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101-762: Erectile dysfunction ( ED ), also referred to as impotence , is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity . It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships. The majority of ED cases are attributed to physical risk factors and predictive factors. These factors can be categorized as vascular, neurological, local penile, hormonal, and drug-induced. Notable predictors of ED include aging, cardiovascular disease , diabetes mellitus , high blood pressure , obesity, abnormal lipid levels in

202-821: A 2015 literature review. According to Gunter de Win , a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think they're addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly." In seemingly rare cases, medications such as SSRIs, isotretinoin (Accutane) and finasteride (Propecia) are reported to induce long-lasting iatrogenic disorders characterized by sexual dysfunction symptoms, including erectile dysfunction in males; these disorders are known as post-SSRI sexual dysfunction (PSSD), post-retinoid sexual dysfunction/post-Accutane syndrome (PRSD/PAS), and post-finasteride syndrome (PFS) . These conditions remain poorly understood and lack effective treatments, although they have been suggested to share

303-448: A biosocial approach to ED considers a person's decision to undergo clinical treatment more likely a result of "society, political economy, history, and culture" than a matter of personal choice. In rejecting biomedical treatment for ED, males can challenge common forms of medicalized social control by deviating from what is considered the normal approach to dysfunction. The Latin term impotentia coeundi describes simple inability to insert

404-409: A common etiology. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain . In both cases, an intact neural system

505-420: A few of these have ever been the object of empirical research. Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction , and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by

606-513: 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. Some sources show that vascular reconstructive surgeries are viable options for some people. The Food and Drug Administration (FDA) does not recommend alternative therapies to treat sexual dysfunction. Many products are advertised as " herbal viagra " or "natural" sexual enhancement products, but no clinical trials or scientific studies support

707-432: A normal, and sometimes even welcome sign of healthy aging. Wentzell's study of 250 Mexican males in their 50s and 60s found that "most simply did not see decreasing erectile function as a biological pathology". The males interviewed described the decrease in erectile function "as an aid for aging in socially appropriate ways". A common theme amongst the interviewees showed that respectable older males shifted their focus toward

808-448: A pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH, but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment. Dhat syndrome is another condition which occurs in men: it

909-414: A pathology was antithetical to the social view these males held of themselves, and their purpose at this stage of their lives. In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. In offering a range of clinical treatments to 'correct' a person's ability to produce an erection, biomedical institutions encourage

1010-493: A practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions , can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990. Iatrogenic conditions need not result from medical errors , such as mistakes made in surgery , or

1111-425: A type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas. Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include: the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis: The prevalence of sexual dysfunction in women

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1212-682: A vicious cycle that often leads to female sexual dysfunction. According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become "an illness that needs treatment" instead of viewing it as a natural part of the aging process. Not all cultures seek treatment; for example, a population of men living in Mexico often accept ED as a normal part of their maturing sexuality. Sexual problems are common with SSRIs, which can cause anorgasmia , erectile dysfunction , diminished libido , genital numbness, and sexual anhedonia (pleasureless orgasm). Poor sexual function

1313-433: A wholly iatrogenic disorder with the bulk of diagnoses arising from a tiny fraction of practitioners. The degree of association of any particular condition with iatrogenesis is unclear and in some cases controversial. The over-diagnosis of psychiatric conditions (with the assignment of mental illness terminology) may relate primarily to clinician dependence on subjective criteria. The assignment of pathological nomenclature

1414-406: Is priapism . Sexual dysfunction A thorough sexual history and assessment of general health and other sexual problems (if any) are important when assessing sexual dysfunction, because it is usually correlated with other psychiatric issues, such as mood disorders, eating and anxiety disorders, and schizophrenia. Assessing performance anxiety, guilt , stress , and worry are integral to

1515-723: Is a culture-bound syndrome which causes anxious and dysphoric mood after sex. It is distinct from the low-mood and concentration problems (acute aphasia) seen in POIS. Sexual pain disorders in women include dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by vaginal dryness . Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause , pregnancy , or breastfeeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex. It

1616-625: Is a blood vessel disorder that affects blood flow to tissue in the penis. The treatment is painless and has no known side effects. Treatment with shockwave therapy can lead to a significant improvement of the IIEF (International Index of Erectile Function). Men with low levels of testosterone can experience ED. Taking testosterone may help maintain an erection. Males with type 2 diabetes are twice as likely to have lower levels of testosterone, and are three times more likely to experience ED than non-diabetic men. A vacuum erection device helps draw blood into

