Erectile dysfunction is the inability of a man to achieve and maintain an erection sufficient for a satisfactory sexual intercourse. This is a permanent or recurring inability to achieve and (or) retain an erection in at least 25% of cases for at least 3 months.
According to the etiopathogenetic principle, 7 types of erectile dysfunction can be distinguished:
Psychogenic erectile dysfunction
The leading pathogenetic link of psychogenic impotence is a decrease in the sensitivity of cavernous tissue to the effects of neurotransmitters of erection as a result of direct inhibitory effects of the cerebral cortex or mediated cortical effects through spinal centers and an increase in the level of peripheral catecholamines. These phenomena are based on fatigue, depression, sexual fears and deviations, religious prejudices, etc.
Vasculogenic erectile dysfunction
There are 2 forms:
- Arteriogenic erectile dysfunction.
The age and pathomorphological dynamics of atherosclerotic lesion of the coronary and penile arteries approximately correspond to each other, which allows considering erectile dysfunction as a disease of age. Other causes of arteriogenic impotence are trauma, congenital anomalies, smoking, diabetes, hypertension.
- Venous erectile dysfunction.
There are 3 forms of venous erectile dysfunction:
- Primary venous erectile dysfunction: it occurs with congenital pathological drainage of cavernous bodies through large subcutaneous dorsal veins or enlarged cavernous or leg veins, cavernous-spongy bypass, etc.
- Secondary venous erectile dysfunction: The reasons for this are functional insufficiency of cavernous erectile tissue as a result of a lack of neurotransmitters, psychogenic inhibition, smoking, sclerosis and fibrosis of the cavernous tissue.
- Corporalovenous insufficiency arises from the inadequacy of the belly coat as a result of traumatic rupture, Peyronie’s disease, primary or secondary thinning.
Hormonal erectile dysfunction
The cause of hormonal erectile dysfunction is the insufficiency of the male sex hormone, either as a result of congenital or acquired hypogonadism, or due to the age-related decline of the male sex hormone.
Neurogenic erectile dysfunction
It occurs as a result of injuries or diseases of the brain or spinal cord, as well as peripheral nerves, which prevent the passage of nerve impulses to cavernous bodies. The most common cause of this ED type is spinal cord injury (up to 75%).
Drug Erectile Dysfunction
It is proved that the long-term use of some medications, most often – antihypertensive drugs, is the cause of impotence. The mechanism of sexual impotence associated with the use of drugs is poorly understood, but it is assumed that it can include both central and peripheral effects.
Cavernous erectile dysfunction
The causes of cavernous insufficiency are different. These causes lead to dystrophy of the smooth muscles of the cavernous tissue, to a decrease in the percentage of elastic fibers and the induction of fibrous tissue development. All this leads to a decrease in the elasticity of the cavernous bodies and the formation of secondary venous leakage. This is due to the violation of vascular, nervous and biochemical processes in the cavernous tissue against the background of the underlying disease.
Mixed form of erectile dysfunction
The mixed form of ED means that a man may have more than one reason causing erectile dysfunction. Many men have both physical and psychological ED causes.
When do you need help: symptoms of erectile dysfunction
Erectile dysfunction can include both complete and partial inability to achieve an erection or ejaculation, as well as a tendency to maintain a very short “period” of erection. Weak erectile dysfunction symptoms are:
- Mild erectile dysfunction;
- A rarely occurring inability to achieve ejaculation.
Usually, these symptoms disappear without treatment. Therefore, men suffering from a mild disorder of erectile function rarely look for medical help. They try to cope with the problem themselves by buying tablets from impotence, using a male vacuum pump and other mechanical devices.
ED that has organic causes is characterized by:
- Gradual development of erectile problems;
- Absence of nocturnal erections;
- Normal sexual desire and ejaculation;
- Systematic (but not permanent) erectile dysfunction.
The leading signs, allowing to assume the psychogenic nature of a decrease in potency, are:
- Sudden appearance of symptoms;
- Certain problems in the relationship;
- Presence of periodic nocturnal spontaneous erections;
- Episodic nature of problems;
- Elimination of dysfunction as the external problem is eliminated.