Erectile dysfunction (ED) Definition: Erectile dysfunction (ED) is the persistent (at least 6 months) inability of the penis to achieve and maintain an adequate erection for satisfactory sexual intercourse. It includes four conditions: 1, the patient fails to have satisfactory sexual life because of erectile dysfunction; 2, the phenomenon of erectile dysfunction occurs frequently, and its frequency should be up to 50% of the sexual act; 3, the duration has lasted for at least 6 months; 4, erectile dysfunction cannot be fully explained by one-off factors such as physical discomfort, mood tension, high work and life stress or overexertion. In layman’s terms: unsatisfactory sexual life; at least 5 out of 10 times of sexual life is impotent; the onset of the disease lasts for more than 6 months; it is not caused by physical discomfort, mental tension, work and life stress, or overexertion. The etiology of erectile dysfunction can be divided into: 1, psychological factors: including disharmony between husband and wife, the influence of moral consciousness, frustrating sexual experience, anxiety and depression. 2, age factors: surveys show that the incidence of ED increases with age, so the older you are, the more likely you are to develop ED. 3, disease factors: (1) endocrine diseases: hypogonadism, diabetes, thyroid disease, hyperprolactinemia. (2) vascular causes including any diseases that may lead to reduced blood flow in the cavernous arteries of the penis, such as atherosclerosis, arterial injury, arterial stenosis, pubic artery shunts and abnormal cardiac function, or the penile white membrane that hinders the closure mechanism of venous return, penile venous leakage due to reduced smooth muscle in the cavernous sinus of the penis. (3) neurological diseases: cerebrovascular accidents, Parkinson’s disease, progeria, certain brain tumors, etc. are accompanied by a high incidence of ED. In addition, patients with pelvic fractures, herniated discs or spinal cord tumors, as well as central and peripheral nerve disease or injury can lead to ED. (4) surgery and trauma Large-vessel surgery, radical prostate cancer surgery, abdominal perineal rectal cancer radical surgery and other surgeries and pelvic fractures, lumbar compression fractures or riding injuries can cause erection-related vascular and nerve damage, leading to erectile dysfunction. (5) Diseases of the penis itself such as penile sclerosis, penile curvature deformity, severe prepuce and glansitis of the foreskin. 4, bad habits: long-term smoking, alcoholism, drug addiction, people prone to ED, often unclean sex is also more likely to ED. 5, certain drugs: certain drugs that act on the central nervous system, hormonal drugs and anti-hypertensive drugs and other drugs have varying degrees of side effects that inhibit the erectile function of the penis. 6, mixed factors: refers to psychosomatic factors and organic causes of erectile dysfunction together. In addition, because the organic ED is not treated in a timely manner, the patient’s psychological pressure increases, fear of failure of sexual intercourse, making ED treatment more complicated. Diagnosis 1, medical history Some people treat 1-2 erectile failures as ED to seek medical attention and produce very obvious psychological disorders; some people, however, see very serious ED as a natural phenomenon inevitable with age or aging and do not pay attention to it, so it is important to take a detailed medical history. In addition, it is best to ask couples separately, so that it is easier to get detailed information to help understand the severity of the patient’s ED and the causes of the disease. There are four main areas. (1) sexual history: ① whether ED is accompanied by other sexual dysfunction, such as premature ejaculation, hypoactive sexual desire, abnormal ejaculation, orgasmic disorder, etc.; ② the degree of erectile dysfunction is not erect, or can not fully erect, or erection maintenance time is too short to obtain a satisfactory sex life; ③ the development of erectile dysfunction, such as whether the previous erectile function is normal, early in the morning or night erection has no obvious (3) the development of erectile dysfunction, such as the previous erectile function is normal, early morning or night erection has no obvious changes, erectile dysfunction has no progressive aggravation and duration; ④ ED has no obvious environmental and emotional factors, such as obvious marital discord, life and work pressure increased, whether the environment of sexual life is safe, warm, etc.; ⑤ the occurrence of erectile dysfunction has a sexual partner of choice. (2) Disease or surgical history: such as cardiovascular