Organic impotence – the inability of the patient to the erection and preservation, not related to psychogenic factors. The most common cause is vascular pathology. Erectile iliac arterial system supplying the penis with blood, includes an internal folly artery, the artery of the penis and corpus cavernosum. This system has the unique ability to dramatically increase blood flow in response to sexual stimulation of pelvic visceral (excitatory) nerves. In normal blood flow is 10 ml / min at rest and approximately 60 ml / min during stimulation (P. Metz, E. Wagner, 1981). This rapid increase in blood flow, along with its neirogennym redistribution in erectile tissues causing an erection.

Lack of blood pressure in small vessels of the arterial bed during sexual stimulation leads to an inadequate blood supply to the cavernous bodies and incomplete erection. This, apparently, is an explanation of the close connection impotence to aging. The degree of arterial bed may be different. Thus, for example, the complete absence of erection may indicate a serious vascular pathology, and relatively good erection at rest that disappear when copulative frictions may be a manifestation of the less severe vascular disease. If the blood flow in the iliac arteries is limited, and in the inner shameless arteries are occluded, then a redistribution of blood flow in the vessels of striated muscles, with less resistance. These vessels are available in the gluteal, muscle, granted with the upper and lower gluteal arteries, which represent a branch of the iliac arteries and internal shameless. In clinical practice, redistribution of blood flow in the load is called the pelvic syndrome “steal”. It can manifest disappearance of erections during active koitalnyh frictions.

Impotence of vascular origin most commonly occurs in patients with a anemneze hypertension, diabetes, peripheral vascular disease, ischemic heart disease, cerebral blood flow. Important role in the occurrence of impotence of vascular origin is smoking. A special group should identify patients with erectile dysfunction of vascular origin, who suffered blunt perineal trauma, irradiation of the pelvic organs.

Waning erektivnoy function with impotence of vascular origin may be gradual, it can be less frequent sexual intercourse, normal or premature ejaculation, not full erection in response to sexual stimulation, inability to maintain the erection until ejaculation. The use of antihypertensive medications patients has further violation of erectile function.

The examination of such patients are evaluating the state of the vascular system. For this palpable pulse in the dorsal artery of the penis at the level of suspensory ligament and evaluate him on a four-point scale (from 0 to 3). On the pulse of the other arteries, for example, on the femur, can judge the state of the proximal aortoiliac segment or the narrowing of the external iliac artery. However, a clear pulse on the femoral artery does not exclude distal lesions of small vessels in podvzdosh-but-cavernous arterial channel. Other signs of peripheral vascular disease, including muscle atrophy of lower limbs, pale skin, lack of hair distribution of the lower extremities may indicate a systemic vascular disease. If impotence is necessary to investigate iliac cavernous arterial bed. The adequacy of the pelvic blood flow is usually estimated non-invasively using Doppler ultrasound of the arteries of the penis. For this standard Doppler probe is placed at 9.5 kHz for each of the arteries, cavernous bodies. Cuff width of 2.5 cm superimposed on the base of the penis and measured occlusal systolic blood pressure in their arteries. Then it is compared with systemic occlusive pressure in the brachial artery and thus establish a comparative penisno-brachial index (PBI). At rest PBI reveals a gradient of blood pressure in the iliac artery stenosis cavernous bed. Since PBI alone is not sensitive enough, also determine its patients in the dynamics, or performing physical exercise. If you suspect a pelvic syndrome “steal” carry out physical activity gluteal muscles for 3-5 min. A significant decrease in the PBI loading confirms the diagnosis of the syndrome of “steal” and explained the phenomenon of redistribution of blood flow to the pelvic arteries with a load: Instead of entering iliac cavernous arterial bed with high resistance, he switches to the gluteal artery with a lower vascular resistance. Having discovered the phenomenon of redistribution of the load gluteal muscles, can identify patients with erectile dysfunction of vascular origin, in which the values of PBI alone may be normal.

The phenomenon of redistribution is also confirmed by measuring the temperature in the urethra during physical exertion. The temperature in the urethra is almost completely corresponds to the temperature in the cavernous bodies. The fall in temperature of the penis during exercise indicates a redistribution of blood flow in the pelvic arteries.

Other noninvasive methods for determining the level of blood flow in the pelvic arteries are plethysmography and radionuclide study. Selective arteriography internal shameless arteries do basically the patients who in the course of non-invasive studies have found deviations from the norm and who are willing to undergo invasive procedures (balloon angioplasty, macro-or microsurgical reconstruction of vessels). By arteriography internal shameless artery should not be resorted to only with the diagnostic purpose, if not expected restoration of vascular permeability.

Enough common type of organic impotence was neurogenic. Normal sexual function is provided by a healthy nervous system, so any of its disorders (neurosis, neurasthenia, spinal cord and pelvic Department parasympathetic nervous system, etc.) can cause impotence. Neurogenic factors can disrupt the process of erections, and the process of their maintenance. Patients with complaints of violations of erectile function should be required to conduct a neurological examination, especially if they have suffered neurological disorders or in their history there are indications of the pathology of the nervous system.

In the center of the neurological examination should be the crotch area and lower extremities. Need to evaluate the cutaneous sensibility of the external genitalia and lower extremities to light touch, jab. Define the threshold of sensitivity of the penis to vibrate. This procedure is carried out using biotenzometra, it is inexpensive, completely painless, gives quantitative information and reproducible results. The deviation in the sensitivity to vibration is an early manifestation of peripheral neuropathy. At the head and the middle part of the penis to the right and left sensors are placed. The patient was asked to note when it senses the vibration, and gradually increase the amplitude of oscillation. The study is conducted several times until, until you obtain reproducible results. This test involves minimal stimulation of the nerves, and therefore can be considered a more reliable indication of peripheral sensory neuropathy in the lewd nerve. Other methods for neurological studies include electromyography muscles of the perineum, the definition of refractoriness sacral nerves, as well as the registration of the potentials of the brain during stimulation of the external genitalia, and so comparisons with objective neurological findings of other studies of erectile function allows you to define more precisely the origin of neurogenic impotence.

