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Erectile Dysfunction: Causes, Pathophysiology, and Treatment Options

Erectile dysfunction (ED) is a sexual disorder characterized by the inability to develop or maintain an erection of the penis during sexual activity. ED can have physical or psychological causes. Physical causes include injury to the nerves, arteries, or veins of the penis. Psychological causes include anxiety, depression, or stress. Treatment for ED may involve medication, lifestyle changes, or surgery.

Erectile dysfunction (ED)- Definition, Causes, Pathophysiology and Treatment Part 1

Erectile dysfunction, also known as impotence, is defined as the inability to obtain or maintain an erection of the penis during sexual activity. It is a sexual disorder that affects men of all ages and is characterized by a decrease in the quality of the erection. The causes of erectile dysfunction can be physical, psychological or a combination of both.

The most common physical causes of erectile dysfunction are due to the following:

  • Vascular disease – The blood vessels that supply the penis with blood are narrowed or blocked due to vascular disease such as atherosclerosis (hardening of the arteries).
  • Neurological disease – The nerves that supply the penis with nerve signals are damaged due to neurological disease such as Parkinson’s disease, multiple sclerosis or stroke.
  • Hormonal disorders – The levels of the male sex hormone testosterone are decreased in men with hormonal disorders such as hypogonadism (a condition in which the testicles do not produce enough testosterone).
  • Drug side effects – Certain medications can cause erectile dysfunction such as beta blockers, diuretics, antidepressants and antipsychotics.
  • Injury – Injury to the penis, spinal cord or pelvic area can cause erectile dysfunction.

The most common psychological causes of erectile dysfunction are due to the following:

  • Stress – Stress can interfere with the sexual response by affecting the hormones that are released during sexual arousal.
  • Anxiety – Anxiety can interfere with the sexual response by causing muscle tension and a lack of focus.
  • Depression – Depression can interfere with the sexual response by causing a loss of interest in sex and a decrease in sexual desire.
  • Relationship problems – Relationship problems can interfere with the sexual response by causing communication problems and a lack of intimacy.

Erectile dysfunction can also be caused by a combination of physical and psychological factors. Treatment for erectile dysfunction depends on the underlying cause. If the cause is physical, treatment may involve medications, surgery or other medical therapies. If the cause is psychological, treatment may involve counseling or other therapies.

In this video, we are going to talk about the Erectile dysfunction or Impotence

Contents:-

a) Definition

b) Classification of ED according to the origin of causes

c) Pathophysiology of ED

d) Treatment modalities of erectile dysfunction

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Video transcription:

