the penis, reduced sensitivity, and decreased penile blood flow.
A vascular condition can cause ED. There is often an underlying vascular disorder such as ischemia, infection, multiple sclerosis, or arteriosclerosis, in addition to the physiological abnormalities that affect blood flow. Hereditary cardiovascular disease can be the cause of ED in individuals with no other risk factors. Another cause is edema. Edema occurs when the body produces extra fluid. Excessive fluid retention causes ED. Both ED and edema may be associated with arrhythmias.
Some studies suggest that ED may be related to aging. Evidence for this is partly based on studies that looked at men in their 70s and 80s. Studies of men in their 60s, 50s, and 40s have found that ED has a similar prevalence. A small study in 2007 also reported that ED was prevalent among people aged between 50 and 69. A review in 2012 found that ED is more prevalent among men in their 50s and 60s than in younger men.
Increasing age was linked to a decreased libido, a decreased ability to achieve an erection, and a preference for oral stimulation. During the study, ED was more prevalent in studies that used penile plethysmography, electrodiagnostic equipment that measures penile size and firmness, compared to studies using only visual assessment of the penis. The finding of an increased prevalence of ED among older men suggests that it is a disease in the aging process. The authors suggested that ED may be a response to a decline in sexual activity.
Disrupted responses of the brain may also be a cause of ED in older men, leading to a reduced interest in sex, resulting in ED. According to a 2013 review, men over the age of 65 may be more likely to develop ED, and a reduced interest in sex is more prevalent among men over the age of 65 than in younger men. Additionally, there was a correlation between the desire for sexual activity and the desire to feel youthful.
Some evidence suggests that ED may be related to autonomic arousal. One review has found that, after a stressful situation, men report an increase in their blood pressure and heart rate; and they are more likely to report decreased desire and arousal. Physical education has been shown to reduce sexual activity among men.ED has been associated with a diagnosis of cardiac arrhythmia.
Such men may have a weakened sympathetic nervous system, which may play a role in ED. Although the mechanisms behind this relationship are unknown, it may be related to penile sensation. Edema may play a role because it causes a restriction in blood flow to the penis.
A 2013 review suggested that penile artery obstruction is more common in men with both ED and peripheral vascular disease. The latter is when a person has a blockage in one or more of their carotid arteries. Inhibition of blood flow to the penis may be a result of a relationship between ED and obstructive coronary artery disease (interstitial and coronary obstructive disease).
It has been suggested that the relationship between ED and CVD may be related to the increased potency of drugs known as dopamine agonists. These drugs decrease blood flow to the penis, which may cause ED.
ED may be a symptom of underlying CVD. According to one review, the relationship between ED and CVD is related to factors such as lower arterial compliance, atherosclerosis, and pulmonary congestion. In addition, levels of substances like cholesterol and triglycerides may be lower among men with ED.
Less commonly, ED may be a cause of CVD.A 2013 review found that in men with CVD, ED was more prevalent among men with both coronary atherosclerosis and peripheral vascular disease. Researchers suggest that this relationship may be related to factors such as the delayed response of vasopressors in patients with cardiovascular disease, impaired perfusion, dysregulated vascular endothelial growth factor-inducible factor (VEGF-I) signaling, and alterations of the cardiac Myocyte growth factor (MIGF) pathway.
However, this relationship has not been confirmed by research in a clinical trial. Risk factors for ED may include marital status, genital tuberosity, and a previous prostate cancer history. It has been suggested that, in men with penile cancer, the symptoms of ED may persist due to immunosuppression.
Genetic factors such as the Klinefelter syndrome, which is characterized by an excessive number of Y-chromosome Y cells in the testes, have been associated with ED, but there is controversy surrounding whether these men have ED.
The incidence of ED in people of different ethnicities is unclear.Research indicates that ED is significantly less common in Asians than in Caucasians, but the rate of ED is similar in both groups. In people of European descent, ED is less common among men from North America than in Europe.ED is less common among women from countries in Western Europe than in Asian countries.
It is estimated that about 35–50% of men between the ages of 40 and 70 years are affected by ED.While many ED patients do not seek medical treatment, those who do usually find a physician with expertise in the diagnosis and treatment of sexual dysfunction. The American Urological Association (AUA) recommends that men with ED see a physician for the diagnosis and treatment of ED if: If these symptoms persist for 6 months or more, it is advisable to see a urologist or a urologist-hematologist for the diagnosis and treatment of ED.
Urinary urgency may be evaluated by some urologists with a simple digital urethrostomy:
1) complete bladder emptying for 30 minutes;
2) no urine flow during the test; and
3) urinary stream; however, the patient must be comfortable undergoing an acute, sudden procedure, such as urinary diversion, which requires the patient to remain fully diapered for the duration of the procedure.