1717-405: Is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation , arousal or orgasm. In men, POIS causes severe muscle pain throughout the body and other symptoms immediately following ejaculation . These symptoms last for up to a week. Some doctors speculate that

1818-474: Is a relatively rare cause of erectile dysfunction. In individuals with testicular failure, as in Klinefelter syndrome , or those who have had radiation therapy , chemotherapy , or childhood exposure to the mumps virus , the testes may fail to produce testosterone. Other hormonal causes of erectile failure include brain tumors, hyperthyroidism , hypothyroidism , or adrenal gland disorders. Anorgasmia

1919-501: Is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis . There are various underlying causes of ED, including damage to anatomical structures, psychological causes, medical disease, and drug use. Many of these causes are medically treatable. Psychological ED can often be treated by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage can be more difficult to treat. One leading physical cause of ED

2020-415: Is actually carcinogenic in its own right, with potential to lead to the development of secondary tumors. In a similar manner, arsenic -based medications like melarsoprol , used to treat trypanosomiasis , can cause arsenic poisoning . Furthermore, aminoglycoside antibiotics can be toxic to the kidneys ; these are prescribed only in severe infections where the risk of nephrotoxicity is preferable to

2121-406: Is also one of the most common reasons people stop the medication. In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs. This combination of symptoms is sometimes referred to as post-SSRI sexual dysfunction . Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by pelvic floor physical therapy ,

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2222-612: Is characterized by the persistent or recurring inability to achieve or maintain an erection of the penis with sufficient rigidity and duration for satisfactory sexual activity . It is defined as the "persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months." ED often has an impact on the emotional well-being of both males and their partners. Many males do not seek treatment due to feelings of embarrassment. About 75% of diagnosed cases of ED go untreated. Causes of or contributors to ED include

2323-510: Is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological cause of anorgasmia is menopause ; one in three women report problems obtaining an orgasm during sexual stimulation following menopause. Premature ejaculation

2424-546: Is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life. ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increased risk appears to be about 1.7-fold. Concerns that use of pornography can cause ED have little support in epidemiological studies, according to

2525-582: Is continual or severe damage taken to the nervi erigentes , which can prevent or delay erection. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries . Diseases are also common causes of erectile dysfunction. Diseases such as cardiovascular disease , multiple sclerosis , kidney failure , vascular disease , and spinal cord injury can cause erectile dysfunction. Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection. Due to

2626-428: Is especially common among people who have anxiety disorders . Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women. Physical factors that can lead to sexual dysfunctions include

2727-431: Is helpful. In some cases, the simple search for a previously undetected groin hernia can prove useful since it can affect sexual functions in males and is relatively easily curable. The current diagnostic and statistical manual of mental diseases ( DSM-IV ) lists ED. Penile ultrasonography with doppler can be used to examine the erect penis. Most cases of ED of organic causes are related to changes in blood flow in

2828-425: Is hypothesized to be prone to iatrogenic complications based on treatment modality. Certain antipsychotics have been shown to reduce brain volumes in animals and in humans over long-term use. Some populations may be at risk of misdiagnosis, including those identified as having substance abuse disorders . At the other end of the spectrum, dissociative identity disorder is considered by a minority of theorists to be

2929-437: Is iatrogenic as well. Bacterial strains resistant to antibiotics have evolved in response to the over prescription of antibiotic drugs. Certain drugs and vaccines are toxic in their own right in therapeutic doses because of their mechanism of action. Alkylating antineoplastic agents , for example, cause DNA damage , which is more harmful to cancer cells than regular cells. However, alkylation causes severe side-effects and

3030-418: Is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women. Testosterone levels in women at age 60 are on average about half of what they were before the women were 40. Although this decline is gradual for most women, those who have undergone bilateral oophorectomy experience a sudden drop in testosterone levels, as the ovaries produce 40% of

3131-436: Is less clear. The hormonal changes that take place during the menopausal transition have been suggested to affect women's sexual response through several mechanisms, some more conclusive than others. Whether or not aging directly affects women's sexual functioning during menopause is controversial. However, many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women, specifically in

