Further examinations are recommended for men with primary erectile dysfunction in order to exclude the organic nature of the disorder. They will also be needed if there is a history of trauma in the pelvic or perineal region.
The next diagnostic method is monitoring of spontaneous nocturnal erections. As you know, a healthy man has up to six erections in REM sleep. Each erection episode lasts 10-15 minutes. The total time for nocturnal erections reaches one and a half hours, that is, 20% of the duration of a night's sleep. In the case of ED, both the quality and the number of spontaneous erections at night decrease.
This makes it possible to use monitoring for the purpose of differential diagnosis of mentally conditioned and organic forms of erectile disorders. If the erection lasted less than 10 minutes, and its rigidity was only 60%, we can talk about sexual dysfunction. It is the study of spontaneous nocturnal erections that is considered today the most reliable method of qualitative and quantitative assessment of a man's erectile ability.
Another informative diagnostic method in this case is Doppler ultrasound of the vessels of the male organ. This procedure gives a good picture of blood microcirculation. And if you do it in B-mode, you can detect changes caused by Peyronie's disease and cavernous fibrosis.
However, using the two modes separately does not give accurate results. Therefore, they often resort to the duplex method of examination. In addition, the effectiveness of the procedure largely depends on the technical level of the medical equipment.
The study of the arteries of the penis is performed twice: at rest and during an erection, which is achieved by visual stimulation (erotic video) or with the help of an erection-stimulating drug. Then the results are compared.
The quantitative indicators of the study are peak systolic velocity and end diastolic velocity (PSV and EDV). Using standard formulas, on the basis of absolute indicators, relative values are calculated: resistance index, pulsation index (RI and PI). The norm is considered if PSV is 30-35 cm / s, sometimes the lower limit of the norm is lowered to 25. As a result of drug stimulation, the peak value for a particular patient isit is not achieved within 6-10 minutes.
For diagnostic purposes, the Viagra test can be combined with video stimulation, while monitoring erection and monitoring the hemodynamics of the penis using ultrasound. The main advantage of such an examination is that it is non-invasive and does not pose a threat of priapism.
But the method also has a significant disadvantage. The fact is that visual stimulation does not provide an opportunity to completely standardize the technique, because different patients require different stimuli for arousal.
Vasculogenic erectile dysfunction is detected using a special test, which involves the intracavernous administration of vasoactive substances (most often alprostadil). The appearance after 10 minutes of a full erection, which lasts at least half an hour, suggests that arterial and veno-occlusive hemodynamics are normal.
For a number of indications, some other studies are also being carried out. These include: cavernosometry. The purpose of this method is to assess the elasticity of a sinusoidal system and determine its closing ability. For this, a saline solution is pumped into the corpora cavernosa, and its volumetric velocity is set, which is necessary for the appearance of an erection.
Cavernosography. The method consists in examining the vessels through which blood is discharged from the corpora cavernosa. Radioisotope phallic scintigraphy. Such a diagnosis gives a complete picture of hemodynamics in the corpora cavernosa of the male organ.
Unfortunately, many of the patients with erectile dysfunction are pessimistic. They do not believe that modern medicine can help them return to a fulfilling sex life. Moreover, some doctors believe that the decline in sexual function with age is natural and irreversible. However, studies show that accurate diagnosis and adequate courses of therapy can improve sexual function in 95% of patients.
For example, men diagnosed with diabetes need safe antidiabetic therapy. Hypertensive patients need to take antihypertensive drugs. In chronic obstructive pulmonary disease (COPD), adrenomimetics and theophylline are canceled, anti-inflammatory inhalation treatment is indicated.
Patients with chronic renal failure need to intensify dialysis and prescribe a course of treatment for anemia. In patients with gastric ulcer, H2-blockers of histamine are replaced with proton pump inhibitors.
The most effective treatment for organic and psychogenic erectile dysfunction at the moment are inhibitors of phosphodiesterase type 5 (PDE5). During sexual stimulation, the nervous system is activated and NO is released.
This leads to the accumulation of cyclic guanosine monophosphate (cGMP) in vascular smooth muscle cells. It has already been noted above that it is he who launches a chain of sequential reactions leading to the appearance of an erection. When the simulation is stopped, cGMP levels are reduced by phosphodiesterase-5. If, due to some factors, there is a shortage of cGMP, then its destruction by phosphodiesterase-5 leads to erectile problems.
