In recent years, erectile impotence has attracted the attention of public opinion in our country. With the increase in the average age of the population, impotence is a problem that affects many people, even sometimes very young.
However, there are still few people who come to the specialist’s door, perhaps motivated by shame or embarrassment, showing that this reality still has some submerged aspects. The preventive role of the Doctor remains an objective to be achieved. The andrologist then still today for the man can not be like the gynecologist for the woman. What alternative then? Talking about erectile impotence is not easy; many people do not like to confide in people closest to them or rely on a specialist. Much easier for those who are interested or involved in the topic, joining the ranks of internet users greedy for answers, to dive in the inviting and powerful means of communication, to look for sites and blogs that dissetino the curiosity of the moment that put in communication, for the most part anonymous, the people who share this disorder. On the Internet it is possible to consult specialists via chat or email in completely confidential and anonymous m odo.
However, as in a toyland virtual, any time you likely to navigate without the card and compass, including links that offer remedies craft much more similar to the ones proposed by the neighbors umbrella, fantamedicina low-cost, parafarmacologia of last-minute, with the purpose of advertising a variety of applications. In this way, internai therapeutic shortcuts are provided with very little noble ends, which only confuse even more those who are already confused and who can put their health in extreme danger. The real threat today lies in the very bad and untrue information. Instead, we are talking about erectile impotence as a problem that afflicts more than half of the male population today between the ages of 50 and 70. Around 40 years old, about 40% of men suffer from any form of erectile dysfunction. Behind many of these people this problem results in a pain of the couple and not of the individual. Impressive numbers about a reality still hidden behind many prejudices.
Sometimes it is difficult to recognize the origin of erectile dysfunction and it is especially difficult to mark the boundary between a psychogenic disorder by an organic one. In fact, the evaluation and treatment of erectile dysfunction differ from those of other pathologies, since this is the preliminary condition is strictly subjective with little objectivity in the clinic. This difficulty of attributing origin can be translated into a wrong approach that could instead be solved by relying on psychologists or sexologists and vice versa.
The Consensus Conference of the National Institutes of Health, 1992, defines erectile dysfunction as “the persistent inability to achieve or maintain an erection of sufficient rigidity and duration such as to achieve a pleasurable sexual fulfillment”. This is how erectile dysfunction is framed as a couple’s disease. Never before has anamnestic interview, sometimes extended to the partner, played a central role in assessing the severity of the disease and in the success of the therapy. In fact, sometimes we witness not only the presence of a simple discomfort of the partner but also the concomitance of female sexual dysfunction.
Anatomically the penis is considered a specialized vascular organ
A real extension of the vascular system. Consists of two cavernous bodies and the glans penis, the tissue consists of groups of small blood vessels called sinusoids, surrounded by smooth muscle cells, stacked in clusters. This so-called syncizio structure, with age tends to deteriorate, causing the inability of smooth muscle cells to relax during sexual stimulation. This appears to be the primary cause leading to erectile dysfunction. When it comes to erectile dysfunction, impotence you can’t help but talk about sildenafil, better known to the public as Viagra, the commercial name, first among the medications of its kind. In the kaleidoscopic media circus that surrounds this issue, Viagra is now the turning point as the discovery of penicillin or the antivaiolosa, and like all great discoveries it was made for the case, as a result of research on vasoactive substances for use specifically in cardiology.
The mechanism of action of sildenafil is based on inhibition of an enzyme called phosphodiesterase 5, improving smooth muscle relaxation that appears to shrink as age progresses. However, not all patients respond to this therapy, since the effectiveness is proportional to the release of nitric oxide, a substance which is vasodilatory at the level of the nerve endings of the cavernous bodies, which would seem to be progressively defective with age. Another discipline that you are interested in of erectile dysfunction is the genetics, the purpose of which is to allow a patient suffering from impotence of organic origin by a gene therapy, an erection, without having to resort to drugs immediately prior to of the sexual act. Experimental studies on gene therapy of impotence are turning in many directions, some on specific research of a gene that you can manipulate, others on the physiology of the corpora cavernosa themselves.
From its very beginning, from the approval of the Food and Drug Administration (FDA) in 1998, Sildenafil has dominated the market, however now with the introduction of new drugs in the same family, namely the phosphodiesterase 5 inhibitors, such as tadalafil and the vardenafil, together with the apomorphine sub-lingual enrich the arsenal that allows for a greater number of therapeutic choices that allow customization of therapy. All that remains is to wait for long-distance follow-up to see if these new molecules can significantly affect this disorder more than sildenafil.
Here’s the official medical response to erectile dysfunction. Everything is contained in a drug to be taken orally, preferably on an empty stomach, so unobtrusive on the bedside table, so comfortable to “take as needed”, so you want to be today, also the subject of a parallel market illegal in the suburbs, the most deprived of our metropolis, so easy to make, even abuse, or by being psychologically dependent.
In erectile dysfunction medical conditions are identified with separate risk factors. Such are age, arterial hypertension, atherosclerosis, diabetes mellitus, dyslipidaemia, smoking, depression, neurological diseases, endocrinopathies, drug use/abuse, radical prostatectomy. The impact of each single condition on the erectile dysfunction is still reason for heated discussion, but within the context of applying of preventive measures also in Andrologia, the attention of the Health is laying on the early identification of risk factors, in order to attempt a preventive intervention.
Also in this category of drugs there has been a great deal of disinformation, especially from the fact that they are considered aphrodisiac and harmful to the body. Actually an erection is the result of a complex neurovascular event, strictly dependent on the individual and the excitement of the situation.
As far as side effects are concerned
It is also necessary to clarify, because sildenafil should be prescribed carefully without demonizing it, considering that as a side effect it can enhance the effects of nitroderivated therapies (nitroglycerin, trinitrin, etc.). Last, but not least, is the false belief that the sildenafil is a panacea, universal cure for all erectile dysfunction. While it remains an important finding to fight impotence, it is necessary to prescribe it according to a correct medical indication.
Our message of Health-care Workers, our Patients, is to approach with more confidence to the Family Doctor and to our Specialist outpatient Clinics, to overcome the embarrassment, to stop believing that impotence erectile is a normal state of old age and of filter with a more critical everything that offer the media. From our point of view, we aim to intervene in a more decisive on the territory, not to propose to the people only with the toll-free reservation center, but demonstrating that the problem of erectile dysfunction you can solve along the way diagnostics and therapeutics, by the side of who submits to our judgment, offering the patient the opportunity to make an informed choice and recommended, on the model of its conditions and needs. We aim to collaborate with colleagues from other specialties, recognizing the multifactorial and multidisciplinary nature of erectile dysfunctions, trying to enrich each other’s knowledge.
“Here’s the solution.” Let’s start with the right information, a proper study of the patient and risk factors that interact in the system , so as to provide the most correct therapeutic indications such as to affect the success of the therapy itself. Don’t trust what you read. Rely on someone who, by competence, can clear up your doubts and can help you, since in medicine almost never the “shortcuts” lead far.