Hi friends, today we are going to talk about erectile dysfunction. So before I start my lecture, how can you actually define a reptile dysfunction? Can anyone tell that? How can you define erectile dysfunction, see there is a panel called National Institute of Health consensus development panel, so this is a panel on importance, so, according to this panel, that Erika dysfunction is defined as the persistent failure to hu, as well as to maintain penile erection during sexual intercourse. So, according to this panel, the erectile dysfunction is it’s not only about achieving the erection, but it is also about the maintaining of penile reduction. So if any individual has this so-called abnormality in achieving, as well as maintaining penile erection for about greater than three months what it is greater than three months, we place these individuals under this condition. Okay, did you understand what is erectile dysfunction? Yes, so now, how can we actually differentiate our? How can we actually distinguish this erectile dysfunction with infertility? Okay, let me tell you that: how can we actually differentiate that so, first of all units to understand what is infertility? Okay, so infertility is the issue about sperm count, sperm motility, as well as from morphology, whereas erectile dysfunction is not the issue about sperm count, sperm, motility and sperm morphology in these individuals we find a normal sperm count. We find a normal sperm motility and we find a normal sperm morphology, but whereas infertile patients are not like that, due to this abnormal sperm counts and abnormals from morphology and abnormal sperm motility, they was they lose to fertilize the over. But we’re asked these individuals are not like that. This individuals has the capacity these. The sperms of this individual has the capacity to fertilize our. So this is the thing. I needs to exactly tell you. Okay. So now I am going to tell you about the structure of this lecture. What I’m going to discuss so, first of all, I’m going to tell you what are the different causes of erectile dysfunction and once I tell you about the causes. I simultaneously tell you: how do we actually place all these causes according to its arising under two terms? Nothing, but I am going to tell you about the classification part. Yes, let me tell you that, so how can you actually classify this peptide dysfunction? Can anyone tell that, depending on depending on its origin, of course, erectile dysfunction can be classified into two types: the first one is Organic erectile disfunction and the second one is psychogenic direct I’ll dysfunction. Now, do you think which is more prevalent, whether the organic have me tell you? What do you mean by organic and what do you mean by psychogenic so out of these two types, two classifications: do you think vision which one is more prevalent? You see it’s not about psychogenic, but rather it’s about organic. Of these two types about 80% of the patients with erectile dysfunction. Has the origin, of course, from organic and remaining patients have the origin, of course, from psychogenic see psychogenic is nothing, but it’s all about dealing the framework of your mind how you are going to response to the sexual stimuli. Yes, you are right, and so, as far as the prevalence is concerned, organic erectile dysfunction is more prevalent when compared it to psychogenic erectile dysfunction. Yes, so what is organic or what this term is actually referring to? So any cause I am going to tell you what do you mean by organic erectile dysfunction, so any cause that is originated from any of your three physiological systems? How many three physiological system you put in your mind? These three physiological systems are called as vascular system, nervous system and hormonal system. So whenever you have the pathology in your vascular system, whenever you have the pathology in your nervous system and whenever you also have the pathology in your hormonal system, you come across a erectile dysfunction, called organic erectile dysfunction. So, depending on its where the pathology is present, whether it is present in your vascular system, whether it is present any of these three, we are going to manage the patient. Yes now. So what are these pathologies that are present in your vascular system that actually takes that individual doing into a condition called organic erectile dysfunction? And what are these pathologies that are present in the nervous system that actually leading the patient to have organic erectile dysfunction? And what are the pathologies that are present in the hormonal system that actually taking the patient with him to have this organic erektile dysfunction? I am going to tell you about the pathologies that are involved in three physiological systems so up to now, what I was telling is I am telling that if you want to have a normal erectile function, then you are these three physiological systems at any cost should be normal if they are abnormal, they are going to have erectile dysfunction, but you should also keep in your mind that it does not mean any pathology in all these three systems is going to lead to erectile dysfunction. It is not like that there are some specific pathologies in these three systems that can actually make you organic erectile dysfunction. Now I will run all this and I will focus on each system and I am going to tell you the different pathologies involved in it. Yes, did you understand so coming to the vascular system so coming to the vascular system, so the pathologies involved in this vascular system are number one. It’s about having peripheral, vascular disease and having a theros chlorosis and also having essential hypertension. If you hear these three words, there should be something striking. In your mind, say all these three systems are actually making your blood vessels to compromise the blood flow to the issue that it is going to deliver. If you have a theorist, chlorosis say, atherosclerosis is not just having the plaque in your coronary arteries, it’s also about having the plagues in any blood vessels. So these a thorough sclerosis is group under a broader term, called arteriosclerosis. So it’s all about these three systems where they are going to compromise the amount of blood flow that it is going to deliver to the tissue that it is