Erectile dysfunction – is the inability to achieve or maintain an erection sufficient for sexual activity. This term was proposed in 1988 by the National Institute of Health instead of the word “impotence”, and in 1992 adopted by international organizations of Urology and Andrology. This definition more fully and accurately characterizes the diversity of expressed sexual disorders. It includes not only the failure to hold the penis erected, but the breach of orgasm and the weakening of libido (sexual desire). They speak about erectile dysfunction only if there is a problem with erectile dysfunction for a long period (3-6 months).

According to the latest data:

- About one in 10 men has some degree of impotence;

- In the world approximately 152 million men have erectile dysfunction;

- More than 50% of men aged 40 to 70 years suffer from erectile dysfunction;

- Every year, 900,000 men are diagnosed with erectile dysfunction.

Mechanism of erection.

An erection occurs due to the increased blood supply of the penis. The sharp increase in the flow of blood fills, stretch and make solid cavernous body. This state is supported by cessation of outflow of blood. Nervous and hormonal systems cause and regulate offensive of erection, producing activating or inhibiting biochemical substances. Certain sections of the spinal cord produce these substances in response to stimulation of the genitals and erogenous zones of the body, and brain structure – under the influence of excitation of communication with sexual partner and sexual fantasies. Thus, an erection occurs as a result of the interaction of vascular, nervous and hormonal systems.

Causes of impotence.

Erectile dysfunction is the result of various causes. The most common causes are organic (injury, disease, side effects). Below there are the major risk factors for the development of impotence:

Treatment of prostate cancer (surgery and irradiation);
Heart disease;
Diabetes (primary cause of impotence);
Arteriosclerosis;
Hypertension;
Smoking;
Side effects of drug therapy;
Alcoholism;
Hypohepatia;
Neurological disorders (spinal cord injuries or multiple sclerosis);
Hormone imbalance.

Organic causes of erectile dysfunction reduces or do not allow the blood flow or conducting a nerve impulse to the penis. At the present time believe that erectile dysfunction in approximately 50% of cases is caused mainly by organic factors, 20% – predominantly psychogenic and 30% – a combination of organic and psychogenic causes. In most cases, men with impotence feel anxiety, guilt or depression. These states further worsen the patient’s condition.

Organic impotence begins gradually. The first signs – reduction of rigidity and the frequency of erections, the appearance of incomplete erections, and then complete loss of erectile function. Normally the libido is stored, so the disease affects quality of life and self-esteem, causes stress and difficulties in communication. Fear to be untenable causes impotence.

Erectile dysfunction can be treated and complete cure is often observed at the patients. According to the American Medical Association doctors can effectively treat 95% of cases of impotence.

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Endoprosthesis of the penis. The surgeon places a small, saline-filled device that raises erectile function. The prosthesis delivers fluid to the penis when you need an erection. This device is completely hidden. This procedure is applied under the condition when no other method is effective. The effectiveness of the method is more than 90%. Contraindications are the obliteration of the cavernous bodies, urethral cavernous fistula, mental illnesses.

Vascular surgery on the penis. Operations are conducted on the vessels of the penis. They are aimed at enhancing the flow of arterial blood to the penis and difficulty of venous outflow.

Psychotherapy. If you have any reasons for erectile dysfunction, a man need consult the sexologist. He must learn to cope with anxiety before sexual intercourse.

Drugs for treatment of impotence.

Intra urethral introduction of suppositories. The man puts before 20 minutes to sex the soft tablet into the urethra. His penis absorbs the medication. Blood flow increases, as a result an erection comes.

Intra cavernous introduction of drugs. Before the proximity a man produces injection of vasodilator drugs in the corpus cavernous of the penis. The result is high quality and long-lasting erection. In papaverine hydrochloride it was first detected the ability to improve erection. However, the use of this drug is limited to high risk of priapism and development with regular use the progressive multiple sclerosis of cavernous.

Alprostadil is more effective. It is a synthetic analogue of prostaglandin E1. Its efficacy is 40 – 70%. The drug has a-adrenoceptor blocking and direct muscle relaxing effect on the tissue of the corpora cavernosa, increases clearance sinusoids and cavernous arteries, thus contributing to increased blood flow. The advantages of the method are high efficiency, ease of use, low risk of priapism, the minimum number of side effects. The disadvantages are the introduction of invasiveness, pain at the injection site, the fear of the patient before the injection into the penis.

