Erectile function: physiology and pathophysiology of process
The Erectile Function (EF) represents the increase in a penis in volume with sharp increase in its elasticity caused by stretching and filling of cavernous bodies at sexual excitement. Phenomenon EF consists of a difficult chain of neurovascular changes in cavernous fabric in which end body is the relaxation of smooth muscle elements of arteries, arterioles and sinusoid.
At the end of the last century new data on erection physiology, the causes of ED and, respectively, new opportunities of its correction appeared. To Posovremenny representations, at sexual stimulation there is an activation of a parasympathetic nervous system. Release of neurotransmitters - in particular nitrogen oxide (NO) from an endothelium of vessels - cavernous bodies guanozinmonofosfa-that leads to accumulation cyclic in cavernous fabric, to relaxation of smooth muscle cells of walls of prinosyashiy arteries and cavernous bodies. Filling with an arterial blood of lacunas causes a prelum of venules and blocking of outflow of blood from a penis (the venoocclusive mechanism).
Respectively development of ED can be connected, with an insufficient vazodilatation owing to the bad susceptibility of vessels weakened by a compression of penilny veins owing to growth of connecting fabric; besides, the combination of above-mentioned reasons can take place (de Boer B. J. et al., 2004).
The possible reasons of ED, are diverse: age involution and mental and neurologic disorders, endocrine and somatopathies, diseases or injuries of genitals side effect of a number of drugs. It is shown that ED in 80% of cases has the organic nature and arises as a complication of various somatopathies. According to a number of authors inverse relation between the frequency of emergence of ED, education level, physical activity and alcohol intake is observed (Nicolosi A. et al., 2003).
The age, certainly, has an impact on full value and duration of an erection at men. At elderly people the blood-groove speed, testosterone level, sensitivity, a nervous system and elasticity of vascular walls decreases that corresponding, influences image EF. However such "natural" changes seldom lead to ED, and the people who do not have chronic diseases of internals are quite capable to live, full-fledged sex life and in 80 years. The vast majority of men the main reason of frustration of EF as a rule has a somatopathy (Barret-Gonnor E. et al., 2004). Almost in all population researches devoted to ED communication of its emergence with arterial hypertension (AF), the diabetes mellitus (DM) and atherosclerosis is revealed.
Erectile function and diabetes mellitus (DM)
ED six times more often arises at a diabetes mellitus and three times - at AE (Roth A. et al., 2003). Moreover, according to some authors, identification of ED can demonstrate availability at the patient of one of these diseases in the latent preclinical form (De AngelisL. et. al., 2001). According to M.K. Walczak et al., (2002), from 154 men who asked for the help in connection with ED, for 44% AF also was diagnosed for 23% - a diabetes mellitus.
Jaffe. And. et al., (1996) noted communication of disturbances of sexual function with deterioration of life at the sick AG receiving treatment by hypotensive drugs, generally diuretics, R-adrenoblockers or metildopy (the last - certainly, usually is not used in treatment of AG in connection with high, the frequency of side effects any more). Approximately at 78% of patients at whom the quality of life (significantly worsened according to their wives) decrease or lack of sexual interest was observed. The researches conducted more than 30 years showed that from 2.4% to 58% of men with AG test one or more symptoms of disturbance of sexual function of this or that severity throughout treatment by antihypertensive drugs.
Especially often emergence of ED is connected with reception; thiazide diuretics and R-adrenoblockers; (Ralph; Dretal., 2000, FogariR. et al., 2002, Micklei H. et al., 2002). So, according to data of Wassertheil-Smoller S. et al., (1991), received during multicenter, randomized, placebo - the controlled research TAIM the problems connected with an erection came to light at 11% of the patients receiving r-adrenoblocker (atenolol) within six months and at 28% of the patients receiving thiazide diuretic (Chlortalidonum). To D.T. et al., (2002) carried out the metaanalysis and estimated safety of use of r-adrenoblockers at AG and ischemic heart disease. In the metaanalysis there were vklyuchenyrezultata of 15 researches (more than 35 thousand patients).
It was established that use of drugs; this group it is connected with small, but statistically significant risk of developing of sexual dysfunction (one additional case on each 199 patients receiving treatment by R-adrenoblockers within a year). R-adrenoblockers of the first generations cause ED more often, than modern.
ED connected with AG or with its treatment can reduce quality of life of such patients and affect their commitment to therapy. So, for example, the research Medical Research Council (MRG) including 17,354 patients with AE conducted within five years showed that disturbances of EF are a frequent reason for refusal of patients of reception of antihypertensives. During this observation the premature termination of treatment in connection with ED was observed considerably to a bowl at the patients accepting thiazide diuretic or R-adenoblokator (r 0.001) in comparison with patients the applying placebos. Up to 70% of patients with AF at which side effects were revealed do not observe the mode: intake of antihypertensive drugs and 40-60% stop treatment more often, in comparison with patients whose quality of life did not change.
For this reason the practicing doctors need to remember possibility of various side effects, in the sexual sphere against the background of hypotensive therapy and to lead with patients discussions on this subject (Ferrario G. M of et al., 2001). In, many cases change of the mode of administration of drugs can help the patient to overcome negative changes in sexual, the sphere, the treatments which are observed at some types. Besides, it is expedient to choose not only highly effective in respect of decrease in the ABP, but also tactics of hypotensive therapy which is not affecting quality of life of the patient.
At a diabetes mellitus AD-develops is three times more often also 10-15 earlier, than in healthy population. Its frequency according to the majority of researches, meets at 50-75% of men with SD (Guay A. etal., 2000). B the research DeBerardis G.etal., (2002) took part 1460 patients with SD-2 observed in 114 clinics. At inspection of ED it is revealed at 34% of patients, periodic disorders of sexual function - at 24%, and only 42% had no problems in sexual life. At inspection of 1010 men suffering SD observed within nearly three years, ED vyyavlyalaya in 68 cases on 1000 patients a year (Eedele D. et al., 2001). Frequency of development of ED in men with SD increases with age and depends on disease duration. If aged till 30 flyings ED meets at patients in 9-15% of cases, aged from 30 till 60 flyings - more than in 55% of cases, then 70 years of ED are more senior suffer up to 95% of sick SD (Chu.N. V. et al., 2002). Apparently, because of differences in age, ED meets more often at SD-of the second, than at SD of the first type (Alexander W; et aU, 1999).
Basic reasons of organic ED at SD consider diabetic polyneuropathy macro and a mikroangiopatiya. It is proved that ED at men with SD correlates, in addition to age, with the level of glikozilirovanny hemoglobin, availability of peripheral and vegetative neuropathy, retinopathy (Romeo J. And. et all, 2000).
Thus, ED for 80% has organic character and arises as a complication of somatopathies such as AF, SD, etc. Various mechanisms can participate in development of ED: neurogenic, vascular, influence of medicines. At the same time inverse relation between the frequency of emergence of ED and education level, physical activity, alcohol intake and smoking matters.