actually exposing on yes, so here, for example, you consider that there is a blood vessel that is supplied to your pennies, specifically, that is supplied to your corpora cavernosa in the next lecture. I am going to discuss about the structure of finish. I am going to discuss about how this sexual stimuli is actually making your brain. You have erectile Ness I am going to discuss in that necklace next lecture, but in this lecture you just assume that whenever you have these three pathologies, it is actually going to compromise the amount of blood flow to the corpora cavernosa of the penis, not only corpora cavernosa, but also corpus spongios. Yes, you just noted down these so coming to the next system. That is nervous system and the pathologist involved in the nervous system. See nervous system is all about nerve conduction, so that pathology should alter with your narrow conduction. It should change your nerve conduction. Am I right? So what are these pathologies that can actually change your nerve, conduction? Okay, the first one is spinal cord injury and stroke, and the second one is the most common diabetes mellitus. So whenever you have the spinal cord injury, whenever you are having a stroke, what it is going to do is it is going to cut down the nerve conduction, but not peripherally rather centrally, but whereas diabetes mellitus is not like that. It is going to cut down your nerve conduction peripherally for what to the structure of Penney’s, specifically to the structures of erectile tissues that are present in the penis. We call it as corpora cavernosa and spongy osseous, so about 50% of the patients who are suffering with diabetes, mellitus they’re having erectile dysfunction. You noted down about 50% of the patients who have diabetes mellitus. They are going to have erectile dysfunction and around 20 to 25 percentage of the patients who are taking those classes of drugs, not diabetes, mellitus anti-diabetic, military drugs, but other drugs. Those classes of the drugs can actually make you erectile dysfunction. I will tell you what are these class of drugs? The statistical data you should note is about. 50% of the individuals, have erectile dysfunction of dad dis, mellitus and around it 20 to 25 percentage of the patients who are using some specialized the class of drugs. They are exposed to erectile dysfunction. Yes, this is about nervous system so coming to the hormonal system. So here we are going to have two things. The first one is primary hypogonadism and the second one is secondary, see it’s all about hypogonadism, yes, so what do you mean by hypogonadism? So, first of all, what do you mean by go? Nuts go nuts are of those things that are present not only in just males but also in females, so what they are actually going to do, they’re actually going to produce they’re actually going to synthesize sex hormones. For example, if you consider the gonads in males these are called as testes, and if you consider the gonads in females, they are called as always, whereas testes they are going to produce hormone called testosterone and the others are going to produce hard. What’s called yeast origin as well as progesterone the important point you should notice, they are not going to produce the hormones on their own. There should be some signal that should come from your hypothalamus, and this signal should pass to your anterior pituitary and then this anterior pituitary should release those hormones that these hormones through the blood they reach to the testes, as well as they reach to the ovaries in females such that they make those go nuts to release mr. Eisen and progesterone in females and testosterone in males. There are some diseases that are associated with hypogonadism and those diseases that are associated with hypogonadism, make the go nuts in the males in such a way that they lose this capacity to produce testosterone and whenever they lose this capacity. We call this conditioners hypogonadism, so, depending upon the cause, we are going to tell whether it is primary or secondary, say. Primary hypogonadism is actually referring to a normal aging process and it is actually referring to whenever you remove the testes due to the presence of district clerk answer two things one is: it is associated with a normal aging process as part of our life, and the second thing is: it is associated with not only normal aging process, but also removal of the testes, and whenever you find these two conditions, we call it as primary hypogonadism, but whereas secondary hypogonadism is not like that, it’s all about the disorders that are present in your hypothalamus and the disorders that are present in your which Atari gland. So whenever you are having the disorders, do you think this signal system is going to be coming down? No, this signal is going to break sorry for the inconvenience see what I’m going to tell you is I am telling that whenever you are having the disorders in your pre to carry gland as well as hypothalamus, the signal is going to break and whenever the signal is going to break, it is going to alter the levels of testosterone hormones in the blood. But the other thing you should note is due to these disorders. There is another neurotransmitter called dopamine is going to fluctuate and the levels of dopamine is going to increase. Do what happens when dopamine is going to increase, see whenever the dopamine is going to increase? It is going to inhibit a very special type of a factor called prolactin, inhibiting factor, so this is a factor that is inhibiting the productive. So whenever the dopamine is going to increase, it is going to inhibit that factor that inhibits a prolactin. So whenever the factor is inhibited, do you think the prolactin levels are going to increase? It is going to increase? Yes, we are inhibiting the factor that is inhibiting the prolactin by increasing the dopamine levels due to Schumer’s in your hypothalamus and pituitary gland. Due to the disorders, we are trying to inhibit that factor whenever they. Whenever we inhibit this factor, the levels of prolactin is going to increase. Do what happens when prolactin increases when prolactin is increased in your blood? It is going to suppress the levels of testosterone hormone, so we saw that testosterone hormones can be affected by two ways. The first one is normal