ED is a male erectile dysfunction abbreviation. The prevalence of ED is particularly high in certain groups, aging, hypertension, heart disease and diabetes risk of ED patients in very high, especially in diabetic patients, their ED prevalence rate was 35% ~ 75%, diabetes, men's self-ratings The ED than non-diabetic men, more than 3 times higher, and the ED occur at younger ages than non-diabetic men, as early as 10 to 15 years. ED is a male erectile dysfunction the title, refers to the penis can not be sustained to achieve or maintain adequate erection, can not be a satisfactory sexual life, usually manifested an erection will not be strong, insert the difficulties, impotence Zaoxie, loss of libido, orgasm and ejaculation function barriers. Depending on their degree of ED were divided into mild, moderate and severe degrees of erectile dysfunction are severe ED.
ED occurs in patients with high risk of diabetes
The prevalence of ED is particularly high in certain groups, aging, hypertension, heart disease and diabetes risk of ED patients in very high, especially in diabetic patients, their ED prevalence rate was 35% ~ 75%, diabetes, men's self-ratings The ED than non-diabetic men, more than 3 times higher, and the ED occur at younger ages than non-diabetic men, as early as 10 to 15 years. Can be seen, diabetes can cause ED, the ED often diabetes is "Alarm." Disease more than 5 years by half in patients with type 1 diabetes can cause ED.
Early in the 15th century, people think ED is the devil possessed the 18th century, considered to be caused by masturbation, the early 19th century that the ED are psychological diseases, 50 years after the 20th century, considered to be acts of disease until 70 years after the gradual Recognizing that its organic cause. While it is recognized that psychological factors can cause ED, but for most of the men, ED and many diseases (hypertension, diabetes, cardiovascular disease), drugs, trauma and related surgery.
In May 2007, held the First National Conference on the endocrine gland, the PLA General Hospital, Chief Physician Department of Endocrinology, Professor Li Jiangyuan pointed out that the prevalence of ED patients with diabetes is 35% ~ 75% in all ED patients, caused by diabetes, accounting for 1 / 3, we still need more, while the age of diabetes than non-diabetic ED patients to be as early as 10 to 15 years.
Endocrinology Branch of the Standing Committee of the Chinese Medical Association, gonads, head of school, Department of Endocrinology, PLA General Hospital, Chief Physician, Professor Yoshiaki mother said, the domestic 42 hospitals had 6193 cases of male endocrine clinic with type 2 diabetes research studies found that type 2 diabetes mellitus in patients with ED is a common complication, ED occurred, as well as the severity of diabetes prevalence and age, disease duration, blood glucose control clearly related conditions and other factors. Duration of longer than 10 years, the proportion of ED patients with severe 22%, less than 2 years duration in patients with ED prevalence rate was only 4.69%. Patients with type 1 diabetes have higher rates of ED, the sick more than 5 years by half in patients with type 1 diabetes can cause ED.
Mother Yoshiaki, penis-shaped sponge from the three long, comprising of 2 in the dorsal penile corpus cavernosum and is located in a ventral corpus spongiosum. Corpus cavernosum is the erectile tissue, especially the cavernous sinus and the arterial wall smooth muscle. Surrounding the penis followed by the organization outside to the inside skin, penis, superficial fascia, deep fascia and tunica albuginea penis. In penile erection, these fascia to extend and increase the circumference, and formed a straight erection, maintain a high degree of stiffness and axial forces; weakness in the penis, these fascial layers becomes soft.
Under normal circumstances, first by the brain to deliver stimulation signals to the nervous system, blood vessels, so that within the corpus cavernosum smooth muscle relaxation, small arteries, cavernous blood flow and pressure increased dramatically, while multi-level arrangement will enable a fascia Layer another layer of fascia in the slide, in the penis during erection to prevent venous outflow, leading to congestive expansion of the erectile tissues of the full.
Penile erection is due to partial genital sensory stimulation (reflex erection), and the brain to accept or generate mental stimulation (psychogenic erection) caused.
