The term erectile dysfunction determines the impossibility of a full-fledged sexual intercourse due to insufficient or absent penile erection in a man who has a periodic or permanent nature. This pathological condition develops due to the impact of various etiological (causal) factors ( psychological factors , hormonal disorders, anatomical deformation of the cavernous bodies of the penis). The most common cause (up to 70% of all cases of this pathology) are vascular disorders.
Definition and development mechanism
Vascular (vasculogenic) erectile dysfunction is a disorder of potency associated with organic or functional changes in the vessels of the male penis. An erection is a complex physiological process in which, during sexual stimulation, there is a restriction of blood flow through the veins, due to the reduction of sphincters, with increased inflow through the arteries, which leads to filling of the cavernous bodies, increasing pressure in the penis, and increasing also the acquisition of hardness necessary for full sexual intercourse. In case of vascular disorders, there is an insufficient blood flow or a decrease in the tone of the sphincter that regulates its outflow, which causes an insufficient increase in the volume of the cavernous bodies.
Fig. 1 - The mechanism of erection.
Why does it occur?
Vascular erectile dysfunction develops due to 2 groups of causes:
- impaired flow of arterial blood into the cavernous bodies of the penis;
- an increase in blood outflow during erection from the cavernous bodies of the penis as a result of a decrease in the functional activity of the venous sphincters, which during erection maintains blood pressure in the cavernous (cavernous) bodies.
The causes of impaired blood flow with occlusion (reduction of the lumen) of the arterial vessels of the penis include:
- Systemic atherosclerosis is a pathological condition in which cholesterol is deposited in the walls of the arteries with the formation of atherosclerotic plaques, which cause a decrease in the lumen of the vessels. This cause of vascular erectile dysfunction is the most common, it occurs in 90% of cases.
- Diabetes mellitus is an metabolic disorder characterized by an increase in the level of sugar in the body of a man and systemic disorders of the functional activity of the arterial vessels.
- Reduced pumping function of the heart in ischemic disease , cardiosclerosis, after myocardial infarction , leading to a decrease in the volume of blood flow to the cavernous body of the penis.
- Hypertensive heart disease is a prolonged increase in systemic arterial pressure, leading to organic changes in arterial vessels, including cavernous bodies.
- Local changes in the arterial vessels of the penis and pelvis, which are the result of trauma to the abdomen and groin - this cause of vascular erectile dysfunction can most often occur in young men not older than 40 years.
Almost all the causes of insufficient blood supply to the cavernous bodies of the penis have an effect on men older than 40 years, which leads to a higher number of cases of impaired potency. Violation of the functional activity of the venous sphincters, due to which the outflow of blood during erection from the cavernous bodies of the penis increases, which leads to a decrease in pressure in them (venous leakage), develops due to several main reasons:
- Increase in the lumen of the veins, which may be primary (occurs when the hereditary factor is realized) and secondary (passion for spicy food, smoking, systematic use of alcohol).
- Degenerative changes in the protein shell (the shell covering the cavernous bodies), leading to insufficient closure of the venous sphincter - these changes are most often defined in older men, against the backdrop of Peyronie’s disease (curvature of the male penis due to sclerotic changes in the cavernous bodies and the protein membrane), previous injuries of the perineum, as well as diabetes.
- Organic changes in the inner layer of venous vessels, which are the result of trauma, elevated blood lipids (hyperlipidemia), age-related involution (extinction of the functional activity of the reproductive system).
- The formation of venous shunts, in which blood is discharged to bypass sphincters, after undergoing surgical interventions on the structures of the genitourinary system.
- Impaired contractility of the smooth muscles of sphincters due to impaired innervation or organic changes.
Most of the causes of vascular disease are the result of the influence of provoking factors affecting the condition of the arteries, veins and cavernous bodies of the penis. These factors include:
- The age of a man - a violation of potency often develops in men older than 40-50 years, which is associated with the age-related involution of the reproductive system, as well as the gradual decompensation of the chronic pathology of the cardiovascular system.
- Harmful habits - alcohol, nicotine are vascular toxins, they have a negative effect on the arterial walls, leading to a gradual decrease in their lumen with the development of occlusion.
- Sedentary lifestyle - low motor activity is one of the main reasons for the development of cardiovascular disease, including those with lesions of the arteries of the penis.
- The predominance in the diet of men fatty, fried and spicy foods that have a negative impact on the condition of the venous vessels and sphincters of the male penis.
- Various transferred injuries with their localization in the lower abdomen and perineum.
Table 1 - Proven risk factors for erectile dysfunction (MMAS, 2005).
Knowledge of the causes of the development of vascular erectile dysfunction, as well as the effects of risk factors help to select the most optimal and effective treatment for this disorder.
Methods of diagnosis of vascular pathology
Diagnostics of vascular erectile dysfunction includes a comprehensive examination of the male body using various methods of laboratory, instrumental and functional research, which include:
- Biochemical analysis of blood with the determination of cholesterol and lipid profile - allows you to diagnose atherosclerosis.
- Electrocardiogram (ECG) is a functional study of the electrical activity of the heart, which makes it possible to detect a decrease in its pumping function ( arrhythmias , ischemic disease, myocardial infarction).
- Ultrasound examination of the vessels of the penis with dopplerography at rest and after stimulation of erection is one of the main diagnostic methods. It is an instrumental study with ultrasound visualization of the state of blood flow.
Based on the results of additional diagnostic studies, the doctor makes a conclusion about the causes of erectile dysfunction, as well as the degree of vascular disorders.
Treatment of vascular erectile dysfunction is complex. It primarily includes therapeutic measures aimed at improving blood flow in the cavernous bodies of the penis, their choice depends on the diagnosed cause of the development of a violation of potency. The main methods of treatment include the use of various drugs, surgery and physiotherapy. The use of drugs, the choice of which depends on the causes of vascular erectile dysfunction, includes several pharmacological groups of drugs:
- Inhibitors of phosphodiesterase 5 (PDE 5) are agents that block the enzyme phosphodiesterase, resulting in a cGMP compound (cyclic guanine monophosphate) accumulating in the cavernous bodies of the penis, as well as expanding the arteries, which increases blood volume and erections. The main representative of the drugs in this group is sildenafil (Viagra, Konegra). It improves an erection only in the presence of sexual stimulation of the man. Sildenafil and its analogues do not eliminate the main cause of the development of vascular erectile dysfunction.
- Statics (simvastatin) - drugs that reduce the level of cholesterol in the blood, thereby preventing the formation of atherosclerotic plaques and the development of atherosclerosis. These drugs are used to improve the condition of the arteries in atherosclerosis.
- Antispasmodics (papaverine) - reduce the smooth muscle tone of the arteries, help to increase the filling of cavernous bodies with blood.
- Alpha 1 -adrenoreceptor blockers - also help to reduce the tone of the arteries.
Most pharmacological agents for the treatment of vascular erectile dysfunction increase blood flow in the cavernous bodies. In the case of ineffectiveness of therapy with the help of drugs, surgical interventions can be carried out with the aim of plastic reconstruction of the vascular system of the corpus cavernosum, as well as the tunica albugineum. In the complex therapy of vascular disorders, physiotherapy is used to improve erection. The most common and effective method of physiotherapy is the use of a local negative effect (LOD-therapy) .
General practitioner Krivoguz I. M.