diease

Erectile Dysfunction


Erectile Dysfunction overview and Definition

It is defined as the difficulty in maintaining the penis in the erectile position or making the penis to stand erect that is required for  the sex.


Pathophysiology

The neurovascular events that ultimately occur result in the  inhibition of adrenergic tone and the release of the nonadrenergic , noncholinergics neurotransmitter, nitric oxide. Nitric oxide is believed to be released from the nonadrenergic, noncholinergic nerves and endothelial cells. It subsequently stimulates the guanylate cyclase enzyme system in penile smooth muscle. This results in increased levels of cyclic guanosine monophosphate (cGMP) and ultimately in smooth muscle relaxation, enhancement of arterial inflow, and veno-occlusion, producing adequate firmness for sexual activity. The release of the nitric oxide leads to the relaxation of the corpus cavernosum the main tissue which helps in the erection of the penis.


Clinical signs & symptoms

Feeling hard to keep the penis in erectile dysfunction

Loss of sexual activity in the shorter duration of time

Feeling insecure


Differential Diagnosis

The main step is the discussing with the person’s history of symptoms. To rule out whether the erectile dysfunction is due to differentiate between the whether cause is due to physiological or pathological. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED

Ultrasonography:

Penile ultrasonography or doppler can be used to examine the erection of the penis. Most causes of the erectile dysfunction of organic causes are mainly related to alteration sin the blood flow in the corpora cavernosa which can be represented as the occlusive artery disease in whoch only less amkunt of blood is made into enter the penis. The arteries supplying the penis is also viewed.

Penis nerves function:

Tests such as the bulbocavernous reflex test are used to ascertain to check whether there is enough nerve sensation to the penis. The physician squeezes the glans that is the head of the penis  which immediately tell the anus to contract if the nerve function is normal.

Nocturnal penile tumenescence:

 It is normal for the man to have 5-6 erections during the sleep especially during rapid eye movement.

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]

Penile biothesiometry:

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis

             Dynamic infusion cavernosometry (DICC):

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:

Cavernoscopy is the  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.

            Magnetic resonance angiography (MRA):

This is similar to the normal magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. The doctor may inject into the patient's bloodstream a contrast agent, which causes vascular tissues to stand out against other tissues, so that information about blood supply and vascular anomalies is easier to gather.


Prevention

  • Work with your doctor to manage diabetes, heart disease or other chronic health conditions.
  • See your doctor for regular checkups and medical screening tests.
  • Stop smoking, limit or avoid alcohol, and don't use illegal drugs.
  • Exercise regularly.
  • Take steps to reduce stress.
  • Get help for anxiety, depression or other mental health concerns.

 


Reference

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)

https://www.healthline.com/health/erectile-dysfunction

https://www.webmd.com/erectile-dysfunction/default.htm