Weak Erection
School of nursing bidaπ₯π₯π²π²π²π²ππ☕☕πππ₯¦π₯¦π₯π₯π±π±πππππ¬π¬π₯₯π₯₯π π π π πΆ️πΆ️ππππCausess summary and analysis: Cannon's explanation EditAccording to Cannon, the emotion of fear working on the mind, which he terms the "sympathetic" or "sympathico-adrenal" division of the nervous system, causes a fall in blood pressure as brought on by "a reduction of the volume of circulating blood".[2] Cannon explains the loss of blood volume by the constant injection of adrenaline into the small arterioles which constrict, preventing a proper flow of blood within the body and causing a drop in blood pressure. From there, the weak blood pressure prevents the sufficient circulation of the blood by damaging the heart and nerves responsible for the maintenance of the vessels which transport blood, thus making it harder for circulation to continue since the very organs necessary to maintain proper blood circulation are deteriorating. An accelerated heart rate then ensues, followed by rapid breathing. Added to these symptoms are the effects of no food or drink in the person experiencing psychological distress: Cannon suggests that true shock, in the medical sense, could be the cause of death as a result of little food or drink. States Cannon: "The combination of lack of food and water, anxiety, very rapid pulse and respiration, associated with a shocking experience having persistent effects, would fit well with fatal conditions reported from primitive tribes."
Modern explanations Edit
Since 1942, scientists have discovered many more of the processes involved in the effect of stress upon the body, such as the region of the brain called the amygdala. The series of events by which a sensory stimulus is introduced to the mind, and the amygdala processes the emotion of fear which follows is called the "vision-to-fear pathway", or the "auditory-to-fear pathway", depending on the stimulus.
The generally recognized sequence of events, as enumerated by Esther M. Sternberg, MD, in 2002, stands as follows: various chemicals and electrical impulses are released that are transmitted by nerve fibers. Simultaneously, hormones are excreted from the brain, adrenal and pituitary glands in response to stress on the system. Cardiac arrhythmias are often the result of an overabundance of these hormones on the system.
In 1981, Wylie Vale, PhD, discovered corticotrophin, the brain's hypothalamic stress hormone, or CRH: this hormone secreted by the hypothalamus coordinates with "the brain stem adrenaline centers involved in initiation of the sympathetic response ... to cause a massive release of both adrenaline-like nerve chemicals and stress hormones. Together these might well cause illness, including loss of appetite, weakness, cardiac arrhythmias, and even vascular collapse that could result in death.
Martin A. Samuels, MD, elaborates further on still another process of death, stating that with the release of adrenaline and an increased heart rate, sometimes catecholamines, stress hormones, will build up, leading to calcium channels opening and remaining open, resulting in an overflow of calcium into the system, killing off
A physical cause can be identified in about 80% of cases. These include cardiovascular disease, diabetes mellitus, neurological problems such as following prostatectomy, hypogonadism, and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings; this is somewhat less frequent, on the order of about 10% of cases. In psychological impotence, there is a strong response to placebo treatment. The term erectile dysfunction is not used for other disorders of erection, such as priapism.
Treatment involves addressing the underlying causes, lifestyle modifications, and addressing psychosocial issues. In many cases, a trial of pharmacological therapy with a PDE5 inhibitor, such as sildenafil, can be attempted. In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile implant, a penis pump, or vascular reconstructive surgery. It is the most common sexual problem in men.
Signs and symptoms
ED is characterized by the regular or repeated inability to achieve or maintain an erection of sufficient rigidity to accomplish sexual activity. It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months.
Psychological impact
ED often has an impact on the emotional well-being of both men and their partners. Many men do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated.
Causes
Causes of or contributors to ED include the following:
Prescription drugs e.g., SSRIs, beta blockers, alpha-2 adrenergic receptor agonists, thiazides, hormone modulators, and 5Ξ±-reductase inhibitors.
Neurogenic disorders e.g., diabetic neuropathy, temporal lobe epilepsy, multiple sclerosis, Parkinson's disease, multiple system atrophy,
Cavernosal disorders e.g., Peyronie's disease
Hyperprolactinemia e.g., due to a prolactinoma,
Psychological causes: performance anxiety, stress, and mental disorders
Surgery e.g., radical prostatectomy,
Aging: It is four times more common in men aged in their 60s than those in their 40s.
