Erectile dysfunction bothers men since ancient times and many healers have tried to solve this problem. Broadly speaking, erectile dysfunction consists not only in inability to maintain sexual organ in a state of erection, but also in violations of orgasm and weakening of libido, that is, sexual attraction. This term was introduced by the National Institute of Public Health of the USA instead of «impotence». Later it was adopted by international organizations of urologists and andrologists. According to Canadian Pharmacy data in the world approximately 10% of men over the age of 21 have problems with erection. And in the age range of 40 – 70 years problems with erection affect about half of men.
Erection and Erectile Dysfunction
Erection is called a neurovascular phenomenon, under control of hormones. Penis consists of two cavernous and one spongy bodies. In spongy body there is urethra, and also balanus is formed from spongy body. During erection cavernous bodies increase in 3 – 4 times. At rest, muscular layer of cavernous arteries compresses their lumen to a level at which only a small amount of blood passes through them for nutrition. At sexual stimulation, central nervous system sends a signal to penis along the nerves, causing relaxation of muscular layer of arterial wall. Lumen of arteries expands, and blood flows to cavernous bodies. Their increase compresses veins, reducing outflow of blood from penis. Contraction of ischial-cavernous muscle strengthens erection.
From the point of view of medicine, erectile dysfunction (impotence) is not a threat to life of the patient, but the disease has a negative impact on physical and psycho-emotional health, as well as quality of life of men.
Prevalence of Impotence
According to epidemiological data available today, it can be confidently claimed that erectile dysfunction is widespread among men all over the world. The first study of the disease at professional level was organized in the state of Massachusetts.
In the course of the study, specialists conducted a survey and necessary observations of older residents of the area, resulting in finding that more than 52 percent of American men between the ages of 40 and 70, particularly those who did not have to go to hospital, suffer from impotence. These common indicators correspond to current situation in Boston and surrounding areas. As for specific prevalence of erectile dysfunction with minimal, moderate and complete manifestations, here the percentage is 17.2, 25.2 and 9.6.
Cologne study, in which patients aged from 30 to 80 took part, showed that 19.2 percent of men had signs of erectile dysfunction, and with increasing age of participants, these indicators increased by 2.2 – 53.4 percent. Another study, abbreviated as NHSLS, showed that sexually-functional disorders outside impotence directly manifest themselves in 31 percent of cases. So, every year, the number of new patients per group of 1000 people increased by 26, according to data from MMAS, 65.6 (duration of observation is no more than two years) according to data of Brazilian scientists and 19.2 (duration of observation is about 4.2 years ) according to data of Danish scientists.
Such a gap is due primarily to different methods used, age of patients and socio-economic situation corresponding to populations under consideration.
Research in Cologne
Over the past few decades, there has been a significant increase in average life expectancy in Central Europe. Improving quality of life of elderly people is the task of doctors all over the world. German urologists conducted a study of epidemiology of erectile dysfunction, in order to track prevalence of the disease and number of men who need treatment.
For this purpose, 8,000 volunteers aged between 30 and 80 years living in Cologne were selected. Men were tested on a special questionnaire. Results showed prevalence of erectile dysfunction of 19.2%, with increase in proportion to age (2.3 – 53.4%) and presence of concomitant diseases (hypertension, diabetes, urinary system diseases, and surgical interventions in pelvic region). Regular sexual activity in young age group was 96.0% and 71.3% in the older group of subjects.
31.5% – 44% of respondents reported discontent with their lives, 6.9% of men needed to treat erectile dysfunction. At the same time, only 46.2% of respondents are willing to pay 25 euros a month for treatment of impotence.
Conclusions: regular sex life and activity is interesting for men of any age. However, high cost of treating erectile dysfunction does not allow anyone to consult a doctor. Also, many patients consider ED a chronic, non-treatable disease. Therefore, it is important to tell patients about all possible treatment options for ED.
Research in Massachusetts
A similar study was conducted in the United States. For this purpose, 1749 women and 1,410 men aged 18 to 59 years were selected. Studies have shown that erectile dysfunction of a partner bothers 43% and only 31% of men worry about this. In most cases, erectile dysfunction accompanies other violations of physical and mental health of men. In addition, sexual dysfunction is often associated with negative experiences in sexual relationships and worries about general well-being.
Conclusion: Results show that sexual dysfunction is an important public health problem, and emotional problems most likely contribute to aggravation of problems with potency.