Psychogenic erectile dysfunction

Cialis and ED

Psychogenic erectile dysfunction

Psychogenic erectile dysfunction

Psychogenic erectile dysfunction

 

Various aspects of psychogenic erectile dysfunction (ED), its pathogenetic mechanisms are considered. Psychogenic sexual dysfunctions, including ED, are the result of a systemic interaction of a number of adverse factors: situational, traumatic, partner problems, and personal response characteristics. As a rule, several of the above reasons play a role in the development of psychogenic erectile dysfunction in men. Treatment of psychogenic ED includes psychotherapy and pharmacotherapy. The main group of drugs used for ED are phosphodiesterase type 5 inhibitors, the origin of which is sildenafil (Viagra).

 

Of all the physiological sexual reactions of men, erection is the simplest and phylogenetically ancient, because it is mediated only by vascular and neurogenic mechanisms. An erection can occur due to reflex mechanisms even without sexual attraction and arousal. This distinguishes it, for example, from ejaculation, in which motor and excretory functions are also involved. Paradoxically, but at the same time, erection is also the most vulnerable link in a series of psychosexual reactions of a man.

 

Male sexuality is, in fact, “phallocentric” (phallus – erect penis unlike penis – penis alone). Having an erection (phallus) proves “male competence”, “potency”, i.e. the possibility of sexual intercourse itself. In all human cultures, the phallus in symbolic and mythological terms has always been a symbol of power, strength and power. At the subconscious psychological level, for a man the most significant is not the actual sexual intercourse, but the possibility of its holding. Therefore, erectile dysfunction is perceived not only as a sexual failure, but also as a collapse of male wealth in general [five]. That is why the Latin term impotentia coeundi has become obsolete and has not been applied in the international literature in the last decade. He is considered as obsolete, inaccurate and unreasonable with condemning overtones that degrade human (personal) dignity. Instead “impotence” today talk about “Erectile dysfunction” or about “erectile dysfunction” (ED).

 

At a young age at 4–5 times more common psychogenic erectile dysfunction.

 

ED is called the inability to achieve an erection or keep it at a level sufficient to perform intercourse., at least 25% of attempts at sexual intercourse. Psychogenic ED can occur at any age and manifests itself in many forms. More often men complain of a weak erection, which does not allow them to insert the penis into the vagina. Sometimes the patient has a fairly strong erection, but when trying to mate, it quickly disappears. In other cases, the man is able to achieve a normal erection only under certain conditions.

 

An erection is controlled by two mechanisms. The first – this is a reflex erection that occurs when you touch the penis, the second – psychogenic erection resulting from erotic stimuli. Reflex erection is controlled by peripheral nerves and centers localized in the lower part of the spinal cord. Psychogenic erection is controlled by the limbic system of the brain. With the development of reflex erection, penile stimulation causes the release of nitric oxide, which in turn leads to the relaxation of the vessel walls in the cavernous bodies of the penis. They fill with blood and an erection occurs. To develop an erection, a sufficient level of testosterone in the blood is also required. Thus, erectile dysfunction may occur due to disorders of the hormonal system, diseases of the nervous system, insufficient blood supply to the penis, or psychological problems. In any case, the sexual response is a psychosomatic process, and psychological and somatic factors are usually involved in the origin of sexual dysfunction. Most often, especially with erectile dysfunction in adulthood, it is difficult to determine the relative importance of certain factors; then such disorders can be defined as mixed.

 

Worldwide, ED affects over 80 million young men, over the age of 40, their number doubles.

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According to European [7] and american [6] ED researchers worldwide suffer more than 80 million young men, over the age of 40, their number doubles. There are constant disputes between specialists: what is more common – Erectile dysfunction for psychological reasons or for organic, ie, due to vascular, neurological, urological, endocrine diseases? Psychotherapists, especially those of the psychoanalytic trend, confidently estimate the ratio of psychogenic and organic disorders as 80:20. Exactly the same ratio, but leading urologists lead in favor of the organic nature of erectile dysfunction. In fact, both indicators are correct, but only taking into account the age aspect: at a young age of 4–5 times more common psychogenic disorders, at age 40–A 45-year-old ratio becomes 50:50, and then organic causes begin to predominantly prevail, and by the age of 65, they account for 90% of all causes of erectile dysfunction.