Kidney failure
Lifestyle habits, particularly smoking, which is a key risk factor for ED as it promotes arterial narrowing.
Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.
ED can also be associated with bicycling due to both neurological and vascular problems due to compression.The increase risk appears to be about 1.7-fold.
Concerns that use of pornography can cause ED have little support in epidemiological studies, according to a 2015 literature review.
Pathophysiology
Diagnosis
In many cases, the diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma.
One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED. Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep that is, when the mind and psychological issues, if any, are less present, tends to suggest that the physical structures are functionally working. Similarly, performance with manual stimulation, as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED.
Other factors leading to ED are diabetes mellitus, which is a well-known cause of neuropathy. ED is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease, such as coronary artery disease and peripheral vascular disease. Screening for cardiovascular risk factors, such as smoking, dyslipidemia, hypertension, and alcoholism is helpful.
In some particular cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in men and is relatively easily curable.
The current diagnostic and statistical manual of mental diseases, has included a listing for ED. workup methods
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans head of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence NPT
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement REM. Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic infusion cavernosometry
technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Corpus cavernosometry
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualized by infusing a mixture of saline and x-ray contrast medium and performing a cavernosogram. In Digital Subtraction Angiography DSA,
Magnetic resonance angiography MRA
This is similar to magnetic resonance angiography uses magnetic fields and radio waves to provide detailed. Doctors may inject a "contrast agent" into the person's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.
Treatmentds arrows.
Penile ultrasonography with doppler can be used to examine the penis in erected state. Most cases of ED of organic causes are related to changes in blood flow in the corpora cavernosa, represented by occlusive artery disease, most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism. Preceding the ultrasound examination with Doppler, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, as well as to evaluate the appearance of the cavernous arteries, which can be tortuous or atheromatous.
Erection can be induced by injecting 10-20 mg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25-30 min. The use of prostaglandin E1 is contraindicated in patients with a predisposition to priapism π£️π€±e.g., those with sickle cell anemia, as well as in those with an anatomical deformity of the penis or a penile implant. Phentolamine 2 mg is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial.
Prior to the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, it is expected that systolic and diastolic peak velocities will increase, decreasing progressively with vein occlusion and becoming negative when the penis becomes rigid (see image below. The reference values vary across studies, ranging from 25 cm/s to 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific. The data obtained should be correlated with the degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenicOne ad from 1897 claims to restore "perfect manhood. Failure is impossible with our method".Another "will quickly cure you of all nervous or diseases of the generative organs, such as Lost Manhood, Insomnia, Pains in the Back, Seminal Emissions, Nervous Debility, Pimples, Unfitness to Marry, Exhausting Drains, Varicocele and Constipation. The U.S. Federal Trade Commission warns that "phony cures" exist even today.
Treatment depends on the underlying cause. In general, exercise, particularly of the aerobic type, is effective for preventing ED during midlife .6, 18–19 Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex. Medications by mouth and vacuum erection devices are first-line treatments, 20, 24 followed by injections of drugs into the penis, as well as penile implants. 25–26 Vascular reconstructive surgeries are beneficial in certain groups. Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex.
Medications
The PDE5 inhibitors sildenafil Viagra, vardenafil Levitra and tadalafil Cialis are prescription drugs which are taken by mouth. 20–21 As of 2018, sildenafil is available in the UK without a prescription. Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED. Penile injections, on the other hand, can involve one of the following medications: papaverine, phentolamine, and prostaglandin E1, also known as alprostadil. In addition to injections, there is an alprostadil suppository that can be inserted into the urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour. Medications to treat ED may cause a side effect called priapism.
Testosterone
Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection. Men with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men.
Pumps
Main article: penis pump
A vacuum erection device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it. These pumps should be distinguished from other penis pumps supplied without compression rings which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.
Surgery
Main article: Penile implant
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[26]:26 Some sources show that vascular reconstructive surgeries are viable options for some people.
Alternative medicine
The Food and Drug Administration FDA does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as "herbal viagra" or "natural" sexual enhancement products, but no clinical trials or scientific studies support the effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products. The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is. For more information about this post please contact US On our social media. Thanks.
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