aging process and removing the testes out due to testicular cancer, and the second way is disorders in your pitch dairy gland disorder. So your hypothalamus not really directly influencing it, but also increasing the levels of dopamine. So this is about the pathology in hormonal system. Now it’s not about the end of causes. We needs to discuss some other causes. I will do that do whenever the individual smokes he is taking. What see whenever the individual smokes cigarette? Do you think he is taking? Yes he’s going to take nicotine and what is the action of nicotine on muscles? Not so what see the action of nicotine on the muscles is Vasil constriction I am talking about smooth muscles that are lining the blood vessels, so the effect of nicotine on the smooth muscles of the arteries is going to have vasoconstriction and whenever the vasoconstriction is going to occur due to the intake of nicotine, that is cigarette smoke. Do you think there is a normal blood flow? No, there is an we don’t have a normal blood flow. The blood flow is altered to that tissue. So the first one is cigarette smoke. What it is doing it is compromising that blood flow. The second money is intake of yes, intake of you should be so fancy it is. It is about intake of ethanol, so what ethanol is going to do? It is going to do three things. I will tell you that so the first one is it is going to do. Is it is going to cause peripheral neuropathy and it is going to cause chronic liver disease, and it is also going to cause deficiency of androgens say we hear this term androgens many times. We have seen the alteration of this hormone in hormonal system and we have seen the deficiency of androgens now so in the part of treatment we are actually replacing the androgens. There is a treatment to replace this androgens so that the person does not have a decrease in libido, yes, and he is not going to have secondary erectile dysfunction. Okay, these are my other causes like cigarette smoke. Intake of ethanol, such as it is going to cause peripheral, neuropathy, chronic liver disease and deficiency of androgens. So friends, this is all about the organic erectile. So now I am going to discuss about psychogenic erectile dysfunction. Let me rub it out, so what do you mean by psychogenic erectile dysfunction? What do you mean by psychogenic erectile dysfunction? The psychogenic is not about having pathologies in your system. It’s dealing with your framework of your mind. How are you going to receive the sexual stimuli? Yes, for example, there is an individual. There are two individuals and this individual whenever he is use sexual stimuli, psychogenic, stool and then this individual has the ability in response to that sexual stimuli, to produce an erection. So this individual is normal, but you are having another individual upon receiving the sexual stimuli. Then this individual is not going to integrate or he is not going to process this sexual information in specialized iteration of brain such that. Do you think these impulses are going to pass down from the brain to the Penny’s No? So there is cutting of these impulses. That is passing down from the brain. To Penny’s, so this individual is abnormal. Can you tell what are these like sexual stimuli? Yes, erotic sites, it’s all about seeing an attractive partner that is erotic sites and number two is erotic. Sounds it’s all about erotic, smells erotic, hearings, erotica, touch, erotic touch. This is called as erotic smell and we also have a perceptional way to stimulate Penny’s. That is erotic touch yes. So whenever you have this sexual stimuli tha t this individual has the capacity to process, this information in a very specialized relation of a brain called a medial, preoptic nucleus that is present in the medial part of hypothalamus I, am going to discuss when I discuss in the next part. That is called normal physiology of penile erection. How it is coming down from the brain to Venice. I am going to discuss in the next lecture, but whereas this individual is not so happy because he is not able to process the sexual information, it means he is not able to process the sexual information in that region and he is not able to pass this information to the penis’. This is what exactly happening. The thing you need to understand is it’s not about organic cause. You keep it to your mind, it’s not about organic cause. It’s about psychogenic cause. The causes are very so different when compared to the organic cause, shall I tell you the causes why this information is not processed by this individual see. The first cause is, let me rub it out. The first cause is depression. Yes, it comes in the first place, the first person’s depression. We call it as a reactive depression and the second cause is all about anxiety and the third cause is malaise and the fourth causes Alzheimer’s disease, so the first cause is reactive, depression. The second causes performance, anxiety and the third causes, having realised and the fourth causes, having Alzheimer’s disease. The fifth course is it’s all about any psychiatric disorder, whether it is anxiety a there. It is depression or you take any psychiatric disorder. It is going to make that individual do not to process the information in that part of hypothalamus called medial, preoptic area of hypothalamus, so that the information cannot be passed down. So how can you actually differentiate? Organic and psychogenic? Can even tell that organic erectile dysfunction is differentiated from psychogenic. Erectile dysfunction do to the presence of cause in any three physiological systems. Yes, but whereas psychogenic erectile dysfunction is all about loss of perception to the sexual stimuli. In one word, you can tell that in one sentence, loss of perception you should keep in mind loss of perception to the sexual stimuli, even though there is sexual stimuli is present, the person has lost his perception of sexual state. So friends, this is mind off my lecture in the next part. I am going to talk about what is the normal physiology of penile erection. Nothing, but I am going to tell you how these sexual stimuli is actually going to cause an action in Venice. So if you like this video, please share your comments in the comment section and please share this video. Thank you.

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