The occurrence of erectile dysfunction after pelvic irradiation is a potential complication that must be reported, especially in the case of radiation therapy for prostate carcinoma.
With the progressing development of vascular surgery and the anesthesiologically intensive medical possibilities, an increasing number of reconstructive interventions in the area of the abdominal aorta are performed. Preoperative erectile dysfunction in the context of general angiosclerosis can be surgically corrected only to a very limited extent.
Diseases of the corpus cavernosum with a possible negative influence on erection include induratio penis plastica, local enamel body damage after trauma or diseases without an identifiable cause, but also damage resulting from treated or untreated priapism.
Due to the relatively slotted position of the genitalia between the trunk and the muscle mass of the thighs, injuries in this area are relatively rare.
The range of diagnostic tools currently available has undoubtedly improved the possibilities for recording organic pathological findings. A probationary therapy without corresponding previous diagnostics therefore appears obsolete; it deprives the patient of the possibility of a cause-oriented therapy of his complaints.
Further investigation methods are currently being carried out primarily from a scientific perspective. A relevance for current use in practice can therefore not yet be conclusively assessed.
Pneumoplethysmographic examinations have also been classified as useful, noninvasive examinations for objectifying an arterial circulatory disturbance of the penile vessels.
Since in healthy men erections of 20 to 50 min duration occur physiologically during the REM phases of sleep, it was believed that by measuring nocturnal penile tumescences it would be possible to distinguish between organic and psychogenically induced impotence.
Angiographic imaging of the penile vessels is an invasive, technically complex radiological diagnostic procedure whose use is no longer justified for purely diagnostic purposes.
Duplex ultrasound devices represent the combination between ultrasound cross-sectional image (B-scan) and built-in Doppler.
Laboratory diagnostics includes general diagnostics as well as endocrinological diagnostics.
Based on the hair pattern, fat distribution and constitution, the patient is classified as male, female, or eunuchoid.
The anamnesis of a patient with erectile dysfunction is divided into 2 parts, the sexual anamnesis and the general anamnesis. At the first presentation in the andrology consultation or practice, the patient should first be asked about the duration and extent of the erectile dysfunction within the framework of the sexual anamnesis.
Major factors influencing erection are the functioning of the supplying arteries, veins, nerves and the endocrine system as well as an erection-favoring psychological status.
The erection process is to be understood as a neurally controlled, hemodynamic event, which is influenced by an intact hormonal situation and an adequate mental state. As a cerebral sexual center, the limbic system localized in the temporal lobe is considered to be of the greatest importance.
The functionally most important parts of the penis are the corpus cavernosum and the corpus spongiosum. The corpus cavernosum arises with paired cavernous bodies from the inferior pubic branches.
Due to the sexual liberalization and enlightenment beginning at the end of the 1960s and the associated detabooization of the sexual sphere, sexual pathology is becoming increasingly important in today's medicine.
The intensity of sexual desire in healthy men and women differs from one person to the next. Hypoactive desire, which affects millions of people worldwide, is probably the most underestimated, neglected, undefined, difficult to evaluate and treat, and frustrating sexual disorder.
Whereas erectile dysfunction, even in diabetics, used to be understood primarily as a psychogenic issue, intensive research and improved diagnostic capabilities over the past 10 years have led to a much more in-depth understanding of the regulatory mechanisms of male erection and possible pathological processes.
The Greek physician and so-called father of medicine, Hippocrates, attributed erectile dysfunction to man’s professional preoccupations and the ugliness of the female. Eighteenth- and nineteenth-century religious moralists maintained that it was caused by excessive sexual activities such as masturbation, prostitution, and promiscuity.
Impotence is one of the most common complications of the disease in men with diabetes. The occurrence of potency problems is clearly related to the quality of metabolic control, the presence of other risk factors, the duration of diabetes, and age.
The connection between male sexuality and an intact testicular function has been known since ancient times and has always found practical application in the form of aphrodisiacs containing, for example, animal testicular extract.
The penis has been dubbed “the barometer of a man’s health,” and rightly so, as any abnormality in its anatomy, physiology, or functioning may reflect an underlying disease or disorder. Furthermore, the penis is considered to be the symbol of virility, power, manhood, strength, and authority.
A prerequisite for the therapy of erectile dysfunction is knowledge of the anatomical structures and physiological processes that are important for the development, maintenance, and decline of erection.
Sex is an integral part of an intimate relationship and forms the basis for a couple’s shared love and respect, but many people cannot fully enjoy these pleasures. A sexually dysfunctional man, for example, may lack the desire or self-confidence to participate in sexual activity.
In the case of erectile dysfunctions that are based entirely or predominantly on psychological and/or partnership factors, sexual psychotherapy is the treatment method of choice. It represents—in the case of psychogenic erectile dysfunction—one of the few causal therapy options that we have at all in the field of erectile dysfunction.
To recognize erectile dysfunction and understand its causes, it is important to remember that penile erection is a continuous neurovascular phenomenon under psychological control and requires a proper hormonal milieu for its successful achievement.
The following is intended to provide some practical guidance on the sex therapy approach to erectile dysfunction.
Erection relies on healthy vascular and neurologic tissue and genital organs, as well as an adequate male hormonal milieu. Numerous factors pertaining to the brain, spinal cord, nerves, blood vessels, smooth muscles, and hormones are crucial to a man’s optimal sexual expression and pleasure.
The pioneering work of Masters and Johnson in the 1970s shed significant new light on the possible causes of sexual dysfunction. Their publications emphasized the influence of religious orthodoxy, fear of failure, homosexuality, and maternal influence as contributors to erectile dysfunction.
The appearance and presentation of erectile dysfunction by affected men, in our experience, marks a characteristic split.
Oral medication for erectile dysfunction therapy is the preferred treatment alternative for most sufferers, according to reports in the literature and experience with our patients.
The phases of the male sexual response have distinctive physiologic characteristics that include the erectile process, which is a continuing series of neurovascular events occurring within a normal hormonal milieu (primarily, an appropriate level of serum testosterone) and with an intact psychological setup.
Meta-analyses that include otherwise unpublished randomized trials are uncommon, but are welcome and can inform in circumstances where information is conflicting.
Sildenafil citrate has been shown to be effective in a wide range of patients with erectile dysfunction and has been approved in the United States for this indication. The overall clinical safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, in the treatment of erectile dysfunction was evaluated in more than 3700 patients.