Psychogenic erection is to listen, smell, visual, taste, touch, or thought to stimulate the imagination and so excited about the cerebral cortex hub, and through the spinal cord sympathetic thoracolumbar erection center by the spread, but also through the spinal cord sacral erection center came from the parasympathetic , the dominant erectile tissue. Reflex erections are from foreign receptors to stimulate the genitals and from internal organs (including the rectum and bladder) and in sensory stimulation, through the pudendal afferent inputs by sacral parasympathetic dominance came erectile tissue. Psychological stimulation and reflex stimulation often synergistic effect, but can also be separate roles. On the other hand, mental stimulation can suppress and hinder the reflex erection.
Thus, penile erection is a complex neurovascular response, which in addition to the male reproductive organs and the normal psychological state, but also depends on the hypothalamus - pituitary - gonadal Shaft endocrine system and nervous, vascular system's integrity.
ED patients with diabetes are mostly organic disease
MU Yi-ming points out that in clinical practice, there are many diabetic patients to the hospital due to ED treatment, and then found to be suffering from diabetes. Because of high blood sugar diabetes, hypertension and lipid disorders such circumstances susceptible to neurological and vascular lesions, damage erectile function. On the other hand, patients with diabetes because the disease often produces anxiety, depression and other negative emotions, psychological causes can lead to ED. Although diabetes may occur in patients with psychogenic ED, but most patients also are organic in ED.
Penis autonomic neuropathy in diabetic ED pathophysiology plays a major role. Diabetes blood sugar is too high, will cause some of its nerve fibers of carbohydrate (for example, polyols, etc.) deposition, so that nerve fiber degeneration, swelling, but also caused some nerve endings to reduce the release of neurotransmitters, causing endoneurium reduce blood flow and nerve conduction velocity reduced, hinder penile erection.
Vascular disease, whether large or small vessel disease are the main reason for diabetes complications and mortality. The blood sugar too much, will definitely lead to blood vessel lining cells, metabolic abnormalities and damaged, thus causing the vessel wall lipid deposition, thrombus formation, calcification and vascular wall degeneration, eventually leading to lumen narrowing and narrow, so that is bound to affect intravascular blood flow. When the supply of the penis significantly reduced blood flow, penile erection is not any good way to complete the task.
Mother Yoshiaki, atherosclerotic vascular disease leading to the most common causes of organic ED. In patients with clinically significant peripheral vascular disease in men, 40% ~ 50% are suffering from ED, of which 80% is organic ED. When the atherosclerotic penile arteries blocking the supply of more than 50% occur when the ED, 40% ~ 45% of atherosclerosis in patients with diabetic ED penis ultrastructural abnormalities, such as the reduction in smooth muscle cells. In addition, the cavernous venous dysraphism organic ED in all patients with the incidence rate is as high as 86%, probably due to trabecular smooth muscle elastic fiber structural components changed.
Of androgen on the male reproductive tract and secondary sexual characteristics of the growth and development has an important effect on the sexuality and sexual behavior is also yes. At present, have been found sacral parasympathetic nucleus, hypothalamus and limbic system the existence of androgen receptor, indicating androgen may be through these central processes involved in the regulation of erection. In addition to gonad dysfunction, the thyroid, pituitary and adrenal disease, and hyperprolactinemia may also lead to ED.
MU Yi-ming, ED diagnosis does not necessarily require sophisticated inspection, simply fill in a symptom scale, according to patients and their spouses of the self-reporting can make a diagnosis. The most simple and widely accepted international questionnaire erectile function scale is -5 (IIEF-5). 5 questions of the questionnaire and scoring are as follows:
When you try to sexual intercourse, how many times feel satisfied?
0 points: No intention of sexual intercourse
1 min: Almost no
2 points: a small number (less than half)
3 hours: about half of the
4 pm: Most (more than half)
5 pm: Almost always
Your right to obtain and maintain an erection how much confidence?
0 points: No sexual activity
1 min: very low
2 points: low
3 pm: Medium
4 pm: High
5 points: very high
When the sexual stimulation, how many times can get enough into the vagina erection hardness?
0 points: No intention of sexual intercourse
1 min: Almost no
2 points: a small number (less than half)
3 hours: about half of the
4 pm: Most (more than half)
5 pm: Almost always
When sexual intercourse inserted, how many times to maintain an erection?
1 min: Almost no
2 points: a small number (less than half)
3 hours: about half of the
4 pm: Most (more than half)
5 pm: Almost always
When sexual intercourse, to maintain an erection to completion of row feet how much difficulty?