Psychogenic erectile dysfunction

 

Selected failures (lack of erection or its loss at the most inappropriate time) can occur in any man – This is quite normal. Such isolated episodes do not indicate sexual weakness; they may be the result of temporary physical stress or any psychological factors (tension, lack of privacy, or the need to get comfortable with a new partner). If a man, instead of taking such incidents calmly, begins to experience his failure, to think about whether he will be able to achieve an erection next time, he thereby creates the basis for the occurrence of these difficulties. The reaction of a man to an erection disorder is very diverse. – from horror and confusion (probably the most typical reaction) to complete indifference (least typical).

 

The reaction of a man to an erection disorder is very diverse. – from horror and confusion (probably the most typical reaction) to complete indifference (least typical).

 

Psychogenic sexual dysfunctions include functional psychogenic sexual disorders., arising with the direct participation of psychological mechanisms and manifested qualitative or quantitative disorders that are not associated with organic pathology. Here it is necessary to clarify that erectile dysfunction, which occurs in severe mental illness, sexual perversions, are actually not psychogenic, but psychopathological (psychiatric) disorders. Most often they are mediated by endogenous mechanisms and are not associated with psychological stress. This is particularly relevant nowadays due to a change in attitude towards depression as an endogenous disease, rather than psychogenic. That is, erectile dysfunction in case of apparent depression should not be considered as psychogenic and, accordingly, should be treated completely by different principles, as will be discussed below.

 

Psychogenic sexual dysfunctions are the result of a systemic interaction of a number of adverse factors: situational, traumatic, partner problems and personal response characteristics. [one].

 

Situational factors include the lack of conditions for complete privacy.; the possibility of being taken by surprise by other people; fear of unwanted pregnancy; fear of contracting a sexually transmitted disease; current mental or physical “weakened condition” due to fatigue, prior stress, somatic indisposition, alcoholic intoxication; improper conduct of a preliminary period of sexual intercourse, when the occurrence of transboundary inhibition as a result of super-strong excitation of the sexual centers from too long caress leads to a breakdown of the physiological program; external stimulus of considerable force (sudden shout, knock, shout, shot), resulting in the breakdown of sexual intercourse by the mechanisms of external inhibition; very long period “sexual abstinence” (assuming no masturbation activity) when, due to “detraining” it takes time to gradually restore full function.

 

Psychogenic ED may develop due even to the seemingly so unimportant fact as the impossibility of having sexual intercourse with a condom. The policy of many pharmaceutical companies, seriously supported by the influence of the media, leads many young people to the firm conviction that sex without a condom is completely unacceptable. Meanwhile, for a number of psychological reasons, putting a condom on the penis is a certain stress for a man, which is often completely incompatible with a normal erection.

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Traumatic experiences can be painful memories of previous sexual failures., including partner’s dissatisfaction with the quality of sexual intimacy; worrying concerns about your own sexual inferiority and fear of rejection if you fail “to satisfy” partner properly; fear of losing erection or premature ejaculation.

 

Partnership problems – this is a violation of interpersonal relationships, frequent conflicts, increasing negative emotions; mutual distrust or chilling partners; inappropriate behavior of a sexual partner who behaves inadequately, aggressively, mockingly or demonstrates coldness and unwillingness of intimacy; the difference in sexual preferences (range of acceptability, sexual technique) and disharmonious sexual interaction between partners.

 

Anxiety-suspicious traits of character are among personal features.; reduced self-esteem; tendency to constant self-control during sexual intercourse; unattainable in reality setting the maximum satisfaction from each sexual contact; erroneous attitudes regarding sexuality (due to the lack of correct knowledge about sexuality, due to improper upbringing or own negative experience of intimate contact); unconscious hostility towards the opposite sex; guilt in connection with sexual pleasure, as well as a deep fear of intimacy in love relationships.

Psychogenic erectile dysfunction

 

Sexual disorder may also be due to sexual illiteracy and blind faith in myths. An example of the influence of cultural myths on the formation of people’s attitudes toward sex and their sexual behavior is, in particular, the conviction that with age sexual functions necessarily fade out, or that a man must be the initiator and leader in sexual relationships.

 

As a rule, several of the above reasons play a role in the development of psychogenic erectile dysfunction in men. Of great importance and so-called. the sexual constitution of a particular man. Under sexual constitution in sexology, we understand the totality of the innate properties (anatomical, physiological, hormonal, etc.) of an organism, which determines the individual need for sexual activity, its maximum value, and the resistance of the sexual sphere to pathogenic influences. Of course, the weaker the sexual constitution of a particular man, the easier external mental influences can trigger the development of sexual dysfunction.

 

Fear of possible failure – “Will I be able to keep an erection?”, “Will I be able to satisfy my partner?” – leads to inhibition of sexual arousal and loss of erection.

