Human sexuality

Organic etiological factors of erectile dysfunction

1. Vascular pathology:

a) Arterial (lesions in the aorto-iliac zone and in the pool of the internal genital arteries):
– atherosclerotic lesions of the arteries;
– Post-traumatic injuries of the pelvic arteries (usually occur after a fracture of the pelvis bones);
– iatrogenic damage to the arteries (during surgery on the pelvic organs, aortic bifurcation, the effects of radiation therapy for prostate cancer or rectal cancer;
– congenital anomalies of the arterial bed of the genitals (arterial dysplasia, arteriovenous fistulas).
b) Venous:
– cavernous venous idiopathic insufficiency;
– congenital anomalies of venous outflow;
– acquired non-traumatic venous outflow abnormalities (for example, in Peyronie’s disease);
– posttraumatic venous insufficiency (cavernous-spongy and arteriovenous fistulas).
c) Combined arteriovenous pathology.

2. Neurological pathology:

a) Cerebral disorders (damage to the limbic system and the temporal region as a result of injury, aneurysm or angioma):
– temporal epilepsy, Parkinson’s disease;
– tumors and vascular lesions of the brain.
b) Spinal disorders (damage and injuries of the spinal cord):
– lesions of the brain stem as a result of ALS, syringomyelia, multiple sclerosis, late neurosyphilis (“spinal cord”), arachnoiditis, spinal cord abscess, spinal artery thrombosis, herniated disc, myelitis and spinal cord tumors.
c) Extraspinal disorders (caudites, plexitis, neuritis, peripheral neuropathy in diabetes mellitus, tumor processes that cause damage to the nerves involved in erection mechanisms):
– traumatic (for fractures of the pelvic bones) and iatrogenic (for urological operations and operations on the lower parts of the intestine), damage to the peripheral nerve pathways of the erection reflex.

3. Endocrine pathology:
– hypothalamic-pituitary insufficiency as a result of idiopathic disorders, somatic diseases (tuberculosis, sarcoidosis), injuries and cysts of the brain;
– hormonally active pituitary tumors (prolactin-secreting adenoma);
– hyperestrogenic with estrogen-secreting tumors or conducting antitumor therapy, with alcoholic cirrhosis of the liver;
– congenital testicular disorders (testicular agenesis, bilateral cryptorchidism, Klinefelter syndrome);
– Acquired testicular disorders (consequences of parotitis or bacterial orchitis, testicular injury);
– age involution – causes disturbances in the hypothalamus-pituitary-testicles;
– adrenal tumors;
– common endocrinopathies (diabetes mellitus, acromegaly, hypothyroidism, hyperthyroidism, hypercorticism.

4. Pathology of the genitourinary system:
– malformations, tumors and traumatic injuries of the genital organs;
– diseases of the urinary organs (acute and chronic cavernitis, Peyronie’s disease, etc.);
– fibrosis and sclerosis of cavernous tissue of various etiologies (injuries, injuries, inflammations suffered, consequences of frequent and long-term intracavernous injections);
– kidney disease with symptoms of chronic renal failure.

5. Toxic effects:
– Alcohol abuse and drug taking (cannabis, opiates); tobacco smoking;
– lead poisoning, herbicides, etc.

II. Psychogenic factors.

1. Situational factors:
– unfavorable conditions for sexual intercourse;
– fear of unwanted pregnancy women;
– fear of contracting a venereal disease;
– the threat of publicity of sexual intercourse during extramarital sexual contacts;
– mental overwork, alcohol intoxication.

2. Traumatic experiences:
– painful memories of previous sexual failures;
– worrying concerns about their ability to satisfy a woman;
– fear of possible failure in sexual intimacy.

3. Partnership problems:
– violation of interpersonal relationships with a partner;
– growing negative emotions and mutual distrust of partners;
– Inadequate behavior of a woman who behaves aggressively, scoffs at a man or in every possible way demonstrates her coldness and unwillingness of intimacy.

4. Personality factors:
– anxious and suspicious traits of character;
– reduced self-esteem and increased tendency to self-analysis;
– excessive responsibility for the successful implementation of sexual intercourse;
– erroneous beliefs and attitudes regarding sexuality.

The most persistent form of neurotic disorders, leading to erectile dysfunction (insufficiency or lack of genital response according to ICD-10) is the anxious waiting for sexual failure syndrome (CTOCH). At the first stage, it contains the transformation of the arisen thought about a possible failure with coitus in reality, that is, a peculiar visceralization of intellectual, logical constructions (regional vegetative dystonia is formed, making it difficult to adequately increase blood flow in the cavernous bodies to the level necessary for the emergence and / or maintenance of a stable erection with sexual intimacy). In the intimate life, anxious expectation of new breaks can occur after one or several unsuccessful attempts at coitus in a man who had previously been completely healthy sexually, or this syndrome aggravates the structure of sexual disorder due to other causes. A typical stereotype of this disorder is as follows. Situationally conditioned sexual failures cause doubts in their abilities in an uncertain and anxious man, leading to hypercontrol of another intimate rendezvous. He begins to act as an observer for his sexual reactions and actions, as well as the behavior of his partner. As a result, the man is less and less involved in sexual activity, which loses the spontaneity and naturalness necessary for the emergence and maintenance of sexual arousal and erection. This entails new breakdowns and an increase in obsessive fears of failing again, forming the classic “vicious circle.” Anxiety of a man about the sexual difficulties that have arisen is the primary (starting) psychological factor determining the development of physiological manifestations (behavioral, somatovegete-tive) of emotional stress. If the main symptom of the syndrome of anxious waiting for sexual failure – an obsessive fear of a new breakdown – reaches a degree of confidence in its own inferiority, coitophobia is formed, which sharply limits or excludes sexual contact. With a long period of coitophobia, a secondary decrease in libido occurs, and the interests of such men often shift to other needs: overeating, alcohol abuse, obsession with work, care in active social activities, the emergence of a new hobby or hypertrophy of previous hobbies, etc., which is compensatory in nature.

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