1 min: extremely difficult
2 pm: very difficult to
3: Difficulties
4 pm: a little difficult to
5 points: There is no difficulty
Rating: Total 5 ~ 7 minutes was severe ED, 8 ~ 11 is divided into moderate ED, 12 ~ 21 are divided into mild ED, greater than or equal 22 are divided into non-ED.
Third-line therapy governance Diabetes
Mother Yoshiaki, treatment of diabetic ED patients first need a good blood glucose control, proper diet, adequate exercise, less alcohol quit smoking, maintaining a balanced state of mind and improve associated with high blood pressure, high cholesterol, obesity and so on.
The first-line treatment for diabetic ED are mainly oral medication, psychological counseling and vacuum erection devices to help. Oral medication, including oral drugs, such as promoting erectile sildenafil (Viagra), vardenafil, apomorphine and phentolamine, etc. One of the most effective is sildenafil. Sildenafil right, including diabetes caused by different etiology, including ED are valid.
Sildenafil fewer side effects will arise after a small number of patients treated with facial flushing, headache, indigestion, nasal congestion and diarrhea. In general, most patients need to take 100 mg, each about 1 hour before sexual activity taking it up to take a times a day. The age of 65 or more, liver and kidney dysfunction or receive erythromycin, cimetidine in patients treated with 25 mg is preferred. Taking ritonavir (HIV protease inhibiting agents) in patients taking sildenafil within 48 hours of each dose of a maximum of 25 mg.
In addition, sildenafil can not be combined with nitrates, otherwise it will result in significant drop in blood pressure. Because diabetes is often accompanied by hypertension and coronary heart disease, therefore, taking these drugs, patients need attention and activities related to the cardiovascular risk. A bleeding disorder, peptic ulcer disease, hereditary retinitis pigmentosa, penis anatomy easily cause deformities and suffering from priapism should be used with caution in patients with the disease. In the beginning of sexual activity, such as occurs angina, dizziness, nausea and other symptoms, the need to terminate sexual activity.
Yoshiaki mother said, many drugs can affect sexual function, but each of different doses of a drug's effects on sexual function is different in different people or the same person at different times in response to medication is not the same, so patients should have Under the guidance of experienced doctors and reasonable use of drugs.
The pathogenesis of diabetic ED patients in part because of the psychological factors, many patients are often once in a failure of the sexual life of an enormous psychological pressure, over time, forming a vicious circle. Therefore, ED patients to conduct psychotherapy.
Psychological treatment needs of both husband and wife co-diabetic ED patients should first clear the majority of ED can be improved or cured, so should take the initiative to conduct psychological adjustment. Between husband and wife should be to overcome the pessimism, and foster the confidence to overcome the disease and eliminate anxiety and tension caused by mental burden. Meanwhile, the need to strengthen the self-body sexual function and its influencing factors and understand the incidence of psychogenic causes of ED, the lack of self-confidence, fear of failure, the excessive value their own or spouse's sexual response capability, will reduce the excitability of penile erection . Both husband and wife in sexual life but also to enhance sex life prior to the preparation of pre-and multi-sexual pre-caressing, stimulation.
Mother Yoshiaki, patients in the first-line therapy to be ineffective, or patients can not tolerate the adverse reaction, can take second-line therapy. Second-line treatment is mainly carried out by a specialist intracavernous injection (prostaglandin E, etc.).
Intracavernous self-injection of vasoactive drugs in the last 10 years, for the treatment of ED of the most important advances achieved in one of the earliest use of vasoactive drugs papaverine hydrochloride, phenoxybenzamine, and alprostadil. Intracavernous self-injection of vasoactive drugs on arterial blood flow and normal function of cavernous venous closure of diabetic patients with ED have a good effect, but the venous closure insufficiency in patients with poorer treatment outcomes of diabetic ED. The treatment of the most common adverse reaction is the formation of painless intracavernous fibrosis, nodules, and sometimes can cause penile curvature, can also cause serious systemic adverse reactions, such as vasovagal attacks and syncope. The occurrence of nodular fibrosis and injection frequency and injection treatment related to the onset of vasovagal syncope, and hypotension may be related.
Third-line therapies, including penile prosthesis implantation and arterial bypass, vein ligation, but these methods are highly invasive, and prone to a variety of complications, with the drugs and other non-invasive, minimally invasive therapy for treatment of ED has made a good effect, at present, surgical treatment has been limited in China.
