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Erectile dysfunction (Impotence) Presented by Dr/ Said Said Elshama

Erectile dysfunction (Impotence) Presented by Dr/ Said Said Elshama. Definition Erectile dysfunction (ED) impotence :- Inability to achieve or sustain an erection for satisfactory sexual activity . (inability to perform sexual act) Erectile dysfunction is different from other

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Erectile dysfunction (Impotence) Presented by Dr/ Said Said Elshama

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  1. Erectile dysfunction(Impotence)Presented byDr/ Said Said Elshama

  2. Definition Erectile dysfunction (ED) impotence :- • Inability to achieve or sustain an erection for satisfactory sexual activity . (inability to perform sexual act) Erectile dysfunction is different from other conditions such as:- 1- Lack of sexual desire (decreased libido) 2- Problems with ejaculation and orgasm (ejaculatory dysfunction).

  3. Mechanism of erection • Tactile sexual stimulation by touching the penis or mental by sexual fantasies →→ Erection. • Sexual stimulation →→ electrical impulses along the nerves of penis →→ release nitric oxide →→ increases production of cyclic GMP in smooth muscle of the corpora cavernosa. • cGMP →→ relaxation of smooth muscles of the corpora cavernosa →→ allow rapid blood flow into the penis →→expand the penis. Sustained erection by :- • Pressure from expanding penis compresses veins to trap blood in the corpora cavernosa →→ sustaining erection. Reversion of erection by:- • Levels of cGMP ↓↓↓ by phosphodiesterase enzyme type 5 →→ contraction of smooth muscles →→ stopping the inflow of blood + opening veins to drain blood from penis →→ reversion of erection .

  4. Risk of impotence • Advanced age . (Increases with age) • Systemic diseases. (Diabetes , C.V.S) • High cholesterol. • Cigarette smoking. • Drug use. • Depression or other psychiatric diseases. • less healthy lifestyles. • eat aless healthy diet. • drink more and exercise less. • Physical exercise lessen the risk of impotence.

  5. Severity of Erectile dysfunction (ED) • Total inability to achieve an erection. • Inconsistent ability to achieve an erection. • Sustain only brief erections. Diagnosis of erectile dysfunction :- Repeated inability to achieve or maintain an erection for satisfactory sexual performance for at least three months.

  6. Causes of erectile dysfunction Achievement and sustained erections requires:- - healthy (nervous -arteries-smooth muscles-fibrous tissues) - adequate levels of nitric oxide in the penis. The following are causes of erectile dysfunction: • Age ( old age – before puberty ” physiological “) • Systemic diseases (Diabetes mellitus, Hypertension, C.VS) • Nerve or spinal cord damage, Cigarette smoking • Local disease ( congenital malformation ) or trauma . • Substance abuse (Marijuana, heroin, cocaine and alcohol) • Low testosterone levels ( maintain nitric oxide levels ) • Medications .antihistamines, antidepressants, tranquilizers. • Psychic causes - depression ,anxiety, stress and fear of sexual failure (performance anxiety). • Prostate massage under light anesthesia leads to erection

  7. Medico-legal aspect of ED ( impotence) 1- Sexual offences (rape) 2- Divorce 3- Disputed paternity 4- Mal-practice

  8. Examination of ED case History • erectile dysfunction, loss of libido ,disorder of ejaculation, psychological or physical erectile dysfunction. • involuntary erections in morning and during sleep. Healthy • psychological factors such as stress and anxiety maintain + involuntary erections. • physical causes (cigarette smoking, heart attacks, stroke ) + No involuntary erections. • Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities (diabetic nerve damage). • Loss of sexual desire , gynecomastia and diminished facial hair suggest low testosterone levels. • medications

  9. Physical examination • Body development - secondary sexual characters • Small testicles, lack of facial hair, gynecomastia →→ hormonal problems (low testosterone levels). • Diminished arterial pulses of legs or bruits (reduced flow of blood) →→atherosclerosis. • Congenital anomalies of genitalia • Touching of the penis →→no response →→ nervous problem. • Unusual characteristics of the penis. • Psychosocial examination

  10. laboratory tests • Lipid profile: High levels of LDL cholesterol atherosclerosis. • Blood glucose levels: diabetes mellitus. • Serum creatinine: kidney damage due to diabetes. • Liver function tests: livercirrhosis →→ hormonal imbalance and low testosterone levels. • Total testosterone levels: A low total testosterone level. • Other hormone levels: (LH, prolactin ,cortisol, Thyroxin) • Ultrasound of the penis and testicles to check for structural abnormalities.

  11. Thank you

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