Oral drugs. Currently physicians have effective oral medications for the correction of erectile dysfunction.

Phosphodiesterase inhibitors. They cure erectile dysfunction by increasing blood flow to the penis. The brain responds to sexual stimulation by sending nerve signals. In response to these signals substance nitric oxide is released, which relaxes the muscles of the penis and this increases the blood flow to the penis. The body also contains the enzyme phosphodiesterase, which blocks the release of nitric oxide, thereby reducing erections. Preparations of this group inhibit phosphodiesterase.

Yohimbine hydrochloride.

Iohimbine is an alkaloid of the bark Coryanthe Yohimbe, which grows in West Africa. It was isolated in 1896 by the German scientist Spiegel, who gave that name. Yohimbine hydrochloride is a selective a2-adrenoceptor blocker. The drug increases the flow of sympathetic impulses from the CNS and the release of norepinephrine from nerve endings. When the application of yohimbine hydrochloride, it occurs removal of spasm (relaxation), the pelvic arteries that leads to a sharp increase in blood flow to the cavernous bodies of the penis. The drug normalizes sexual function and ability to coitus, weakened by stress, removes the inhibition of erection.

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Since ancient times, men assume the hardest work – fought with neighboring tribes, hunted, built housing, defended the family. According to the biological laws of nature man’s body is much more resistant to external influences than the female. It would seem that men are sick less often, and men’s health should be much stronger. However, the XXI century with its technological progress, sedentary lifestyle, diet, air pollution and a huge amount of stress impacts minimized the benefits of male body over the female. Men are now suffering from various diseases not less but even more than women.

Strong sex used to be strong: men rarely seek medical care.
One of the most common male diseases is prostatitis. It is hard to believe, but after 50 years about 50% of men have latent or overt manifestations of prostatitis. Less common adenoma and prostate cancer. And even despite the fact that the symptoms of all prostate diseases give strong man inconveniences, men don’t immediately go to the doctor.

No less urgent is the question of male infertility, which is the cause for 40% of cases of infertility in the families. The problems of infertile marriages involved urologists, endocrinologists, therapists and psychotherapists. The causes of male infertility may include chronic inflammatory diseases of the male reproductive system, diseases, sexually transmitted infections, and the so-called metabolic syndrome, which manifests with arterial hypertension, obesity, diabetes, lipid disorders and atherosclerosis. Excessive drinking can be the reason for male infertility and erectile dysfunction. It should be remembered that under the influence of alcohol can occur degenerative changes of a very subtly arranged epithelium of testes, which produces sperms. The number of sperms may persist, but their quality is suffering: they lose their mobility, they become defective, lethargic. I.e. ejaculate during sexual intercourse is exuded, but the sperms do not perform their function.
Elderly men are often concerned about the manifestations of menopause. Male menopause – is a normal physiological process of aging, which occurs at the age of 45-60 years. However, most men are afraid of this process, are ashamed, they feel deficient. Only a qualified doctor can distinguish the symptoms of various diseases of male genital physiological menopause and its manifestations.

Every man should take care of his health, make regular visits to hospitals for checkups and lead a healthy way of life.
The most important things you can do to stay healthy are:
- Visit doctor regularly.
- Don’t smoke.
- Eat healthy food.
- keep healthy weight.
- Go in for sports

The positive effect of active sports to men’s health seems to be long known, and is a kind of axiom. Nevertheless, the results of studies of Scientists showed that men need to think carefully before start go in for active sports. The thing is testosterone – regular endurance training can influence on the content of the male sex hormone.

Active exercises can affect men’s health, in particular, affect the reproductive function due to reduced production of sperm. Insufficient testosterone leads to a decrease in sexual desire.
So having so disturbing information of the impact on the health of men engaged in sports, one should think about their need. Maybe you just need to be a bit more moderate in active sports.

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Presently known a set of studies conducted by scientists, who study and analyze the size of penis. The biggest and thorough study was conducted by Dr. Richard Edwards (Dr. Richard Edwards) from Canada in 1998, during which 3100 men of different ages were asked 43 different questions.

According to the research almost 90 % of men have a penis in length from 8 to 12 cm in relaxed state. Making of statistics on the size of the penis in relaxed state is relatively inaccurate because the size of the unexcited penis can change under the influence of temperature, mood and other factors.
Despite this, the size of the penis in erect state can be judged by the size of a relaxed penis. Small and not very thick penis in relaxed state and in a state of erection will be the same.

