Approach to the Patient: Erectile Dysfunction
A good physician-patient relationship helps to unravel the possible causes of ED, many of which require discussion of personal and sometimes embarrassing topics. For this reason, a primary care provider is often ideally suited to initiate the evaluation. A complete medical and sexual history should be taken in an effort to assess whether the cause of ED is organic, psychogenic, or multifactorial (Fig. 492). Initial questions should focus on the onset of symptoms, the presence and duration of partial erections, and the progression of ED.
Female Sexual Dysfunction: Treatment
General An open discussion with the patient is important as couples may need to be educated about normal anatomy and physiologic responses, including role of orgasm in sexual encounters. Physiologic changes associated with aging and/or disease should be explained. Couples may need to be reminded that clitoral stimulation rather than coital intromission may be more beneficial.
Behavioral modification and nonpharmacologic therapies should be a first step. Patient and partner counseling may improve communication and relationship strains.
Male Sexual Dysfunction: Treatment
Patient Education Patient and partner education is essential in the treatment of ED. In goaldirected therapy, education facilitates understanding of the disease, results of the tests, and selection of treatment. Discussion of treatment options helps to clarify how treatment is best offered and stratify first- and second-line therapies. Patients with high-risk lifestyle issues, such as smoking, alcohol abuse, or recreational drug use, should be counseled on the role these factors play in the development of ED.
Tham khảo sách 'erectile dysfunction – disease-associated mechanisms and novel insights into therapy edited by kenia pedrosa nunes', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả
The risk of sudden death from cardiac causes is increased among survivors of acute
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Obesity is associated with a high prevalence of erectile dysfunction; how-ever, the pathophysiological link between obesity and erectile dysfunction
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From clinical studies sepsis can be seen as a continuum of severity that begins with an
infection, followed in some cases by sepsis, severe sepsis – with organ dysfunction – and
septic shock. There has been a substantial increase in the incidence of sepsis during the last
decades, and it appears to be rising over time, with an increasing number of deaths
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The area of treatment of sexual disorders has undergone an enormous expansion
during the last few decades. The introduction of pharmacological treatment of
these disorders (e.g., sildenafil for erectile dysfunction or antidepressants for
paraphilias) rekindled the interest of physicians from different disciplines
(psychiatrists, urologists, gynecologists) in sexual dysfunctions. Physicians are
finding these disorders amenable to pharmacotherapy
Disorders that affect the sacral spinal cord or the autonomic fibers to the penis preclude nervous system relaxation of penile smooth muscle, thus leading to ED. In patients with spinal cord injury, the degree of ED depends on the completeness and level of the lesion. Patients with incomplete lesions or injuries to the upper part of the spinal cord are more likely to retain erectile capabilities than those with complete lesions or injuries to the lower part.
Pathways that control erection and detumescence. A. Erection is mediated by cholinergic parasympathetic pathways, and nonadrenergic,
noncholinergic (NANC) pathways, which release nitric oxide (NO). Endothelial cells also release NO, which induces vascular smooth-muscle cell relaxation, allowing enhanced blood flow, and leading to erection. Detumescence is mediated by sympathetic pathways that release norepinephrine and stimulate α-adrenergic pathways, leading to contraction of vascular smooth-muscle cells. Endothelin, released from endothelial cells, also induces contraction.
Physiology of the Female Sexual Response
The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.
Sexual motivation is heavily influenced by context, including the environment and partner factors.
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