AErectile dysfunction has many causes and the type of treatment depends on the cause. In my opinion, the fact that all kinds of drugs and devices are recommended on satellite channels with a hundred percent guarantee for the treatment of erectile dysfunction is nothing more than a fraud. First No disease can be diagnosed from a distance. Medicines in some people, for example, people with heart problems, are complicated and can be dangerous. Therefore, dear compatriots should not fall into the trap of such advertisements. But we come to the diagnostic measures for erectile dysfunction.
Erectile dysfunction is a relatively common disease and affects 1 in 5 men in their lifetime. Erectile dysfunction is a type of sexual disorder, and there are many types of sexual disorders in both men and women. One of the most important sexual disorders in men is erectile dysfunction. Every disease has its own definition in medical science. Therefore, the first step in diagnosing erectile dysfunction is to match it with the scientific definition, which is unfortunately often ignored by doctors. A person may have certain expectations of himself or mistakenly think that he is sick, it is the doctor who determines whether there is a disease or not. For example, if a man goes to the doctor with chest pain and claims that he had a heart attack, his claim alone is not acceptable. The doctor performs various tests to prove whether the patient has had a heart attack or not. The same is true for erectile dysfunction. Because this disease is very common, the lack of proper diagnosis causes heavy costs to be imposed on the health care system of the country. If a man “in more than 50% of the cases of marital relations has difficulty in getting an erection or maintaining it until the end of the marital relationship”, he has erectile dysfunction.. Therefore, if a man occasionally has trouble getting an erection, he is not sick, and this happens in the life of all men, that is, he should not be considered sick and perform all kinds of medical procedures or prescribe medicine.
On the other hand, if a man has erectile dysfunction according to the above definition, he should be carefully examined and its cause determined. In many cases, as soon as a man states that he has erectile dysfunction, a prescription is immediately written and given to him. The cause of the disease must be determined. In many cases, erectile dysfunction can be treated, and in some cases, erectile dysfunction is incurable, and the patient should be told clearly to avoid high costs. Therefore, patients who come from the city and expect that their problem will be diagnosed and treated in the first visit, it is not correct. Most of the patients who come from the cities have been suffering from erectile dysfunction for a long time and because of the lack of results, they turn to Tehran. I have many patients who, for example, have arrived in Tehran from Kerman in the morning and come to see me in the afternoon to be treated and return to Kerman again at night. For the information of dear readers, I must say that this is not possible and it is not morally correct to prescribe medicine to a patient without diagnosis. On the contrary, patients who come from abroad because they know that they need to be examined, they adjust the length of their stay in advance.
After it is proven that a man has erectile dysfunction according to the scientific definition, the first step is to prove whether the problem is psychological or physical. that’s mean Erectile dysfunction is divided into two major categories:
- Spiritual or psychogenic
- Physical or organic
In a number of cases, the type of erectile dysfunction can be determined by taking the patient’s history. Since it is very important to differentiate between two types of mental-psychological or physical erectile dysfunction, it should be done using a special test. To differentiate mental-psychological erectile dysfunction from physical erectile dysfunction, there is a very sensitive test called RigiScan, which can differentiate psychological-psychological erectile dysfunction from physical erectile dysfunction with more than 90% accuracy. In this test, a sensitive electrode is connected to the patient’s penis and the patient sleeps according to his current method. In a normal man, an erection occurs 2-3 times during a night’s sleep, this device electronically records all the details of the erection at night in different parts of the penis and provides valuable information about the erection process in a man. (Figure 1-3). As soon as it is determined that erectile dysfunction is a physical or mental illness, more investigations are carried out. Here it is assumed that the regi scan test showed that the patient’s erectile dysfunction is physical.
In general, physical erectile dysfunction can have 4 causes:
We cannot request all examinations for the patient at once. In medical science, a diagnosis should be made with minimal examinations and tests, which is called “cost-effective examination”. The doctor will decide which tests should be done by taking the history and examination. Here is a brief explanation about the types of physical erectile dysfunction and their diagnostic methods.
Only about two percent of physical erectile dysfunction has a hormonal cause. Not all patients need hormonal tests, but sometimes the patient’s erectile dysfunction has a hormonal origin. If necessary, some specific hormones are measured in the blood to prove it. It should be remembered here that the administration of hormones has a very small place in erectile dysfunction and their improper use not only does not cure erectile dysfunction, but also causes many and harmful side effects.
But vascular causes are the most important and common causes of physical erectile dysfunction. One of the basic things for normal sexual function in a man is the presence of sufficient blood supply to the penis (Figure 4), sometimes the vein that supplies blood to the penis is cut off or blocked. Now, no matter how much this person undergoes different drug treatments, it will be useless. If in a young man it is proved that the penile vein has been severed, vascular surgery will be required to transplant the vein, and to prove the diagnosis, an image of the vessels in the pelvic area, which is called angiography, must be taken. An important point that I want to mention again is the importance of a natural blood supply to the penis. In a man, for normal sexual function, not only enough blood should reach the genital system, but also this blood entering the penis should stay in it and not come out. There are very complex mechanisms in the male penis, which stop the blood entering it. There are some diseases that disturb these natural mechanisms and we call it “We say “venous leakage”, that is, the blood entering the penis is not trapped in it and comes out (Figure 5). This is one of the worst types of erectile dysfunction in men, and its treatment is very difficult. The diagnosis of this disease requires special radiological methods, one of which is Doppler ultrasound of the penis. In Doppler ultrasound of the penis, a special substance is injected into the penis, and then the amount of blood flowing in and out of the penis is carefully measured. By using this test, it is possible to accurately state whether the patient’s problem is vascular or not, and if it is vascular, whether the problem is arterial or venous. Sometimes the patient’s problem is compound, that is, it is both arterial and venous. In these patients, not only does not enough blood reach the penis due to clogging of the blood vessels, but also the small amount of blood that enters the penis does not stay there, but leaves.
The third and important type of erectile dysfunction is physical, nervous. To create a normal erection in men, the innervation of the genital area must be normal. In some patients who come to us because of impotence, after taking the history and examination of the patient, we realize that the innervation of the genital system may be disturbed. In these cases, special tests must be used to prove the diagnosis, including tests that quantitatively measure the speed of impulse conduction through the nerves. Things that can cause erectile dysfunction of the nervous type include damage to the spinal cord, lumbar disc, stroke, concussion, surgery on the nervous system, pelvic surgery that causes damage to the nerves of the reproductive system, Parkinson’s and MS. A percentage of patients with MS suffer from sexual impotence at a young age, the cause of most cases in these patients is the progressive destruction of nerves, which can be diagnosed with the help of neurological tests.
The fourth type of physical erectile dysfunction is the anatomical type. In this type, due to anatomical changes, the man is not able to have a normal marital relationship, for example, the patient is suffering from penile curvature, which makes penetration painful or impossible.
Physical erectile dysfunction and psychological erectile dysfunction have many causes that are beyond the scope of this article. The above cases were the most common ones that were brought for the information of our dear readers.
· The first step in dealing with a man with erectile dysfunction is to determine its psychological or physical type.
· If the erectile dysfunction is physical, its cause should be identified with proper examinations.
· In a man with erectile dysfunction, the cause of the disease should be diagnosed and treated, rather than relieving the patient’s problem with drugs.
Each disease has its own treatment.
Source-Source-Dr. Mohammad Reza Safarinejad