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Erectile dysfunction (ED, "male impotence") is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance.

An erection occurs as a hydraulic effect due to blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. There are various circulatory causes, including alteration of the voltage-gated potassium channel as in the case of arsenic poisoning from drinking water. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects.

Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitor drugs (the first of which was sildenafil or Viagra). In some cases, treatment can involve prostaglandin tablets in the urethra, intracavernous injections with a fine needle into the penis that cause swelling, a penile prosthesis, a penis pump or vascular reconstructive surgery.[3]

The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.[vague] The study of erectile dysfunction within medicine is covered by andrology, a sub-field within urology.

Signs and symptoms

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. There are several ways that erectile dysfunction is analyzed:

Obtaining full erections at some times, such as when asleep (when the mind and psychological issues, if any, are less present), tends to suggest the physical structures are functionally working.
Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy)

Causes

Drugs (anti-depressants (SSRIs) and nicotine are most common.
Neurogenic Disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke.[4])
Cavernosal Disorders (Peyronie's disease.[5])
Psychological causes: performance anxiety, stress, mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits.[6]), psychological problems, negative feelings.[7][not in citation given]
Surgery (radiation therapy, surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.[8])
Ageing (UK), or Aging (US). It is four times higher in men in their 60s than in men in their 40s.[9]
Kidney failure
Diseases such as diabetes and multiple sclerosis (MS), While these two causes have not been proven they’re likely suspects as they cause issues with both the blood flow and nervous systems.
Lifestyle: Smoking is a key cause of erectile dysfunction.Smoking causes impotence because it promotes arterial narrowing.[12] See also Tobacco and health. )

A few causes of impotence may be iatrogenic (medically caused).
Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for prostate cancer. Some studies have shown that male circumcision may result in an increased risk of impotence, while others have found no such effect, and another found the opposite.

Pathophysiology

Penile erection is managed by two different mechanisms. The first one is the reflex erection, which is achieved by directly touching the penile shaft. The second is the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.

Diagnosis

There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Diabetes is considered a disorder, but is also a risk. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Duplex ultrasound: Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.
Penile nerves function: Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence (NPT): It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
Penile biothesiometry: This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic Infusion Cavernosometry: (Abbreviated DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Corpus Cavernosometry: Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.;[20] Digital Subtraction Angiography: In DSA, the images are acquired digitally.
Magnetic resonance angiography (MRA): This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.

Treatment

Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes.
Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition.
ED can in many cases be treated by drugs taken orally, injected, or as penile suppositories. These drugs increase the efficacy of nitric oxide, which dilates the blood vessels of corpora cavernosa.
Exercise, particularly aerobic exercise is an effective cheap treatment for erectile dysfunction.[21][non-primary source needed]
When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. More drastically, inflatable or rigid penile implants may be fitted surgically.
All these mechanical methods are based on simple principles of hydraulics and mechanics and are quite reliable, but have their disadvantages.

Medications

The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyse the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.
One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally.[22] They work by blocking the action of PDE5, which causes cGMP to degrade.
A method entitled intracavernous pharmacotherapy is also used by men with certain medical conditions such as hypertension or high blood pressure, and is used by companies such as Boston Medical Group, National Male Medical Clinics and others as an alternative to Viagra and Cialis.[23]

Alprostadil

Alprostadil has become available in some countries as a topical cream (under the brand name Befar),[24] and preliminary studies have shown a clinical efficacy of up to 83%.[25][non-primary source needed]

Surgery

Main article: Penile prosthesis
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.[26][unreliable source?]

Devices

Vacuum Therapy

Main article: penis pump
The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription.

Alternative medicine

The FDA does not recommend alternative therapies to treat sexual function.

Exercises and Tests

NURSING CARE IN INSOMNIA

UNDERSTANDING

Sleep is part of the body's biological rhythms to restore stamina. Sleep needs vary in each person, usually 6-8 hours per day. To stay healthy, keep in mind is the quality of sleep (www.depkes.go.id).

Insomnia is difficulty in initiating or maintaining sleep that can be temporary or persistent (Kaplan & Sadock, 1997).

Insomnia is a common phenomenon in the sleep pattern disturbance. Long term can cause somatic symptoms and disease progression. He can even lead to mental illness with dimensions (www.ncbi.nlm.nih.gov).

Insomnia Insomnia is the inability to sleep, staying asleep, or feel refreshed by sleep. Acute and transient during periods of stress, insomnia may become chronic, causing constant fatigue, extreme anxiety as an approach to sensation, and psychiatric disorders (www.wrongdiagnosis.com).