Depending on the etiology of neurologic injury onset may occur in different ways – either gradually or suddenly. An erection may be absent or be incomplete when there is a lack of rigidity of the penis. At the potency affect neurological disorders, in alcoholism, diabetes, conditions after radical surgery for pelvic, spinal cord infection, tumors or trauma, degeneration of intervertebral discs, as well as in tumors or brain injury and cerebral insufficiency. Often, impotence is directly attributable to two causes – neurological and vascular, for example. patients with diabetes mellitus.

The primary basis of substandard erections may be psychological factors. In men with erectile disorders frequently observed changes in the psyche. Sometimes the question arises, in which cases they are the cause, and in what – a consequence of impotence. For the distinction between primary and secondary psychological factors in the impaired erectile require special examination.

The physical basis of impotence caused by a primary psychological factors, is inadequate stimulation kortikosakralnogo way. It can be attributed to many causes, in particular the effects of symptomatic hyperstimulation as a result of anxiety, depression, feelings of aggression or guilt during sexual stimulation. In these patients, there are psychological factors of the disease, but the majority still do not, they are the primary etiologic cause. Regardless of the presence of organic disease with impotence manifest such feelings as depression, aggression, his own guilt, decreased self-esteem and loss of self-respect. Patients with impotence caused primarily by psychological factors, as a rule, relatively young (45 years), noted the sudden appearance of the disease, which is usually associated with a very definite occasion. Sometimes they are experiencing a “situational” impotence – the inability to have sex in certain circumstances. In patients with impotence have been some mental disorders, which is understandable, since the self-esteem, self-esteem and awareness of one’s self is often closely linked to the implementation of adequate sexual function. It is therefore necessary to gather information on the manifestations of anxiety, aggressiveness, depression, feelings of guilt, inferiority. However, it is sometimes difficult to determine whether these factors are the primary cause of impotence or a consequence of it. For psychological impotence is characterized by clinical polymorphism, variations in the degree of sexual function disorders have emerged, the presence of success in any particular situation, with persistent disability in other contexts. Thus patients are observed decreased sex drive and dominance of braking torque while maintaining libido.

Patients with low sexual desire to celebrate sexual weakness, but detailed surveys is that they have saved and erection and ejaculation, but there is no desire for sexual intimacy or the desire expressed incompletely, and dimly realized on debt rather than on need. Some patients have an erection does not arise even if the relevant circumstances. Others do not get satisfaction, despite the full implementation of sexual intercourse with the physiological side.

When you save the sexual appetite of patients have a variety of symptoms: lack of erection, sometimes its absence, too fast ejaculation or, conversely, a phenomenon aspermia. The most characteristic should be considered as the disappearance of an adequate erection at the most crucial moment, before sexual intercourse, while the preparatory period took place normally. Also characteristic spontaneous erections in the morning, with erotic fantasies, along with its disappearance in the real world of convergence.

There are patients with a decrease in sexual desire, stemming from years of sexual abstinence, negative or distracting influences, hobby work, negative attitudes towards his wife because of her sexual frigidity, general state of fatigue, long-term concern, and emotional depression. The cause of sexual disorders, may be inadvertently insulting spoken word, for example, the reproaches of his wife about her husband’s sexual disorders are pathological stimulus, significantly aggravating the already existing disease that causes profound inhibition of erections. Consequently, any negative emotion, even indirectly affect the integrity of sexual impulse of man, may acquire pathogenic character and fortitude to fix the disorder arose. Osobennosilny experiences with failures during casual sex. Even more severe are the experiences with the crisis in the first wedding night, when an unexpected setback threatens the future relationship between the spouses.

Dramatically influenced by the traumatic loss of an adequate erection, leading to the impossibility of convergence. Highly pathogenic significance is suddenly experienced by ejaculation before intercourse, especially if it occurred before the first proximity. Pathogenic effects of this experience can be so strong that a man for a long time (sometimes several years), considering themselves inferior, does not dare to start sexual life.

Premature ejaculation (premature ejaculation, premature ejaculation)
Treatment of premature ejaculation (treatment of premature ejaculation), weak erection, reduced potency (poor erection), impotence

Impotence – the inability of men to make a full sexual intercourse. This is a special form of disorder of sexual function in men, different from other violations, such as the pathology of libido, orgasm, the passage of sperm or ejaculation. Impotence the inability to create a cavernous bodies of the penis pressure necessary for its introduction into the vagina or maintain this pressure until the moment of ejaculation. Rigidity of the penis, which determines the capacity for erection, is directly related to the magnitude of blood pressure within the corpus cavernosum member, which is approximately 90 mm Hg. Art. Typically, this pressure is sufficient for normal insertion of the penis into the vagina.

There are several classifications of impotence. On the primary impotence say if the patient had no period of normal sexual function, called a secondary violation of earlier sexual potency. Recently considered to be generally accepted classification, which is based on the estimated pathophysiological mechanisms of impotence. In particular, distinguish impotence, primarily due to psychological causes, and organic. Among the causes of organic impotence is called mechanical damage, vascular, neurological, hormonal disorders and their combinations.

According to the traditional evaluation of the disease, approximately 90% of impotence is caused by psychological reasons. However, many studies in recent years increasing emphasis on organic factors. A number of studies shows that more than 50% of surveyed patients with erectile dysfunction found organic pathology.