Sexual disorders not only affect males, but also affects her partner so that it can cause severe psychological disorders. In 2025, the number of men who experience erectile dysfunction in Europe is estimated to reach 43 million people (Baziad, 2003).
As the elderly population is rising sharply, the incidence of erectile dysfunction (ED) also increased and the need for treatment is also increasing. In 2005, there were allegedly 322 million men experience erectile dysfunction around the world (Wibowo, 2007).
In Indonesia there are no exact data about the number of men who have erectile dysfunction and other sexual dysfunction. Presumably less than 10% of men who married in Indonesia have erectile dysfunction.
Erectile dysfunction is the inability to persist or constantly to achieve or maintain a penile erection quality so as to achieve a satisfying sexual relationship (Wibowo, 2007, Feldman, 1994).
The condition of ED increases with age, the cross-sectional study of community-based, among men aged 40-49 years, prevalence of severe ED (complete / severe) at 5%, while the DE medium (moderate) 17%. In men aged 70-79 years, prevalence of severe ED (complete / severe) at 15%, while the DE medium (moderate) 34% (Baziad, 2003, Feldman, 1994).
Objectives and Benefits
1. The purpose and benefits of this paper is that medical students learn how to diagnose, manage, action and management of erectile dysfunction in accordance with scientific writing and literature based on existing procedures, also based on evidence-based medicine.
2. In order for the general public and the laity to know and understand about erectile dysfunction.
Anatomy and Physiology
Anatomy
The composition of the anatomy of the penis consists of:
1. corpora cavernosa, composed of two parallel cylinders of erectile tissue (easy to get up into upright)
2. corpus spongiosum, a smaller building located at the ventral single cylinder, the bottom of the building the corpus cavernosum. He surrounds the urethra, while the edges to form the glans penis. (Wibowo, 2007).
Bleeding the system:
Abdominal aorta as high as fourth lumbar vertebra will ramify common iliac artery. In the sacroiliac joints in linea terminalis this artery branches into the internal iliac artery which memvaskularisasi perineal region (area between the buttocks and genitals) and pudendalis region (the area around the genitals).
Internal iliac artery branches into:
1. The internal pudendal artery, the artery continues to the ventral penile
2. Internal spermatic artery, obeying deferen duct, into the testes
3. External spermatic artery, the dorsal scrotal mensarafi
4. Skrotalis inferior artery.
Physiology
Penile erection is the result of penile smooth muscle relaxation which is essentially mediated by a spinal reflex involving the central nervous processes and the integration of tactile stimuli, olfactory, auditory, and mental. (Anderson, 1995).
In penile erection can occur at - least two mechanisms, namely psychogenic and refleksogenik that interact during normal sexual activity. Psychogenic erections are initiated in response to stimulation of central vision, hearing, pembauan or imagination. Refleksogenik erection occurs due to race on sensory receptors in the penis, which the spinal interaction, cause somatic and parasympathetic nervous action.
In stage arrausal, the sympathetic activity triggered a series of events with the release of nitric oxide, terminated by the increase in cGMP (cyclic guanosine monophosphate). The increase in cGMP causes the relaxation of penile blood vessels and trabecular smooth muscle. Blood flow into the corpora cavernous rise dramastis. Rapid filling cavernous spaces will consequently venous pressure venous blood flow to the outside decreases. The combination increase blood flow into and out of place than the blood will rapidly raise the intra-cavernous pressure. The result is there a progressive penile rigidity and erection perfect condition. (Wibowo, 2007).
Erection occurs because the process as follows. Dilated cavernous arteries and tissues, causing blood to flow into the cavernous tissue. Relaxation of trabecular smooth muscle wall of cavernous tissue lakuner room provides space due to increase blood flow. This expansion will push the outer trabecular walls against the tunica albugenia cavernous tissue around it. As a result, the veins that exit the room through the wall lakuner trabeculae and the tunica becomes depressed, reducing the flow of venous blood out of the room lakuner.
Venosa closure occurs passively, while the muscular contractions isiokavernosus can constrict the proximal corpora cavernous and will also lead to the closure of the vein. Relaxation occurs due to contraction of arterial smooth muscle tissue and trabeculae. Kontriksi arteries reduces blood flow to the space lakuner. The contraction causes the emptying of the lacunae and trabeculae of this contraction will also pull away from the outer wall of lacunae albuginia tunica, and open venous flow (Guyton, 2006).
Control systems erection through the nervous system, the corpus cavernosum smooth muscle tone is controlled by a complex biochemical process in the peripheral and central nervous system. The autonomic nervous sympathetic, parasympathetic, and somatic nerves controlling the corpus cavernosum smooth muscle tone and vaskulernya system through neuroanatomical relationships that are integral to the innervation of the urinary tract. (Wibowo, 2007).
There are three types of nerves that maintain the sexual organs, namely:
1. Sympathetic nerve torakolumbal: hypogastric nerve and lumbar sympathetic nerve
2. sacral parasympathetic nerves: nerve pelvikus which then commonly known as nerve erigentes
3. somatic pudendal nerve
Stages of Male Sexual Activity
1. Penile erection
Erection due to parasympathetic impulses that release nitric oxide and vasoactive intestinal peptide, or in addition to acetylcholine (Guyton, 2006). During erection, the tissues of the arteries supplying blood at least 100-140 ml. At the peak of erection, intracavernosal pressure exceeds the systolic pressure (Wibowo, 2007).