Most men have a normal size of a penis, but not everybody is quite satisfied with the size of a penis. The desire to increase the “average” penis is also normal, as well as a desire to increase muscle mass and gain new physical abilities. In different times many people attach great importance to the size of the penis. So in ancient Greece and Rome there were phallic worship, but a large and aesthetically perfect penis was a personification of man’s power, wealth, and might. Such beliefs and traditions are preserved in the minds of men till now.

Some men believe that their penis is far from an ideal existing in their minds, or compared with what they saw in magazines, in porn films or sports club in the locker room. Therefore it is not surprising that many modern men want more “representative” and bigger penis just in a relaxed state. A desire to increase the size of the penis in erection is most often defined by the desires of the sexual partner. After all, many women get the most pleasure during sexual contact from touching the penis to the cervix and prefer rather long phalluses.

So many men resort to such methods of penis enlargement as surgical intervention.
Plastic surgery for lengthening and thickening of the penis is an original surgical technology for lengthening of the penis by 2-4 cm due to its plastic ligaments and skin-fat flap.

The operation is performed under general anesthesia. The operation of lengthening can be complemented by the introduction of autologous fat in the body of the penis for the purpose of thickening the entire length.

Rehabilitation period is 2 weeks. During the rehabilitation period you will be closely observed by the surgeon, who provides for: dressings and routine inspections.
Operation intervention on increasing and thickening of the penis has no effect on erectile function. In case of disturbances of erectile function a man should refer to specialists: sexual pathologist, urologist, even before the operation on penis enlargement.

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What is impotence or male incapacity (sexual weakness of men)? Under the impotent should be understood such a state, when constantly with the same woman (partner) in the most favorable conditions, the husband (partner) cannot produce a copulation, while all other cases must more properly attributed to functional sexual neurosis (disorder). Doctors use very rarely the diagnosis “impotence», as a man with a diagnosis of impotence felt branded, condemned to inevitable impotence, whereas he perceives differently functional disorders.

Sexual disorders (impotency) include: rapid ejaculation (premature ejaculation, when the duration of sexual intercourse is very short, less than 2 minutes, and the wife is unable to achieve an orgasm), the weakening of adequate erections until the impossibility intro mission (insertion of the penis into the vagina) combination of these symptoms, reduced sex drive (libido), infertility.

This disease is fairly widespread. When purposefully questioning 150 men who consider themselves healthy sexually, 52% were observed the symptoms of sexual disorders. According to various medical examinations, the vast majority of men suffering from sexual disorders are between the ages of 22 to 45 years that is the age of greatest sexual activity.

It is well known that, in contrast to women, men suffering from sexual disorders survive very hard this condition. They have developed pronounced neurotic reactions, various neuroses, depression, etc. For this reason, families often raise complex conflict situations.

Sexual disorders.

According to our data, 39% of men seeking medical care had the accelerated ejaculation, 32% – lack of erection, at 21% – both violations and 9% – reduction of sexual desire. And, according to E. Schnabl, almost 42% of men with sexual disorders called premature ejaculation, 32% – lack of erection and 20% – both violations together.

Men worry about erection very much when it is insufficient or absent, and ejaculation – when it occurs earlier than his wife wishes. No man complains of the rapid orgasm of his wife, and – on the contrary. The problem of sexual dysfunctions must be decided together; for example, when an accelerated ejaculation, it is necessary understand: whether she reacts too slowly, or very quickly? Men should analyze his lifestyle. Often sexual disorders were observed in those who constantly have a deficit of time, and are afraid not to be in time, hurry, and nervous, excited, work a lot, sleep a little, etc. Sexuality should be integrated into a well-organized, rewarding lifestyle.

Causes.

The causes of sexual disorders are highly diverse. Impotence occurs when severe somatic disease (eg diabetes), nervous, mental, endocrine, urological and other diseases, but in most cases – it is different functional disorders of the nervous activity, often they occur at younger ages, and in more senior dominate various urological diseases, and, in particular, chronic prostatitis. It should be noted that the importance of chronic prostatitis in the occurrence of sexual disorders in most cases is overestimated. Thus, according to the data, chronic prostatitis at patients with severe sexual constitution was accompanied by sexual disorders only in 6.7% of cases and persons with weak sex constitution -nearly at every second one (46% of cases).

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