ERECTIL DYSFUNCTION

Incapacity of reaching or maintaining erection of enough rigidity for the crito in 50% or more of the attempts, being able to or not to be accompanied of loss of the libido and bankruptcy in ejaculating.
The loss of the libido more commonly is associated to the hipogonadismo testicular or hipotalamico, as well as diseases intercurrentes, drugs and psychiatric problems.
NPT - 4 to 8 associate REM with the age as well as REM.
The precocious ejaculation is an I presage of the impotence 90%.

Epidemiology

Increases with the age, after the 50 years.

5  -  10% -------------------- 6ª decade
20%        -------------------- 7ª decade
30 - 40% -------------------- 8ª decade
50% ------------------------- 9ª decade

Incidence of Impotence in Several Diseases

Diabetes mellites
Genetics Hemocromatose
Fibineastica
Celiac disease

Uremia 68%
Uremia + transplant 21%
Metabolic Alcoholism 69%
Serious diseases 56%

Hypertension 25%
Vascular Diseases artodiacas 53%
Coronary artery 64%

AVE 70%
Neurology multiple Sclerosis 71%
Powders cranial traumatism 58%

Obstructive lung disease 35%
Inflammatory irritable Colon 11%
Ressecção perineoabinominal 55%
Renal Anastoniose 40%

Post operative of prostate 47%
Post iridium of the penises 28%
Neoplasica Powders cure testicle 25%
Powders operative of rectum 5%
Powders Rx hodgkin 58%

Psychiatric Esquisitemia 54%
Neurolepticos 30%

· The most part of the secondary impotence is associated to the arteriosclerosis and its complications: infarct BIRD, vascular diseases, the blood pressure peniana and risk of vascular disease. APSP indicates risk for CVD.

Erection mechanism

It depends on the interaction of the libido and potency the libido consists in the desire, thoughts and satisfactions.
Androgens are important for the libido and frequency of erections in the erotic ones or reflexas including NPT and they are important to stimulate the seminal vesicle and prostate to produce flowed seminal, it seems that you/they are not involved with erections associated with erotic incentives.

The SNC answers to erotic incentives reverting the tonic suppression the adrenergica as well as the stimulation of the centers of erection toracolombar and sacral that activate the nerves erécteis. These come from pelvic plexuses and they converge for the cavernous nerves whose endings powders synaptic operate the liberation through of I rust nitric, to relax the arterial flat muscles of the cavernous bodies and sinusoids. The increase in double of the arterial and corporal diameter provides the great increase in the feixo in the cavernous breasts distending the same ones. The sinusoids distended compress the plexus veined subtunical and the penetrating veins that you/they drain most of the body of the penises through the ternica albuginea, reducing the drainage albuginea largely, reducing the veined drainage largely. The erection is caused by the increased influx and reduced drainage.

The ditumescencia can be passive or consequence of the activity vasoconstrictora to 1 Sinipatica. The ejaculation happens so much for action of SNC and arches reflexes that are going until the endings nervous sinipaticas in the testicles, seminal vesicles, prostate and flat muscular structures of the pelve.
With the aging and need of more intense erotic incentives, it increases the latency for erection, the aging of the penises is made more slowly and drainage larger veined result in a less firm maximum erection. Frequently the time for ejaculation is prolonged. The increase in the absolute difficult period inhibits a next erection. NPT decrease with the age and in many patient the sensibility of the penises decreases.
The erectil dysfunction is shown to be associated with alterations isquemicas in the cavernous bodies that you/they include loss of the integrity of the flat musculature, lipidic infiltration and fibrosis intersinesoidal; that at the present time will be considered the basic alterations that you/they take to the impotence and that diseases of larger blood vessels play secondary part.

PARTNER

The erectil dysfunction is a problem of the couple and the dependent treatment of the participation degree, interest and health of the partner. The integrity of the partner's sexual apparel depends on the menopause and hormonal replacement.
Women particularly of the geriatric group they should be prepared for the resurgence of your partner's erectile capacity. It is fundamental in the evaluation to include the partner, to discuss the problem erectil with her; and to determine your sex point of view and of the several alternatives of therapeutics.
The erectil dysfunction can be presage of diseases clinical or psychiatric serious.

LABORATORY TESTS

Completes clinical evaluation