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3232-427: Is misdiagnosis of bipolar disorder for another disorder, especially in pediatric patients considered to have major depressive disorder and prescribed stimulants or antidepressants. Other conditions such as somatoform disorder are theorized to have significant sociocultural and iatrogenic components. Chronic Fatigue Syndrome/Myalgic Encephalomyelitis was historically viewed as a psychiatric/somatoform condition, and

3333-475: Is most common in young men and children. Individuals with sickle-cell disease and those who use certain medications can often develop this disorder. There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which include depression , sexual fears or guilt, past sexual trauma, and sexual disorders. Sexual dysfunction

3434-466: Is not well known due to a paucity of epidemiological studies, inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment, with studies often excluding women who were without a partner or who were sexually inactive. However, based on incomplete population based studies from the United States, Europe and Australia, unspecified arousal dysfunction (in which a woman

3535-530: Is often added. Visual and tactile stimulation produces better results. Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial. Before the injection of the chosen drug, the flow pattern is monophasic, with low systolic velocities and an absence of diastolic flow. After injection, systolic and diastolic peak velocities should increase, decreasing progressively with vein occlusion and becoming negative when

3636-420: Is rarely a benign process and can easily rise to the level of emotional iatrogenesis, especially when no alternatives outside of the diagnostic naming process have been considered. Many former patients come to the conclusion that their difficulties are largely the result of the power relationships inherent in psychiatric treatment, which has led to the rise of the anti-psychiatry movement. Meessen et al. used

3737-431: Is required for a successful and complete erection. Stimulation of the penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of the smooth muscles of the corpora cavernosa (the main erectile tissue of the penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes ) and an intact pituitary gland are required for

3838-420: Is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich , alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or

3939-416: Is unable to achieve desirable genital or non-genital sexual arousal despite adequate stimulation and desire) was present in 3-9% of women aged 18-44, 5-7.5% aged 45-64 and 3-6% in women older than 65. Anorgasmia with distress (in which women were unable to achieve an orgasm) was present in 7-8% of women younger than 40, 5-7% aged 40-64 and 3-6% of those older than 65. Poor sexual self image leading to distress

4040-405: Is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse ) may play a role. Another female sexual pain disorder is vulvodynia , or vulvar vestibulitis when localized to the vulval vestibule . In this condition, women experience burning pain during sex, which seems to be related to problems with the skin in the vulvar and vaginal areas. Its cause

4141-470: Is unknown. In men, structural abnormalities of the penis like Peyronie's disease can make sexual intercourse difficult and/or painful. The disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection. It has an incidence estimated at 0.4–3% or more, is most common in men 40–70, and has no certain cause. Risk factors include genetics, minor trauma (potentially during cystoscopy or transurethral resection of

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4242-511: Is unknown; however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the National Institute of Health , but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and may be incorrectly diagnosed as such. There is no known cure or treatment. Erectile dysfunction (ED), or impotence,

4343-456: Is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and

4444-684: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders : lack of desire, lack of arousal, pain during intercourse, and lack of orgasm. For both men and women, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease and

4545-432: The willingness to pay for health care is increasing, and the supply side does not stay behind and develops very fast. But the regulatory and protective capacity in those countries is often lagging behind. Patients easily fall into a vicious cycle of illness, ineffective therapies, consumption of savings, indebtedness, sale of productive assets, and eventually poverty. The 20th-century social critic Ivan Illich broadened

4646-421: The 1980s research took the opposite direction of searching for physical causes of sexual dysfunction, which also happened in the 1920s and 30s. Physical causes as explanations continue to dominate literature when compared with psychological explanations as of 2022. Treatments in the 80s for ED included penile implants and intracavernosal injections . The first successful vacuum erection device, or penis pump ,

4747-584: The UK without a prescription. Additionally, a cream combining alprostadil with the permeation enhancer DDAIP has been approved in Canada as a first line treatment for ED. Penile injections, on the other hand, can involve one of the following medications: papaverine , phentolamine , and prostaglandin E1 , also known as alprostadil . In addition to injections, there is an alprostadil suppository that can be inserted into