system diseases, neurological diseases, endocrine system diseases especially diabetes, genitourinary system diseases, etc. In addition, kidney transplantation, surgical treatment of penile sclerosis, radical prostatectomy, transurethral resection of the prostate, posterior urethroplasty, surgery of large blood vessels below the abdominal aorta, rectal cancer or sigmoid colon cancer radical surgery and other surgical procedures also have a high incidence of ED. (3) drug history: ask whether there are drugs that affect sexual function, the type of medication, the time of taking medication, the dose of medication, etc. should be asked in detail. Common drugs affecting sexual dysfunction, such as anti-hypertensives, digitalis preparations, H2-blockers, antipsychotics, hormonal drugs, etc. (4) including the history of smoking, alcoholism, drug abuse and unclean sexual life. Physical examination (1) Genitourinary system examination: such as penile and testicular examination; (2) Endocrine system diseases; (3) Neurological system diseases; (4) Cardiovascular system diseases; (3) Auxiliary examination (1) Psychological tests: Zung anxiety self-assessment scale, Zung depression self-assessment scale, symptom self-assessment scale; (2) Nocturnal brief penile erection measurement: stamp test, Snap-Gauge (3) neurological examination: ball cavernous reflex latency, pubic evoked potentials, urorectal reflex latency, cavernous electromyography, cortical motor evoked potentials and spinal motor evoked potentials; (4) penile hemodynamic examination: penile intracavernosal injection test, color bifunctional Doppler ultrasonography, penile (5) Endocrine laboratory tests: hypothalamic-pituitary-testicular gonadal axis hormone level measurement, thyroid hormone measurement, blood glucose measurement and glucose tolerance test. Treatment 1.Psychosexual treatment As most patients with erectile dysfunction have psychological factors, so psychological treatment is very necessary, it is best for both husband and wife to participate in psychosexual treatment. Sexual concentration training is currently the most important treatment method for psychological erectile dysfunction, applicable to the treatment of almost all sexual dysfunction, the purpose of which is to relieve anxiety, improve communication and communication between the couple, improve the skills from verbal communication to non-verbal communication, and gradually improve the relationship and sexual function of the couple. The improvement rate of this method for erectile dysfunction is in the range of 20% to 81%. Sexual concentration training method: It is required to be performed in a good environment, to ensure that no one interferes, suitable temperature, soft light and relaxing music, etc.. Training 1 hour per day. Training can be divided into the following four stages, but each stage should be organically linked as a complete process, each stage generally last 2-3 weeks. It is important to note that once anxiety and unacceptability occurs in the training, you should stop and communicate in time and return to the previous stage. Phase 1: Non-genital sexual concentration training Specific methods and guidance The couple lies naked together, kissing, hugging and touching each other all over the body, but be careful not to touch the breasts and genital organs. When performing these activities, you can use some intimate language to communicate and experience the resulting skin pleasure and emotional enjoyment, evoking a natural sexual response and making the penis naturally erect. It is important to note that these activities are designed to enhance the sensory capabilities of various body parts, not to make sexual arousal or satisfy the need for intercourse. Although sexual arousal tends to occur in Chongqing during this stage, it is important not to have intercourse and should focus on experiencing pleasure throughout the body. The second stage: genital sexy concentration training specific methods and guidance When both sides in the previous stage of training to achieve the desired effect, then enter the genital sexy concentration training. Although the focus of this phase is to stimulate the genitals, but each training should start from non-genital parts, step by step. The couple caresses each other’s body sensitive points that can cause sexual excitement, such as the penis, inner thighs, inner fossa, nipples, etc., and women’s clitoris, labia, breasts, inner thighs, lips, earlobes and inner fossa, so that sexual excitement gradually increases and the penis can be continuously erected or repeatedly erected. At this stage still do not have sexual intercourse, but try to experience