The AUA recommends no less than two outpatient appointments before undergoing any type of bladder diversion procedure and they recommend no less than three outpatient appointments before undergoing continuous catheterization of the urinary bladder.
The AUA recommends that a urologist monitor a patient during the 24 hours following catheterization for the presence of blood or urine leaking into the peritoneal cavity and on the following 7-day urine collection for the presence of abnormal results on the urinalysis. The AUA recommends that patients who undergo bladder diversion have a written follow-up with the urologist for 6 months, but the AUA suggests that patients have a more specific follow-up during the 24 hours before the next bladder diversion procedure, whenever feasible.
A 2012 review of the evidence from randomized controlled trials found that penile prostheses provide only marginal improvements in sexual function and aesthetics.
In a 2006 report, it was concluded that there is no “silver bullet” treatment for ED and that the primary goal of treatment is to improve a patient's quality of life, with secondary goals of reducing discomfort and related problems.
There is no consensus on the treatment options for ED, although medications are generally preferred to surgical interventions. Intravenous medications are used for ED in many countries. While ED can be controlled with medications, other measures may be required to alleviate associated symptoms. Stimulants, such as methylphenidate, amphetamines, and dopamine agonists are considered the best options to manage ED in clinical practice. Eliminating environmental and psychosocial factors is thought to play a role in ED.
The following dietary and lifestyle factors are associated with ED:
In 2017, a review in “Clin Gastroenterol Nutr” found a connection between increased cigarette smoking, increased consumption of alcoholic beverages, dyspepsia, and diabetes or hypertension with ED. Lifestyle changes, such as smoking cessation, alcohol abstinence, maintaining a healthy weight, reducing salt intake and more exercise may result in a reduction of ED. A 2008 study suggested a link between increased consumption of red meat and ED.
However, the effect was small and the study has been described as “biased”.Long-term abstinence from alcohol has been associated with ED reduction. For example, a 2003 study in the “British Journal of Urology International” reported that men who had abstained from alcohol for at least 10 years were significantly less likely to have erectile dysfunction than men who had consumed alcohol in the 3 months before the study.
A 2016 review of studies that included 28,817 patients with chronic ED found that men with persistent ED who had decreased alcohol consumption during their period of abstinence were more likely to have satisfactory intercourse than men who maintained the same level of alcohol consumption while abstaining from sex.
A 2017 meta-analysis found that daily acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat ED.
In the UK, the Prescribing Services Council has advised that a referral to a urologist may be appropriate when patients have more than a month of ED lasting for 6 months or more, although men should consult a urologist before starting any treatment.
A 2007 review in the “International Urology & Nephrology” journal found that hip surgery is the most commonly recommended treatment for erectile dysfunction.
In 2014, the International Society for Sexual Medicine issued a report on novel therapies in the treatment of erectile dysfunction, which recommended the treatment of primary erectile dysfunction with penile injections and epididymal stents to treat persistent ED.
Those medications that are safe in clinical trials include baclofen, milnacipran, and androstenedione.
A 2005 review concluded that all of these drugs are associated with some degree of adverse effects. Of the studies conducted, the most effective medication for ED was baclofen, with 13 mg of baclofen having the best effect in reducing ED and having few side effects. Propecia is the active ingredient in Proscar and appears to be effective in one-quarter of men. Off-label use of bupropion has been suggested in the treatment of ED.
“Analgesics” such as acetaminophen, naproxen, ibuprofen, and tramadol are used to reduce symptoms of ED; however, they are generally contraindicated in people who may be pregnant or who have any other medications, especially NSAIDs, which may increase the risk of bleeding.”Spironolactone” may also be used, although it has a risk of fluid retention and sexual arousal abnormalities.ED is considered a minor health concern in individuals without serious medical problems.
Gastrointestinal problems may cause ED in less than 1% of men. More than 90% of men with ED have not been diagnosed with underlying psychological disorders.ED is rarely linked to coronary artery disease. Some people who are at increased risk of cardiovascular disease may have mild ED as a side effect of taking calcium blockers. In another 2–6% of men, ED is the cause of their ED. More than 50% of men with ED are undiagnosed; of those who are diagnosed, only 27% of men believe that their condition is treatable.
More than one-third of men who are given a diagnosis of ED who are subsequently treated are not fully cured of their symptoms. Up to 50% of people who have ED are diagnosed only after significant cardiovascular problems have occurred.
Diagnosis is typically based on the individual's medical history, physical examination, blood pressure, and response to particular medications. Erectile dysfunction should also be evaluated in men with persistent genital arousal disorder, and when young men with ED are found to have a higher prevalence of infertility.
Semen analysis is frequently used to diagnose ED. High levels of total sperm count and no sperm DNA are usually considered negative.
In men with low sperm counts, a male fertility hormone, 5 alpha-reductase, may be abnormally low.