4848-496: The United States (excluding recognizable error). An earlier Institute of Medicine report estimated 230,000 to 284,000 iatrogenic deaths annually. The term " iatrogenesis " means brought forth by a healer , from the Greek iatros ( ἰατρός , "healer") and genesis ( γένεσις , "origin"); as such, in its earlier forms, it could refer to good or bad effects. Since at least the time of Hippocrates , people have recognized

4949-453: The appearance of the cavernous arteries, which can be tortuous or atheromatous. Erection can be induced by injecting 10–20 μg of prostaglandin E1, with evaluations of the arterial flow every five minutes for 25–30 min (see image). The use of prostaglandin E1 is contraindicated in patients with predisposition to priapism (e.g., those with sickle cell anemia), anatomical deformity of the penis, or penile implants. Phentolamine (2 mg)

5050-519: The areas of desire, sexual interest, and frequency of orgasm. The primary predictor of sexual response throughout menopause is prior sexual functioning, which means that it is important to understand how the physiological changes in men and women can affect sexual desire. Despite the apparent negative impact that menopause can have on sexuality and sexual functioning, sexual confidence and well-being can improve with age and menopausal status. Testosterone, along with its metabolite dihydrotestosterone ,

5151-643: The blood , hypogonadism , smoking, depression , and medication use . Approximately 10% of cases are linked to psychosocial factors, encompassing conditions like depression, stress, and problems within relationships. The term erectile dysfunction does not encompass other erection-related disorders, such as priapism . Treatment of ED encompasses addressing the underlying causes, lifestyle modification, and addressing psychosocial issues. In many instances, medication-based therapies are used, specifically PDE5 inhibitors like sildenafil . These drugs function by dilating blood vessels, facilitating increased blood flow into

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5252-482: The body's circulating testosterone. Sexual desire has been related to three separate components: drive, beliefs and values, and motivation. Particularly in postmenopausal women, drive fades and is no longer the initial step in a woman's sexual response. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following sexual dysfunctions: Iatrogenesis Iatrogenesis

5353-427: The concept of medical iatrogenesis in his 1974 book Medical Nemesis: The Expropriation of Health by defining it at three levels. Globally it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment, an increase of 51 percent from 94,000 in 1990. In the United States, estimated deaths per year include: Based on these figures, iatrogenesis may cause as many as 225,000 deaths per year in

5454-426: The consequences of the infection. Adverse effects can appear mechanically. The design of some surgical instruments may be decades old, hence certain adverse effects (such as tissue trauma) may never have been properly characterized. In psychiatry, iatrogenesis can occur due to misdiagnosis . This includes diagnosis with a false condition, as was the case of hystero-epilepsy . A potentially iatrogenic circumstance

5555-489: The corpora cavernosa, represented by occlusive artery disease (in which less blood is allowed to enter the penis), most often of atherosclerotic origin, or due to failure of the veno-occlusive mechanism (in which too much blood circulates back out of the penis). Before the Doppler sonogram, the penis should be examined in B mode, in order to identify possible tumors, fibrotic plaques, calcifications, or hematomas, and to evaluate

5656-575: The degree of erection observed. If the peak systolic velocities are normal, the final diastolic velocities should be evaluated, those above 5 cm/s being associated with venogenic ED. Treatment depends on the underlying cause. In general, exercise , particularly of the aerobic type, is effective for preventing ED during midlife. Counseling can be used if the underlying cause is psychological, including how to lower stress or anxiety related to sex. Medications by mouth and vacuum erection devices are first-line treatments, followed by injections of drugs into

5757-539: 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. Spinal cord injury causes sexual dysfunction , including ED. 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 . In many cases,

5858-541: The diagnosis can be made based on the person's history of symptoms. In other cases, a physical examination and laboratory investigations are done to rule out more serious causes such as hypogonadism or prolactinoma . One of the first steps is to distinguish between physiological and psychological ED. Determining whether involuntary erections are present is important in eliminating the possibility of psychogenic causes for ED. Obtaining full erections occasionally, such as nocturnal penile tumescence when asleep (that is, when

5959-525: The domestic sphere into a "second stage of life". The Mexican males of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal "second stage" of life. A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic". Wentzell found that treating ED as