What do you do when feeling pain in the upper abdomen, nausea, and bloating? Maybe you'll get to the shops, drug stores, as well as the nearest pharmacy to buy the-counter heartburn medication. Usually you will be given antacids to reduce the complaints that you feel. So what needs to be in the know about the drugs and disease on this one?
Ulcer disease, Disease What is it? maagMaag derived from the Dutch language, which means the stomach. Someone who experienced ulcer usually experience pain and discomfort in the stomach. Other symptoms are perceived is belching, flatulence, nausea, vomiting, feeling full, or feel burning in the upper abdomen. Maag can appear suddenly in a short time (acute), long time (chronic), or because of special conditions such as presence of other diseases. One example is the acute ulcer discomfort when consuming alcohol and asetosal. Why I'm Sick Ulcer? The disease is also called gastritis is caused by various things. The emergence of ulcer disease is often associated with drugs, medical conditions, physical stress, living habits, chemicals, and infection. Drugs such as asetosal, non-steroidal anti-inflammatory / NSAID (like ibuprofen and naproxen), and potassium supplementation generally cause stomach upset. Swallowing corrosive chemicals (such as acid or alkaline solution), or alcohol also causes ulcers. Bacteria penginfeksi the most common cause of ulcers is the bacterium Helicobacter pylori, causes chronic gastritis.

Overcoming ulcer disease usually by using drugs to reduce stomach acid. This can help reduce symptoms and speed healing complaints (due to stomach acid irritates inflamed tissue). Also, avoid too many foods, beverages, and use of certain medications.
Large selection of medications that can be used in the treatment of ulcer disease. Treatment options must also be based on the examination. For self-medication (swamedikasi) merely eliminate symptoms of the disease. When symptoms of disease does not go to subside after three to seven days, the family doctor should be consulted.
If the ulcer caused by infection of H. pylori, it is likely the doctor will prescribe antibiotics. In addition, there are also drugs used to inhibit gastric acid secretion (inhibiting histamine blockers such as ranitidine 2/H2 and cimetidine), or medication to neutralize stomach acid (antacids). Stronger medication is used to protect the gastrointestinal tract or to reduce stomach acid is available by prescription. Consult with your health.
What I Need to Know About Antacids? Antacids (antacid, antiacid) is one option in dealing with heartburn medication. Antacids given orally (taken) to reduce the pain due to stomach that is too acidic atmosphere, by neutralizing stomach acid. Gastric acid released to help break down proteins. Stomach, intestine, and esophagus is protected from acid by various mechanisms. When the stomach more acidic conditions or inadequate protection mechanisms, stomach, intestine and esophagus damaged by acid to give varying symptoms such as stomach pain, burning, and various other gastrointestinal complaints. Generally antacids is a weak base. Usually consist of active substances that contain aluminum hydroxide, madnesium hydroxide, and calcium (can you see in the packaging antacid). Sometimes antacids combined also with simetikon which can reduce the excess gas.
Side effects are the main active ingredient antacids with aluminum hydroxide were constipation (constipation). While antacids with magnesium hydroxide active substance can cause diarrhea, so that the two active substances are often combined for the side effects can be minimized. Someone who is experiencing kidney problems have to be careful in the use of antacids containing magnesium, even when necessary do not use it. Antacids that contain calcium can control the acidity in the stomach as well as calcium supplementation. Calcium supplements are very important for postmenopausal women. Antacids that contain calcium can cause constipation.

    * All you need to look at one of them how the use of antacids. Antacid tablets consumed with how to chew about a half hour before meals. This allows for faster work time antacid. Antacids in the form of suspension should be shaken before use first.
    * Antacids may interact with other metal compounds contained in food or certain medications, such as isoniazid, penicillin, tetracycline, vitamin B12. Usually your doctor or pharmacist will give information about the use of antacid when given as well to other treatments (intermittent time 1-2 hours).
    * Pay attention when you're on a diet low in sodium, some antacids contain enough sodium
If you know the cause of your ulcer disease, flee to avoid the cause of gastritis. On the use of asetosal, asetosal which covered (coated film) does not cause symptoms of gastritis because the coated tablet does not dissolve in the stomach. Non-steroidal anti infalmasi like ibuprofen side effect on gastric consumed after a meal. Sometimes physicians combine it with antacids.
Almost everyone has experienced gastrointestinal illness and irritation of the stomach. In many cases, occurred only briefly and did not require medical treatment. But if there are symptoms of gastritis that occurs continuously for three days or more, see a doctor. Be sure to inform all that you feel especially when feeling ill after taking drugs like asetosal free or otherwise. Hopefully useful.

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