This is common in older men with ED who are unable to achieve or maintain an erection or may have difficulty maintaining an erection despite not having ED.
In addition to performing the various examinations of the penis, one important factor in diagnosing ED is whether a patient is also experiencing a decrease in libido, which is the desire to have sex.
It is also important to rule out other conditions that may be causing a loss of sexual desire, such as drug or alcohol abuse, neurological disorders, and diabetes.
A urinalysis may be performed to rule out sexually transmitted infections, such as gonorrhea and syphilis.
Imaging tests can rule out prostate and testicular abnormalities and any other serious medical issues that may be causing erectile dysfunction.
Biopsy of the prostate and skin biopsy of the penis, below the penis, and inside the penis are common procedures.
A diagnosis may be confirmed with a blood test or urine test.The PSA test for prostate cancer is considered the gold standard for identifying prostate problems; however, it is not typically performed in people with other types of sexual dysfunction.
It may also be performed if a patient has other medical concerns that suggest it is unlikely that the cause is a prostate problem.
The following 4 tests may be performed:
A semen analysis can be used to identify the presence of spermatozoa and measure their levels of concentration.It is generally the first step in a medical diagnosis.The test involves collecting semen from the scrotum of the penis, allowing it to cool, then storing the sample in a sterile container in a laboratory.
A normal semen analysis requires a normal semen sample; however, a man who has ED may have a low sperm count or may be at increased risk of infertility, and a sperm concentration of less than 15 million/ml may be considered abnormal.
Low sperm counts may be related to lifestyle factors such as alcohol, tobacco use, and stress; these lifestyle changes should be made first.
Urinary tract infection (UTI) may present with a urinary urgency or frequency, blood in the urine, or abnormal urinary symptoms; therefore, these symptoms should also be considered as part of the evaluation for ED.
Urinary tract infection may be caused by bacteria that are both external and internal, and cannot be diagnosed without a urinalysis.Internal infections, in contrast, often cause no symptoms.
Once a diagnosis is made, further evaluation may involve a physical examination and/or blood tests.Since men with ED rarely experience symptoms, a physical examination is usually not performed.This is more commonly performed when diseases that affect the penis are suspected.
A rectal examination and a rectal exam usually do not occur unless a doctor suspects cancer of the prostate.An ultrasound of the urethra, which allows the physician to see the bladder and the urethra, is often performed if a patient is experiencing any of the aforementioned symptoms.
Both the doctor and the patient will look for changes in the urinary tract, bladder, and urethra.
Some treatment options for ED include diet, exercise, stress reduction, sexual therapy, and medication, but the effectiveness of the above interventions is not well understood.
Dietary changes include limiting the intake of foods that may increase sexual arousal, such as caffeine and alcohol.
Exercise is encouraged as it reduces stress, increases blood flow, and relaxes the muscles, and it may also increase orgasm and ejaculation, and improve penile function.
Limiting alcohol may help increase sensation during sexual activity and reduce the urge to ejaculate.
Sexual therapy techniques may include the use of hypnosis or erotic hypnotherapy to relax the body, improve mental outlook, and increase sexual activity.
Erectile dysfunction is treatable, with numerous treatments being approved by the Food and Drug Administration (FDA).
Lifestyle changes such as limiting alcohol and caffeine intake and exercising regularly can help reduce ED.
Psychotherapy, such as cognitive behavioral therapy, is effective, and may also improve the mental outlook, relieve depression, and improve physical and psychological health.
Supplemental testosterone has been found to increase sexual drive, which may help to improve the symptoms of ED.
Some medications, such as alpha-blockers, vasodilators, antidepressant medications, and steroids, can also be used to treat ED.
These medications can be taken in pills, creams, or injections, and may improve sexual function.
Antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) are often prescribed to treat ED.
Steroid injections are not effective.The World Health Organization (WHO) has identified five medications as having the most efficacy in treating ED, and these include Viagra, Cialis, Levitra, and Vardenafil.
Viagra, Cialis, and Levitra are much more effective when used in conjunction with their medications, however, several studies have found Viagra and Cialis to be little more than placebos when used alone.
Levitra, Cialis, and Vardenafil, on the other hand, are more effective in treating ED when used alone.
Aspirin can also be used for ED.
Sertraline, sertraline hydrochloride, is the generic name for the drug with the brand name Zoloft.
It is used for depression and is effective in treating ED.
- Viagra, Cialis, Levitra, and Vardenafil are available by prescription only in the United States.
- Levitra is available in the United States, Canada, Germany, the United Kingdom, Australia, France, Switzerland, Japan, and South Korea.
- Sildenafil is available in the United States, Canada, Germany, France, the United Kingdom, Australia, France, Belgium, Spain, Italy, Netherlands, New Zealand, Denmark, Portugal, Norway, Sweden, Poland, the Czech Republic, Greece, and South Africa.
