Erectile problrms etiology and treatment
Erectile problrms etiology and treatment
Aetiology Contrary to popular belief, as many as 50% of casesof impotence are organic in origin. Where impotence ispsychologically based, it arises out of anxiety. This may bein the context of an episode of anxiety/depression, or as amanifestation of personality disorder.
Organic causes include: Endocrine causes, such as hypopituitarism andhypogonadism Diabetes. At least 30% of diabetic men experienceimpotence by the age of 50 Vascular disease, such as Buerger's disease Alcoholism Drug induced, e.g. diuretics, p-blockers and neuroleptics.
Treatment If psychogenic, the Masters and Johnson approachoutlined below is normally effective. The underlying cause should be treated wheneverpossible. Symptomatic treatment:- Intracavernosal injections of papaverine, papaverineplus an a-blocker such as phentolamine, or alprostadil(prostaglandin E2) can be self-administered and areeffective in up to 70% of cases. The main danger is priapism,and erections lasting more than 4 hours shouldbe treated as an emergency, with venous aspirationtogether with a vasoconstrictor. The drug sldenafil is asignificant advance over these cumbersome measures.In the presence of sexual desire and stimulation itproduces good erections that have a more 'natural'quality.- Mechanical aids such as a vacuum condom are alsouseful in some cases.The Masters and Johnson approachCurrent thinking about sexual dysfunction has beengreatly influenced by the work of Masters and Johnson,who studied the physiology of sexual response and introduceda new classification and treatment for sexualdifficulties.General principles of the Masters and Johnson approachinclude the following:
Treatment is in couples. Sexual difficulties are oftencomplementary (e.g. premature discharge and anorgasmia),even though one member may present as theperson with the problem. The non-presenting partner isgiven the role of co-therapist.
Physical examination and careful history-taking of bothpartners are required both to rule out organic causes ofsexual dysfunction and to reassure the patients that theyare 'normal'. There is more to sex than penetration. Sexual arousal,especially in women, depends on a series of steps, arid aman may need to learn that foreplay cannot usually beomitted if his partner is to be fully aroused. Anxiety is seen as a central element in sexual dysfunction.Anxiety is antagonistic to sexual arousal, and avicious circle can arise in which the patient fears theywill fail (for example to maintain erection, not to ejaculateprematurely, or to have an orgasm), which makesthem 'try' harder, which makes them less able to relaxand respond to sexual stimuli and thus more, rather thanless, likely to 'fail'. The aim of treatment is to break this circle. Paradoxically,the couple are initially instructed not to make love,in order to prevent performance anxiety. They are givena series of graded exercises based on sensate focus orstroking, in which they learn to give and receive pleasure.Initially this is non-genital, but later moves on to'genital sensate focus', i.e. mutual masturbation. It isironic that whereas masturbation was viewed (wrongly)by 19th century psychiatry as a major cause of insanity,it is now considered important that both sexes are ableto masturbate without guilt. Psychological factors in sexual dysfunction may alsoneed treatment, through either individual or maritaltherapy. Unexpressed anger is a common cause of sexualdisharmony: a couple who cannot row may also not beable to make love. Fear of loss of control, ignorance orguilt may also affect sexual pleasure.The results of the Masters and Johnson approach are generallygood, with 60-70% improvement rates reported inwell-motivated couples.
Finding a Cure for Cancer The Best of Razor Bumps Treatments How To Choose The Best Scar Treatment Scar Treatment Options Causes and Treatments For Dry Skin Effective Wrinkle Treatment With Natural Ingredients Generalized Anxiety Disorder - Defeating It Using Natural Treatments and Positive Affirmations for Anxiety Natural Treatments To Get Rid Of Constipation Naturally When in doubt, investigate your options for prostate treatment Have prostate issues? Be informed and consider your options for prostate treatment How Prostate Surgery can help in treatment CASODEX: for later stages of prostate cancer Gynecomastia Causes, Treatment, and Surgery