6060-493: The effectiveness of these products for the treatment of ED, and synthetic chemical compounds similar to sildenafil have been found as adulterants in many of these products. The FDA has warned consumers that any sexual enhancement product that claims to work as well as prescription products is likely to contain such a contaminant. A 2021 review indicated that ginseng had "only trivial effects on erectile function or satisfaction with intercourse compared to placebo". Attempts to treat

6161-816: The environment where sex occurs being uncomfortable, or an inability to concentrate on the sexual activity due to a bad mood or burdens from work. Other factors include physical discomfort or difficulty in achieving arousal, which could be caused by aging or changes in the body's condition. Sexual assault has been associated with excessive menstrual bleeding, genital burning, and painful intercourse (attributable to disease, injury, or otherwise), medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure. Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spousal assault, and completed intercourse were most strongly related to sexual symptoms. Assault

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6262-463: The failure of various organ systems (such as the heart and lungs), endocrine disorders ( thyroid , pituitary , or adrenal gland problems), hormonal deficiencies (low testosterone , other androgens , or estrogen ), and some birth defects . In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for

6363-406: The fields of andrology and gynecology respectively. Sexual desire disorders or decreased libido are characterized by a lack of sexual desire , libido for sexual activity , or sexual fantasies for some time. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may start after a period of normal sexual functioning, or

6464-423: The following: Surgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation , although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery

6565-413: The frequency of POIS "in the population may be greater than has been reported in the academic literature", and that many with POIS are undiagnosed. POIS may involve adrenergic symptoms: rapid breathing, paresthesia , palpitations , headaches , aphasia , nausea , itchy eyes, fever , muscle pain and weakness , and fatigue . The etiology of this condition is unknown; however, it is believed to be

6666-433: The late 19th century as a medical instrument for pain relief and the treatment of various ailments. Sometimes described as a massager, the vibrator is used on the body to produce sexual stimulation . Several clinical studies have found vibrators to be an effective solution for Erectile Dysfunction. Examples of FDA registered vibrators for erectile dysfunction include MysteryVibe 's Tenuto and Reflexonic's Viberect. Often, as

6767-456: The male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and atrophy . If a woman does not participate in sexual activity regularly (in particular, activities involving vaginal penetration), she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse. This can turn into

6868-694: The mind and psychological issues, if any, are less present), tends to suggest that the physical structures are functionally working. Similarly, performance with manual stimulation , as well as any performance anxiety or acute situational ED, may indicate a psychogenic component to ED. Another factor leading to ED is diabetes mellitus , a well known cause of neuropathy . ED 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 . Screening for cardiovascular risk factors, such as smoking , dyslipidemia , hypertension , and alcoholism ,

6969-564: The most optimistic about menopausal life; Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic. Since these women have sexual problems, their sexual lives with their partners can become a burden without pleasure, and may eventually lose complete interest in sexual activity. Some of the women found it hard to be aroused mentally, while others had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners,

7070-414: The newsworthiness of stories about it and heavy advertising . It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction. However, social stigma , low health literacy , and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine. The Latin term impotentia coeundi describes the inability to insert

7171-485: The now-outdated treatment of Graded Exercise Therapy is known to have caused iatrogenic harm. Likewise, many neurological conditions, including multiple sclerosis , are frequently misdiagnosed as functional neurologic disorder , a diagnosis tied to several pathways of iatrogenic harm including stigma, dismissal of patients' own experience, disregard of genuine neurological disorders, and even direct harm from interactions with clinicians. Post-traumatic stress disorder

7272-436: The optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle proposed by William H. Masters and Virginia E. Johnson , and modified by Helen Singer Kaplan . Sexual dysfunction can be classified into four categories: sexual desire disorders , arousal disorders , orgasm disorders , and pain disorders . Dysfunction among men and women are studied in

7373-434: The partners' relationship can also contribute to dysfunction. Additionally, postorgasmic illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation: rapid breathing, paresthesia , palpitations, headaches, aphasia , nausea, itchy eyes, fever, muscle pain and weakness, and fatigue. From the onset of arousal, symptoms can persist for up to a week in patients. The cause of this condition

7474-415: The path to restored male virility, including operations by surgeon Serge Voronoff . Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience showing his papaverine -induced erection. The current most common treatment for ED, the oral PDE5 inhibitor known as sildenafil (Viagra)

