Erectile dysfunction and premature ejaculation, underlying causes and available treatments (#Best Sexologist in Bhopal)
Erectile and ejaculatory disorders comprise the most prevalent sexual disorders in men, with erectile dysfunction (ED) primarily affecting aging men who have coexisting morbidities such as cardiovascular disease and diabetes mellitus. Premature ejaculation (PE) can have an effect on men of all ages and is not typically associated with underlying organic disorders but is believed to be associated with imbalances in serotonin neurotransmission. The availability of oral phosphodiesterase inhibitors has revolutionized the management of ED, replacing less-desirable older products associated with more side effects.
PENILE ANATOMY AND NORMAL ERECTION PHYSIOLOGY
The penis is comprised of several key structures: the corpus cavernosum encased within the tunica albuginea, the corpus spongiosum containing the urethra, and the extensive vascular system of arteries and veins. In the flaccid state, penile smooth muscle tissue is contracted and arterial blood flow which supplies the sinusoidal cavities within the pair of corpora cavernosa is equal to venous drainage from them. With the exception of nocturnal penile tumescence, a sensory stimulus initiates the erectile process via two coordinated pathways involving vasoactive substances, prostaglandins, and circulating catecholamines.9, 10 Nitric oxide, which is synthesized and out from endothelial cells, crosses into smooth muscle cells and improve the activity of guanylate cyclase, which catalyzes the formation of cyclic guanosine monophosphate (cGMP) from guanosine triphosphate (GTP). The second pathway involves prostaglandin E1-mediated activation of G proteins within smooth muscle cells, followed by stimulation of adenylate cyclase and enlarged production of cyclic adenosine monophosphate (cAMP) from adenosine triphosphate (ATP).
DIAGNOSIS AND TREATMENT OUTCOME MEASURES
Despite the high prevalence of erectile disorders, identifying the presence of this situation remains challenging for the physician as patients are often reluctant to discuss this sensitive problem. Although patients may be more inclined to share these issues when the discussion is initiated by their healthcare provider, physicians’ themselves may also have some uneasiness with this conversation. A recent review of several studies found that the prompt recognition and treatment of ED sign associated with underlying endothelial cell dysfunction may improve ED connected outcomes by decreasing the development or progression of vascular comorbidities.
Approximately 80% of men diagnosed with ED will have an organic disease; thus the AUA diagnosis and treatment guidelines recommend a thorough medical history and physical examination for all patients with suspected ED to identify underlying vascular, neurologic, or hormonal abnormalities. The medical history should contain a complete assessment of risk factors associated with organic ED and identification of comorbidities may present unique challenges to developing an effective treatment response. Patients should also be assessed for co-occurring anxiety or depressive disorders to rule out a psychogenic etiology.