Overview : The vulva is a part of the female reproductive system and is also part of the external genitalia. The vulva consists of labia minora, labia majora, mons pubis, clitoris, vestibular bulb, vulval vestibule, urinary meatus the vaginal opening, hymen, and Bartholin's glands. other parts of the vulva include sebaceous glands, urogenital triangle, and pudendal cleft. Pelvic floor muscles support the structures of the vulva and vulva including the entrance to the vagina. Vulva goes through changes during childhood, puberty, menopause, and post-menopause. Structure: A) Mons pubis: it is present in both sexes and act as a cushion during sexual intercourse and is more pronounced in female. the mons pubis is a soft fatty tissue at the front of the vulva in the pubic region covering the pubic bone. the lower part of the mons pubis is divided by a fissure called pudendal cleft. it separates mons pubis and labia majora, the mons pubis, and labia majora get covered by pubic hair at pu...
Erectile dysfunction (ED) - Causes | symptoms | treatment | complications | prevention - Sentelhealth
Erectile dysfunction (ED) - Causes | symptoms | treatment | complications | prevention - Sentelhealth
overview -
In a normal healthy person, erection is caused by the intact nervous and vascular systems working together in coordination.
"A person is called to have erectile dysfunction when he is enabled to attain or maintain an erection for 3 months."
However, the basic mechanism of erection is an increase in the inflow of the blood to the penis with a subsequent decrease in the outflow by causing constriction of the veins draining the blood from the penis.
Causes of erectile dysfunction -
1) Psychological: Psychological factors play a vital role in triggering the events that cause erectile dysfunction mainly depression, anxiety, stress, relationship issues. the psychological component is considered the most important in erectile dysfunction as it is the cause in over half of the cases.
2) Heart disease: Heart disease is one of the most common causes of erectile dysfunction and is preceded by a condition called endothelial dysfunction which is a warning sign of heart disease. A person able to attain but not maintain erection suggests endothelial dysfunction as the causative factor for the disease.
3) smoking: Tobacco use in any form (smoking, chewing) is associated with the risk of erectile dysfunction but, the incidence is highest in smokers. according to a survey, if a person smokes 2 packets(40 cigarettes) a day for ten years there is a 65-70% chance that he will suffer from erectile dysfunction.
5) Alcohol: consumption of alcohol more than the safe range(60-120 ml per week) exposes to the risk of erectile dysfunction. The incidence of erectile dysfunction in chronic alcoholics is high but not as high as in smokers.
6) Obesity: Obesity has been one of the most consistent causes of erectile dysfunction(ED). Obesity leads to the deposition of cholesterol in blood vessels narrowing the lumen of the vessels and causing a decrease in the blood flow of the penis during erection.
7) Diabetes
8) Parkinson's disease
9) Peyronie's disease
10) High blood pressure
11) Sleep disorders
12) Injuries to the penis or pelvic area
Symptoms of erectile dysfunction -
A) The ability to attain but not maintain an erection can be a sign of endothelial dysfunction which proceeds a heart disease.
C) Patients suffering from any kind of mental stress/depression can be found out by asking friends and relatives who can help to treat the condition.
When to consult a doctor
Whom to consult
b) Urologist
These two specialists deal with patients with erectile dysfunction(ED) depending on the cause of the disease.
Treatment of erectile dysfunction -
A) Behavior therapy and counselling - Patients with significant psychological component to their erectile dysfunction can be treated behavior therapy, oriented sex therapy and counselling.
B) Hormone therapy -Apart from behavior therapy and counseling which are used to treat psychological erectile dysfunction hormone therapy is generally used in the treatment of erectile dysfunction due to androgen deficiency(low testosterone).these patients have documented low levels of testosterone. Restoration of testosterone levels can improve libido and the effectiveness of oral medications.
C) Vasoactive therapy - Vasoactive therapy is divided into two types depending on their mode of administration as follows:
1) Oral agents: These include drugs like Sildenafil, Tadanafil, Vardenafil, and Avanafil which primarily increase blood flow to the penis.All these drugs are equally effective and each drug should be initiated at the lowest dose and should be titrated to the effect.
# Side effects of oral agents -
a) When taken with a nitrate medication they cause hypotension and hence these drugs are not advised to the people on nitrates or nitroglycerin.
b) Priapism(rare)
c)Loss of libido: if taken on a regular basis for the long term.
2)Injectable agents: Injectable drugs are directly injected into the penis and these include -
A) Vasoactive prostaglandins
B) Phentolamine
The base and the sides of the penis are used as an injection site.
D) Vaccum erection device - it is a device that creates a vacuum chamber around the penis and draws blood in it, once a sufficient erection occurs elastic band is placed at the root of the penis to prevent loss of erection. However, these devices can cause penile discomfort but, there is no evidence of any serious complications.
E) Penile prosthesis - These are artificial implants that are placed into the penis (inside the muscle layer of the penis). The implants are semirigid or inflatable and come in a variety of sizes and are custom fit to the individual. Inflatable devices are more preferred as they give a natural appearance and better functionality.
A complication with a prosthesis :
1) Mechanical failure
2) Infection
3) Injury to adjacent anatomic structures while surgery
Personal and partner satisfaction rates are high in patients who choose this method.
F) Vascular reconstruction - This is a newer approach and is for patients with disorders of the vascular system (blood vessels). The following two methods are used to treat such causes of erectile dysfunction
a) Ballon dilatation
b)Arterial bypass operation
experience with such treatment is limited and failures are high.
Complications of erectile dysfunction -
1) Relationship problems
2) Stress and depression
3) Inability to have a child
4) Unsatisfactory sex life
Preventing erectile dysfunction -
a) Exercise regularly for at least 30 minutes
b) Keep a check on your blood pressure and diabetes
c) Reduction of alcohol intake and smoking cessation
d) Reduce stress
e) Do regular checkups for any heart disease or other health conditions associated with erectile dysfunction.
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