- Tadalafil is available in the United States, Canada, and Germany.
- Stada Arzneimittel (formerly known as Sertab) is used by prescription in Japan, Austria, and India.
- Cialis is available in the United States, Australia, and Canada.
- Abbott Laboratories sells Cialis in Germany, Poland, and the Czech Republic.
- Zoloft is available in the United States, Canada, Germany, New Zealand, France, Belgium, Spain, Italy, the Netherlands, Japan, Norway, Sweden, Switzerland, South Africa, and China.
- Tadalafil is available in Canada.
- Vardenafil is available in Australia and New Zealand.
- Tadalafil is available in Sweden, Norway, Finland, Denmark, Italy, New Zealand, and Ireland.
- Abbott Laboratories sells Viagra in Australia, New Zealand, and France.
- Roche sells Vardenafil in Sweden, Denmark, Finland, Norway, and the Netherlands.
- Mylan sells Tadalafil in Canada.
- Sildenafil is also available by prescription in the following countries: Argentina, Australia, Austria, Brazil, Chile, China, Colombia, Croatia, Czech Republic, Denmark, Estonia, Finland, Germany, Hong Kong, Hungary, India, Ireland, Israel, Italy, Japan, Korea, Kuwait, Lithuania, Luxembourg, Mexico, the Netherlands, New Zealand, Philippines, Poland, Romania, Singapore, Slovakia, South Africa, South Korea, Spain, Sweden, Switzerland, Taiwan, Turkey, the United Kingdom, the United States, and Vietnam.
- Tadalafil is also available by prescription in Chile, Colombia, the Czech Republic, Greece, and Russia.
- Prescription medications for ED may also be available over the counter in some countries, such as Australia and Canada, as well as in the United Kingdom.
An estimated 1 in 10 men in the United States will experience some degree of erectile dysfunction.
However, data in the United States indicate that the average age of men reporting ED has risen from 30.5 in 1976 to 40.6 in 2006 and that the average age of men reporting the first symptom has increased from 26.4 to 29.5, a 4.6-year increase in the age of onset of ED.
Cerebrovascular disease, obesity, diabetes, certain medications, smoking, and performance anxiety are known risk factors for ED.
Physical factors include low libido, premature ejaculation, poor penile erectile function, and decreased sexual functioning or desire.
Mood disorders such as depression, bipolar disorder, and major depressive disorder are also common causes of ED.
Physical disorders that contribute to ED include excessive size or thickening of the penis, poor blood flow, and atrophic penis wounds.
Anatomical conditions such as spinal cord injury, multiple sclerosis, stroke, and transient ischemic attack can cause sexual dysfunction. Genetic conditions such as familial adenomatous polyposis, hypogonadism, hypogonadotropic hypogonadism, and androgen insensitivity syndrome are associated with ED. Diagnosis is based on clinical symptoms and tests for the presence of prostate enlargement. Abnormalities in the urinary system (e.g. the prostate) are normal on both CT and ultrasound.
The primary sources for diagnosis are clinical history, digital rectal examination, and ultrasound. Some research suggests that digital rectal examination alone, without any special tests, has a sensitivity and specificity of 89% and 96% for the detection of ED, respectively.ED is often diagnosed clinically, but many men may be only semi-conscious of their problem, and some men may not be aware of their problem at all.
Urinary tract disease may be detectable by symptoms such as urgency and difficulty in starting to urinate. Treatment usually begins with the initial diagnosis and evaluation of the cause, which may include lifestyle modifications, antidepressant treatment for depression, or electrodiagnostic testing. Cognitive behavioral therapy may help with ED as well. Antidepressants are recommended for the treatment of depression, but antidepressants do not usually improve sexual function in men.
Dioxin and dioxin-like compounds are the most common cause of ED in humans. Early diagnosis and treatment are the keys to preventing ED. A person with ED can usually avoid serious consequences of prolonged ED, although one study has suggested that erectile dysfunction can be a precursor to developing prostate cancer. In contrast, some men may not be aware they have an ED, may be unwilling or unable to treat it, or maybe in denial or unwilling to acknowledge their condition.
Some men may use substances such as alcohol and opioids to attempt to alleviate the discomfort of ED. Although alcohol and opioid use is not recommended as a treatment for ED, both alcohol and opioid use can trigger dependence. Treatment for ED may involve self-help or referral to a health care provider.
For many men, once they have an ED, they may seek to treat it by using Viagra, Cialis, Levitra, or other drugs. For those who choose to pursue treatment, medications that may help include sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and apomorphine (Apotekex). Acquiring these drugs is usually relatively easy and only requires the individual to visit a local pharmacy and provide a written prescription.