 

The most common form of psychogenic disorders leading to ED, is anxiety waiting for failure syndrome. The typical stereotype of this disorder is as follows. An accidental, often situationally conditioned, sexual failure in the form of a sharp decline or even disappearance of an erection raises doubts in one’s own abilities, prevents another sexual rapprochement. Fear of possible failure – “Will I be able to keep an erection?”, “Will I be able to satisfy my partner?” – leads to inhibition of sexual arousal and loss of erection. The stronger these fears, the higher the likelihood that they will come true (on the principle of auto-suggestion), and the man will begin to feel a real inability to achieve an erection and keep it. Over time, the fear of failure can cause a weakening of interest in sex (avoidance), a loss of self-esteem and an attempt to overcome insecurity (this usually violates the immediacy of sexual intercourse, increasingly turning it from pleasure to certain “act”).

 

In addition, the fear of failure often turns one or both partners into observers who monitor their own sexual response or partner’s reaction and evaluate it. Distracting to the observation and assessment of what is happening, the man usually gets less pleasure from sexual activity, which further suppresses his ability to physical reaction. Thus, a vicious circle arises: a weak erection causes fear of failure, which leads to becoming an observer, and this distracts and contributes to the violation of erection, increasing the fear of failure. If you do not break this circle, it is very likely that a violation of erection will be firmly fixed. With the continued existence of obsessive fear, many men compensatory begin to look for pleasure in other areas: they overeat, abuse alcohol, they look for new hobbies, they become “workaholics” etc.

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Very often, psychogenic effects are leading and with combined erectile dysfunction. For example, the first manifestations of insufficiency of blood supply to the genitals (due to athero-, arteriosclerosis, hypertension, diabetes mellitus) can lead to a slightly reduced erection, its periodic weakening during intercourse, an increase in the period of time until the appearance of a new erection after a completed coitus. Sometimes reproaches of the partner, fixing attention on one’s own sexual reactions lead to an increase in erection failures according to the mechanism of anxiety and obsessive expectation of failure, which is significantly aggravated by insufficient blood supply. Even effective correction of genital blood flow with the restoration of sufficient intake of arterial and venous blood does not lead in most patients to normalize sexual intercourse as long as the obsessive fear of fiasco persists.

 

Diagnostic signs of psychogenic ED [four]:

 

  • 1. Sudden onset of the disease.
  • Psychogenic erectile dysfunction
  • 2. Persistent spontaneous erections in sleep and in the morning awakening.
  • 3. The presence of erections during masturbation.
  • 4. The episodic nature of erection problems.
  • 5. The emergence of an erection when weasel with its subsequent weakening when trying to actually sexual intercourse.
  • 6. The appearance of an erection in situations that provoke sexual arousal, if a man excludes the possibility of sexual intimacy.
  • 7. Selectivity of erectile dysfunction (problems can arise with a specific partner or only in certain situations).
  • 8. Restoring a normal erection after eliminating an external problem.

 

Treatment of psychogenic ED includes psychotherapy and pharmacotherapy. Psychotherapy is an etiopathogenetic treatment aimed at alleviating anxiety and fear of coitus. More often used behavioral methods, including the so-called. sex therapy, first proposed by the classics of sexology science, W. Masters and W. Johnson.

 

Pharmacotherapy has only recently been exhausted by symptomatic means. – tranquilizers relieving anxiety only for a short time, and also yohimbin and nicergolin, whose mechanism of action was associated only with the placebo effect. The situation has changed dramatically in the last 10 years after the emergence in the arsenal of doctors of phosphodiesterase inhibitors of the 5th type, the forefather of which and the most famous representative of the group is the famous Viagra (sildenafil). Sildenafil is used in the ED of any genesis, and when its vascular variant is a true pathogenetic drug. Viagra is also widely used in psychogenic forms of ED [2, 3]. A powerful vascular effect, which always manifests itself in the presence of sexual attraction and stimulation, can be an excellent means of additional psychological protection (“I have nothing to fear, Viagra will help me, even if I panicked a little and the erection starts to decrease…”).

 

“I have nothing to fear, Viagra will help me, even if I panicked a little and the erection starts to decrease…”

 

The appointment of Viagra should be continued until the psychological defense is restored, it will actually “magic wand”. In this case, the effect of the drug will be both symptomatic and pathogenetic. But keep in mind that a strong fear of possible sexual failure can reduce even the powerful effect of Viagra due to violations of the tone of the genital arteries and biochemical imbalance in the cavernous tissue. Therefore, with true psychogenic ED in parallel with the appointment of Viagra psychotherapy should be conducted.

 
 

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