2. Lubrication
During sexual stimulation, parasympathetic nerve fibers also causes bulbouretral secreting glands and urethral mucosal fluids flowing through the urethra.
3. Emission and ejaculation
Emission is the movement of semen into the urethra. Ejaculation is the process terdorongnya cement out of the urethra during orgasm (Guyton, 2006).
4. Resolution
In phase occurs kontriksi JAR trabecular smooth muscle and vasoconstriction arterioles that supply blood to the erectile tissue. Blood flow occurred out of the sinus venosus so the penis becomes limp or flaksid. This phase is mediated by sympathetic adrenergic nerves.
The mechanism involves several elements of sexual function: libido, erection and ejaculation. Sexual dysfunction can occur due to impaired function and combinations thereof.
Erectile Dysfunction
1. Definition
Erectile dysfunction is the inability to persist or constantly to achieve or maintain a penile erection quality so as to achieve a satisfying sexual relationship. The limit shows that the process of male sexual function has two components, namely achieving an erection and maintain it (NIH Consensus Development Panel on impotence, 1993).
2. Etiology (Cause)
Fazio and Brock (as quoted by Wibowo, 2007) classifies the causes of erectile dysfunction as follows:
Causes and examples:
1. age
2. psychological disorders, such as: depression, anxiety
3. neurological disorders, eg cerebral disease, spinal trauma, spinal cord disease neuropathy, nerve trauma pudendosus.
4. hormonal disease (decreased libido), for example: hipogonadism, hiperprolaktinemi, hyper or hypo tiroidsm, Cushing syndrome, Addison's disease.
5. vascular diseases, such as: atherosclerosis, ischemic heart disease, peripheral vascular disease, venous incompetence, cavernosal disease.
6. drugs, such as: antihypertensives, antidepressants, estrogens, antiandrogens, digoxin.
7. habits, for example: users of marijuana, alcohol, narcotics, smoking.
8. other diseases, eg diabetes mellitus, renal failure, hiperlipidemi, hypertension, chronic obstructive pulmonary disease.
3. Classification
According Wibowo (2007) division of erectile dysfunction are grouped into five categories of causes:
a. Psychogenic
Erectile dysfunction due to psychogenic factors are usually episodic, occurs suddenly, which is preceded by periods of severe stress, anxiety, depression. With the psychological causes of erectile dysfunction can be identified by observing the clinical signs are:
• young age of onset (onset) sudden
• Onset associated with a specific emotional events
• Dysfunction in certain circumstances, while in other circumstances, normal
• Erection of the night remains
• previous history of erectile dysfunction that may improve spontaneously
• There is stress in her life, mental status abnormalities related to depression, psychosis or anxiety.
b. Organic
Erectile dysfunction due to organic is divided into two:
1) Neurogenic
Neurogenic erectile dysfunction caused marked with the clinical picture:
• History of injury or spinal surgery or pelvic
• suffering from chronic diseases (diabetes mellitus, alcoholism)
• Suffering from certain neurological diseases such as multiple sclerosis, stroke
• neurological examination abnormal genital area (genital) / perineum.
2) Vascular
Erectile dysfunction caused by vascular abnormalities were divided in two, abnormalities in the arterial and venous disorders. Erectile dysfunction caused by abnormalities vasculogenic arteria have clinical appearance as follows:
• Interest in sex persists tehadas
• In all cases a decline in sexual function
• Gradually erectile dysfunction according to age
• Use prescription or OTC medications associated with erectile dysfunction
• Smoker
• Increase in blood pressure, as evidenced by the acquisition of peripheral vascular disease (bruits, decreased pulse rate, skin and hair changes consistent with arterial insufficiency)
Erectile dysfunction due to vasculogenic disorders venosa has clinical features as follows:
• Inability to maintain an erection that have occurred
• History of priapism (penile always tense) before
• abnormalities (anomalous) local penile
c. Hormonal
Erectile dysfunction is caused due to hormonal had clinical features as follows:
• Loss of interest in sexual activity
• Testicular atrophy, shrink
• Low testosterone levels, prolactin rise
d. Pharmacological
Almost all hypertension medications can cause erectile dysfunction that works disentral, such as methyldopa, Clonidine and reserpine. The primary effect possibly through central nervous system depression. Beta blockers such as propranolol can lower libido
e. Post traumatic surgery
• pelvic pathology (disease process in the pelvis) can damage the fibers of the autonomic nervous pathways for penile erection
• abdominal perineal resection, radical cystectomy, radical prostatectomy, surgical frozen prostate, perineal prostatectomy, retropubic prostatectomy, can damage the pelvic or the cavernosal nerves that cause erectile dysfunction
• Uretroplasti membranasea, transuretra resection of the prostate, spingkterotomi externa, the external urethral stricture incision can cause erectile dysfunction due to damage to nerve fibers adjacent cavernosal
• Internal visual Uretrotomi to stricture can cause nerve damage to cavernosal fibrosis secondary to hemorrhage or extravasation of irrigation fluid may cause erectile dysfunction
• Radiation to the pelvis malignancy rectal, bladder or prostate can also cause erectile dysfunction.
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