Male
Erectile Disorder
Is the recurrent
inability to achieve or maintain an adequate erection until completion
of sexual activity. It is not considered male erectile disorder if
it is merely an occasional problem or if it does not create distress
and interpersonal difficulty.
Chronically or repeatedly, the patient cannot get or keep an erection
sufficient to complete the sexual activity.
Except for another Sexual Dysfunction.
It is not directly caused by substance use (medication or drug of
abuse) or by a general medical condition.
It causes marked distress or interpersonal problems.
Associated
Features:
Mood
Disorders
Anxiety
Disorders
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate against
the following disorders which need to be ruled out to establish a
precise diagnosis.
Hypoactive
Sexual Desire Disorder
Cause:
It can be due
to psychological or a combination of psychological and physical factors,
and it can occur in most or just some settings. For some, the onset
occurs at a specific time in life (acquired) as in response to a specific
situation. For others, it may be of lifelong duration. Erectile
disorders may accompany a fear of failure. Sometimes this disorder
is present throughout life. In many cases the erectile failure is
intermittent and sometimes dependent upon the type of partner or the
quality of the relationship.
Treatment:
Psychosocial
factors are important in all forms of erectile dysfunction. Careful
attention to these issues and attempts to relieve sexual anxieties
should be a part of the therapeutic intervention for all patients
with erectile dysfunction. Psychotherapy and/or behavioral therapy
alone may be helpful for some patients in whom no organic cause of
erectile dysfunction is detected. Other forms of treatment may involve:Injection
of vasodilating drugs into the penis. penile prosthesis or implants,
vascular surgery and vacuum
device therapy.
The treatment
of sexual desire/aversion/arousal/pain/orgasm disorders generally
involves behavioral techniques.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
A trial of androgen
replacement may be worthwhile in men with low serum testosterone levels
if there are no other contraindications. In contrast, for men who
have normal testosterone levels, androgen therapy is inappropriate
and may carry significant health risks, especially in the situation
of unrecognized prostate cancer. If androgen therapy is indicated,
it should be given in the form of intramuscular injections of testosterone
enanthate or cypionate.
Medical
& Other:
Injection of
vasodilator substances into the corpora of the penis has provided
a new therapeutic technique for a variety of causes of erectile dysfunction.
Vacuum constriction
devices may be effective at generating and maintaining erections in
many patients with erectile dysfunction and these appear to have a
low incidence of side effects.
Three forms of
penile prostheses are available for patients who fail with or refuse
other forms of therapy: semi rigid , malleable, and inflatable.
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