7575-406: The penis becomes rigid (see image below). The reference values vary across studies, ranging from > 25 cm/s to > 35 cm/s. Values above 35 cm/s indicate the absence of arterial disease, values below 25 cm/s indicate arterial insufficiency, and values of 25–35 cm/s are indeterminate because they are less specific (see image below). The data obtained should be correlated with

7676-402: 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 under prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of

7777-633: The penis into the vagina , and has been mostly replaced by more precise terms. ED from vascular disease is seen mainly amongst older individuals who have atherosclerosis . Vascular disease is common in individuals who smoke or have diabetes , peripheral vascular disease , or hypertension . Any time blood flow to the penis is impaired, ED can occur. Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower blood pressure , antipsychotics , antidepressants , sedatives, narcotics, antacids, or alcohol can have problems with sexual function and loss of libido. Hormone deficiency

7878-454: The penis into the vagina ; it is now mostly replaced by more precise terms, such as erectile dysfunction (ED). The study of ED within medicine is covered by andrology , a sub-field within urology . Research indicates that ED is common, and it is suggested that approximately 40% of males experience symptoms compatible with ED, at least occasionally. The condition is also on occasion called phallic impotence . Its antonym, or opposite condition,

7979-399: 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. The vibrator was invented in

8080-405: The penis, as well as penile implants. Vascular reconstructive surgeries are beneficial in certain groups. Treatments, other than surgery, do not fix the underlying physiological problem, but are used as needed before sex. The PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken by mouth. As of 2018, sildenafil is available in

8181-421: The person may always have had an absence or a lesser intensity of sexual desire. The causes vary considerably but include a decrease in the production of normal estrogen in women, or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs ), or psychiatric conditions, such as depression and anxiety . While many causes of low sexual desire are cited, only

8282-521: The potentially damaging effects of medical intervention. "First do no harm" ( primum non nocere ) is a primary Hippocratic mandate in modern medical ethics . Iatrogenic illness or death caused purposefully or by avoidable error or negligence on the healer's part became a punishable offense in many civilizations. The transfer of pathogens from the autopsy room to maternity patients, leading to shocking historical mortality rates of puerperal fever (also known as "childbed fever") at maternity institutions in

8383-467: The prescription or dispensing of the wrong therapy, such as a drug . In fact, intrinsic and sometimes adverse effects of a medical treatment are iatrogenic. For example, radiation therapy and chemotherapy —necessarily aggressive for therapeutic effect – frequently produce such iatrogenic effects as hair loss , hemolytic anemia , diabetes insipidus , vomiting , nausea , brain damage , lymphedema , infertility, etc. The loss of function resulting from

8484-440: The problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both. Premature ejaculation has historically been attributed to psychological causes, but newer theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation. Post-orgasmic disorders cause symptoms shortly after orgasm or ejaculation . Post-coital tristesse (PCT)

8585-788: The procedure itself remains a better bet than the probability of death if left untreated. Other situations may involve actual negligence or faulty procedures, such as when pharmacotherapists produce handwritten prescriptions for drugs. Another situation may involve negligence where patients are brushed off and not given proper care due to providers holding prejudice for reasons such as sexual orientation, ethnicity, religion, immigration status, etc. This can cause mistrust between patients and providers, leading to patients to not go in for treatment, resulting in more deaths. Adverse reactions, such as allergic reactions to drugs, even when unexpected by pharmacotherapists, are also classified as iatrogenic. The evolution of antibiotic resistance in bacteria

8686-412: The prostate ), chronic systemic vascular diseases, smoking, and alcohol consumption. Priapism is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation . This condition develops when blood is trapped in the penis and is unable to drain. If the condition is not promptly treated, it can lead to severe scarring and permanent loss of erectile function. The disorder

8787-443: The public to strive for prolonged sexual function. Anthropologists argue that a biomedical focus places emphasis on the biological processes of fixing the body thereby disregarding holistic ideals of health and aging. By relying on a wholly medical approach, Western biomedicine can become blindsided by bodily dysfunctions which can be understood as appropriate functions of age, and not as a medical problem. Anthropologists understand that

8888-448: The required removal of a diseased organ is iatrogenic, as in the case of diabetes consequential to the removal of all or part of the pancreas . The incidence of iatrogenesis may be misleading in some cases. For example, a ruptured aortic aneurysm is fatal in most cases; the survival rate for treatment of a ruptured aortic aneurysm is under 25%. Patients who die during or after an operation will still be considered iatrogenic deaths, but