the euphoria of body and mind during the operation, and gradually focus the euphoria on the genital organs. The third stage: vaginal accommodation stage Specific methods and guidance Generally use the female superior position, after the male penis is erect, the female partner will incorporate the penis into the vagina, but both parties do not move, carefully experience the feelings of this accommodation process, eliminate the previous anxiety that the female partner can not be satisfied during the sexual act, and enhance the self-confidence of being able to complete sexual intercourse. If the erection of the penis starts to fade, the female partner can pump slightly or make the penis withdraw and re-erect with hand stimulation and then insert again, repeatedly operate to strengthen the body experience. When both partners can tolerate vaginal accommodation, the training can progress to a deeper stage, namely vaginal accommodation and pumping training, which simulates sexual intercourse. At this stage, the goal is to experience the sensation of vaginal accommodation and pumping, and to enjoy sexual pleasure, rather than aiming for a formal orgasm. The principle of “moving-stopping-moving” should be adopted for pumping, and the duration of intercourse should be extended as much as possible, while the frequency, intensity and depth of pumping should be changed to enhance the experience of various feelings. 2, medication Oral medication is the simplest and most acceptable first-line treatment for erectile dysfunction. (1) Non-hormonal drugs can be roughly divided into the following categories according to the site of drug action. (1) Oral drugs acting in the central system such as adrenoceptor antagonists; dopamines; 5-hydroxytryptamine receptor antagonists. ② Oral drugs acting in the periphery PDE5 inhibitors (such as sildenafil, tadalafil, vardenafil, etc.) are specific phosphodiesterase inhibitors that inhibit cGMP degradation and increase cGMP concentration, thereby relaxing smooth muscle and causing penile erection. This class of drugs is currently the drug of choice for the treatment of ED, with an overall efficiency of more than 70%. (3) Topical drugs creams and ointments are the oldest methods in the treatment of erectile dysfunction, but the effect is not exact. (2) Hormonal drugs Androgen replacement therapy is mainly used for the treatment of endocrine erectile dysfunction, including ED caused by primary and secondary hypogonadism. ①Primary hypogonadism testicular tumors, Creutzfeldt-Jakob syndrome, trauma, surgery and other lesions can lead to a decrease in testosterone levels and an increase in FSH and LH levels in the body, and exogenous testosterone replacement therapy is most effective in such patients. Secondary hypogonadism is caused by hypothalamic and pituitary lesions. The lack of gonadotropin causes stagnation of gonadal development, and the levels of testosterone, FSH and LH in the body are reduced. After supplementation with gonadotropin or gonadotropin-releasing hormone, libido can be increased and erectile function can be improved. 3.Vacuum constriction device (VCD) The vacuum constriction device (VCD) can be used for erectile dysfunction of any cause and is a second-line method for treating ED. However, the hemodynamics that cause erection are different from those of a normal erection, and it does not have active relaxation of the cavernous body and smooth muscle. Animal tests have shown that arterial blood flow is not increased with VCD, but venous return is significantly reduced, and blood filling of the cavernous body and penile skin leads to penile enlargement. 4.Cavernous body injection therapy (ICI) Intracavernous drug injection is the injection of vasodilating drugs into the cavernous body of the penis to fill the cavernous body with blood for the purpose of penile erection. At present, the most commonly used drugs for cavernosal injection to treat erectile dysfunction are poppy bases, phentolamine and prostaglandin E1, etc. The method has obvious effect and fast onset of action. With the widespread use of oral drugs, the method is less and less used in clinical practice because it is an invasive operation and has side effects such as causing pain, bleeding, abnormal penile erection and penile fibrosis. 5, surgical treatment With the introduction of new drugs and the increased understanding of the pathogenesis of erectile dysfunction, surgical treatment is gradually reduced, but there are still some patients with erectile dysfunction need surgery to solve, generally by various other treatments are ineffective. Surgical treatments include prosthetic implants, revascularization, and venous ligation.