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Congenital and acquired vascular defects, hypoplasia and underdevelopment of the cavernous artery. In adulthood, the most common causes are atherosclerosis, obliterating endarteritis, Leriche syndrome, and abdominal aortic aneurysm. Various neurological disorders. These include lesions of the internal nerves of the pelvis, which are branches of the sacral plexus. Often the cause can be cauda equina syndrome, when the pathological process is localized in the lower part of the sacral segments. Also, often the cause of impotence is diabetic polyneuropathy, which often occurs in old age. Endocrine diseases.

Vascular disorders

In addition to diabetes mellitus, which was mentioned above, hyperprolactinemia and hypogonadism lead to erectile dysfunction. In addition, high levels of estrogens, as well as high concentrations of thyroid hormones in hyperthyroidism and thyrotoxicosis, can "interfere" with an erection.

The primary can simply be attributed to the fear of intimacy, and the secondary is the presence of a history of organic diseases that have been successfully cured. The fact is that the fear of them remained and turned into a secondary psychogenic cause of erectile dysfunction.

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Note: In some cases, researchers have a different opinion regarding primary and secondary dysfunction: primary impotence is called such impotence, in which there was never an erection, and secondary, when there was an erection, but under the influence of some process, or the disease, it was completely or partially lost ...

The diagnosis of severe impotence without signs of disease can beChallenging the qualifications and experience of any professional, the disorder can be difficult to diagnose. The causes of erectile dysfunction are not yet clear, and the correct treatment is often impossible to prescribe.

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In order to facilitate the diagnosis, every man suffering from this pathology must answer himself a few questions that can "shed light" on the problem
How long has the problem been? How quickly did the dysfunction develop and become pronounced?
Was it a sudden shock, or did impotence develop gradually?
How often is sexual intercourse now, and how often was it before dysfunction occurred?
If there is no ejaculation, what do you associate it with? How many "hours" - the clock is understood as the angle of ascent of the penis - do you assess the state of maximum erection for the last week, month or period that you yourself choose?
Do you ejaculate, is there premature ejaculation?
During intercourse, does the erection increase, decrease or does not change?
Are you satisfying yourself, and if so, are you getting a sufficient erection? Are there any difficulties with the introduction of the penis into the vagina, does it require re-stimulation?

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  • The patient must necessarily tell about his diseases, bad habits, especially smoking, about blood pressure figures, about the presence of coronary heart disease. Obesity also leads to erectile dysfunction, or at least contributes to it.
  • It is imperative to clarify with the patient whether he suffered a stroke or focal neurological symptoms, whether he had spinal surgery, numbness in the perineum, weakness in the legs, impaired trophism in the legs (hair loss, brittle nails), whether there were any vascular disorders, such like cold snap and blanching of the skin.
  • All this will allow you to prescribe the correct examination and save on some expensive screening research methods by conducting targeted diagnostics.
  • nocturnal erections
  • tests are performed on the physical condition of the pelvic muscles
  • with the help of plethysmography, pelvic blood flow is determined; check the vibrational feeling in the genital area, a decrease, which indicates polyneuropathy, or multiple sclerosis
  • it is possible to perform a study of the evoked potentials of the brain during stimulation of the genitals
  • according to indications, electroneuromyography of the muscles of the perineum is performed
  • determine the refractoriness of the sacral nerves; in the blood, the concentration of luteinizing hormone, prolactin, testosterone and estrogen is determined
  • In some cases, an MRI of the brain, ophthalmoscopy with the definition of visual fields (if a pituitary adenoma is suspected) are required
  • To top it off, the patient should be consulted by a psychologist, and in some cases by a sex therapist and psychiatrist.

In order to effectively treat erectile dysfunction, you need to know the cause