8989-431: The shame and embarrassment felt by some with erectile dysfunction, the subject was taboo for a long time and is the focus of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by

9090-446: The spongy tissue of the penis, analogous to opening a valve wider to enhance water flow in a fire hose. Less frequently employed treatments encompass prostaglandin pellets inserted into the urethra , the injection of smooth-muscle relaxants and vasodilators directly into the penis, penile implants , the use of penis pumps , and vascular surgery . ED is reported in 18% of males aged 50 to 59 years, and 37% in males aged 70 to 75. ED

9191-471: The symptoms described by ED date back well over 1,000 years. In the 8th century, males of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function. In the 13th century, Albertus Magnus recommended ingesting roasted wolf penis as a remedy for impotence. During the late 16th and 17th centuries in France, male impotence

9292-466: The term "iatrogenic poverty" to describe impoverishment induced by medical care. Impoverishment is described for households exposed to catastrophic health expenditure or to hardship financing. Every year, worldwide, over 100,000 households fall into poverty due to health care expenses. A study reported that in the United States in 2001, illness and medical debt caused half of all personal bankruptcies . Especially in countries in economic transition ,

9393-454: The urethra. Once inserted, an erection can begin within 10 minutes and last up to an hour. Medications to treat ED may cause a side effect called priapism . In a study published in 2016, based on US health insurance claims data, out of 19,833,939 US males aged ≥18 years, only 1,108,842 (5.6%), were medically diagnosed with erectile dysfunction or on a PDE5I prescription ( μ age 55.2 years, σ 11.2 years). Prevalence of diagnosis or prescription

9494-675: The use of drugs, such as alcohol, nicotine , narcotics , stimulants, antihypertensives , antihistamines , and some psychotherapeutic drugs. For women, almost any physiological change that affects the reproductive system— premenstrual syndrome , pregnancy and the postpartum period, and menopause—can have an adverse effect on libido. Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in sexual dysfunction after spinal cord injuries ). Diseases such as diabetic neuropathy , multiple sclerosis , tumors , and, rarely, tertiary syphilis may also impact activity, as can

9595-457: Was approved for use for Pfizer by the FDA in 1998, which at the time of release was the fastest selling drug in history. Sildenafil largely replaced SSRI treatments for ED at the time and proliferated new types of specialised pharmaceutical marketing which emphasised social connotations of ED and Viagra rather than its physical effects. Anthropological research presents ED not as a disorder but, as

9696-405: Was associated with sexual indifference only among Latinas. The most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido; these are predominantly associated with hormonal physiology. Specifically, the decline in serum estrogens causes these changes in sexual functioning. Androgen depletion may also play a role, but current knowledge about this

9797-525: Was considered a crime, as well as legal grounds for a divorce. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. The first major publication describing a broad medicalization of sexual disorders was the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1952. In the early 20th century, medical folklore held that 90-95% of cases of ED were psychological in origin, but around

9898-434: Was developed by Vincent Marie Mondat in the early 1800s. A more advanced device based on a bicycle pump was developed by Geddings Osbon, a Pentecostal preacher, in the 1970s. In 1982, he received FDA approval to market the product. John R. Brinkley initiated a boom in male impotence treatments in the U.S. in the 1920s and 1930s, with radio programs that recommended expensive goat gland implants and "mercurochrome" injections as

9999-399: Was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences. Assault

10100-756: Was seen in 13.4% of women younger than 40 in an Australian population based study. The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity. Several factors influence a women's perception of her sexual life. These can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion. Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study found that African American women are

10201-547: Was the highest for age group 60–69 at 11.5%, lowest for age group 18–29 at 0.4%, and 2.1% for 30–39, 5.7% for 40–49, 10% for 50–59, 11% for 70–79, 4.6% for 80–89, 0.9% for ≥90, respectively. Focused shockwave therapy involves passing short, high frequency acoustic pulses through the skin and into the penis. These waves break down any plaques within the blood vessels, encourage the formation of new vessels, and stimulate repair and tissue regeneration. Focused shockwave therapy appears to work best for males with vasculogenic ED, which

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