Introduction

In the past, doctors and patients have been shown to believe that a decline in sexual function is an inevitable part of aging or that it is caused by emotional problems.

This misconception, combined with the natural reluctance of men to talk about their sexual problems and the experience of doctors and the discomfort of having sex, has led to the inability to deal directly with this problem with many patients.

Fortunately, the awareness of ED as an important and common problem for diabetes has increased in recent years, largely due to the increasing onset of male sexual function and the rapidly growing armamentarium of new therapies designed for impotence.

The ED study suggests that its prevalence in men with diabetes ranges from 35-75% compared to 26% in the general population. The onset of ED also occurs 10-15 years earlier in men with diabetes than their counterparts having sex without diabetes.

A man who is able to have sex should have a series of recurring episodes and many similar procedures for normal erectile function.

You must
1) he has a desire for his sexual partner (libido),
2) the ability to convert blood from the iliac artery to the corpora cavernosa to achieve penile tumescence and sufficient energy (construction) to enter,
3) remove semen and prostatic / seminal fluid from her urethra (ejaculation), and
4) to feel a sense of pleasure (orgasm).

A man is considered an ED if he is unable to fulfill or maintain sexual difficulties. Most men, at some point in their lives, experience periodic failure or sexual abuse.

However, the term “impotent” is reserved for those men who experience erectile dysfunction while trying to have sex more than 75% of the time.

Physiology

Normal male sexual function requires a complex combination of vascular, neurological, hormonal, and psychological systems. The first mandatory event is the discovery and maintenance of a standing rod, which is a vascular condition.

Normal blockage requires blood flow to the corpora cavernosa and corpus spongiosum. As blood flows faster, the pressure inside the intracavernosal space increases with increasing pressure on the venous penile exit.

This combination of increased intracavernosal intracranial hemorrhage and narrowing of blood vessels allows a man to acquire and maintain a solid structure. Nitric oxide also plays an important role. High levels of nitric oxide act as local neurotransmitters and induce relaxation of intracavernosal trabeculae, thereby increasing blood flow and penile engorgement.

Structural loss, or recurrence, occurs when the end of nitric oxide-indased vasodilation ends. Low levels of intracavernosal nitric oxide synthase are found in people with diabetes, smokers, and men with testosterone problems.

Disruption of oxygen delivery or a combination of nitric oxide may prevent intracavernosal blood pressure from rising to a level sufficient to prevent the passage of arteries, leading to failure to obtain or maintain a stable structure.

Examples include decreased blood flow and insufficient intracavernosal oxygen levels when atherosclerosis infects the hypogastric artery or other supply vessels and conditions, such as diabetes, associated with low nitric oxide synthase activity.

Correction also requires neural input to re-regulate blood flow to the corpora cavernosa. Psychogenic erections that follow explicit sexual images or sensory stimuli send spinal input to T-11 to L-2.

Neural nerves flow to the pelvic bone bed, directing blood flow to the corpora cavernosa. Subsequent stimulation of the reflex affecting the penis or genital area activates the arc reflex with sacral roots in S2 to S4.

Night closure occurs during sleep deprivation (REM) and occurs 3-4 times at night. Depressed men rarely experience REM sleep so they do not need to be restrained at night or early in the morning.

Etiology

The causes of ED are many but they usually fall into two categories: organic or psychogenic. Biological causes can be divided into five categories: vascular, traumatic / posturgical, neurological, endocrine, and drug.

Examples of psychological causes are stress, job anxiety, and relationship problems. In people with diabetes, the most serious risk factors are neuropathy, vascular dysfunction, glycemic control, high blood pressure, low testosterone levels, and possibly a history of smoking.

Pathology of Diabetic ED

The natural history of ED in people with diabetes often decreases and does not occur overnight. Both of these arteries are often involved in people with diabetes. Atherosclerosis of the penile and pudendal arteries reduces blood flow to the corpus cavernosum.

Due to loss of delivery to the cavernous trabeculae, venous flow is also lost. This loss of flow causes the corpora cavernosa to fail to enlarge and compress the exit vessels.

Autonomic neuropathy has played a major role in the high incidence of ED in people with diabetes. Norepinephrine and acetylcholine-positive fibers in the corpus cavernosum have also been shown to be reduced in people with diabetes.

This causes the loss of independent muscle relaxation that is important for lifting.

Testing

The first step in getting ED is a complete history of sex and physical examination. History can help to distinguish between the basic causes and the psychological causes. It is important to check the start, progression, and duration of the problem.

If a man gives a history of “no sexual problems overnight,” the problem may be related to the functioning of anxiety, blurred vision, or emotional distress. Apart from these causes, it is a large prostatectomy or other sexual trauma that causes a sudden loss of male sexual function.

The uncontrolled formation of detumescence after ingestion is usually caused by anxiety or vascular steel syndrome. In vascular steel syndrome, blood is diverted from the inside to the oxygen supply of the shortened pelvis.

Questions should be asked about the presence or absence of restrictions at night or in the morning and the ability to masturbate. Complete loss of night energy and the ability to masturbate are symptoms of neurological or vascular disease.

It’s important to remember that sexual desire isn’t lost with ED – only the power to act on those feelings. Medical history focuses on risk factors, such as smoking, high blood pressure, alcohol abuse, drug abuse, trauma, and endocrine disorders including hypothyroidism, low testosterone levels, and hyperprolactinemia, most importantly.

Common drugs that impair sexual function are spironolactone (Aldactone), serious inhibitors such as clonidine (Catapres), guanethidine (Islemin), methyldopa (Aldomet), thiazide diuretics, anti-depressants most importantly, ketoconazole (Nizoral), cimetidine (Tagametetine)), alcohol, methadone, heroin and cocaine.

Finally, an examination of the history of mental illness will help identify emotional issues such as conflict, anxiety at work, depression or anxiety. Physical examination should focus on women’s farms and facilities, femur bruits (abnormal blood vessels), visual impairment (prolactinoma or pituitary mass), chest examination (hyperprolactinemia), penile stem (Peyronie’s disease) ), testicle atrophy (lack of testosterone), and asymmetry or mass (hypogonadism).

Column testing allows testing of both the prostate and sphincter tone, a rare condition associated with independent deformities. Sacral and perineal neurological examinations will help assess independent functioning.

Treatment

Improving glycemic control and high blood pressure, smoking cessation, and reducing alcohol consumption have been shown to benefit patients with ED.

Tadarise Pro 40 mg

Tadarise Pro 40 mg was licensed for ED treatment in February 2003. Tadarise Pro 40 mg is effective from 30 minutes after administration, most effective after 2 h.

The effectiveness of Tadarise Pro 40 mg is maintained for up to 36 h and is not affected by diet. Tadarise Pro 40 mg is given in the required doses of 10 and 20mg and a different daily dose of 5mg. The recommended dose of Tadarise is 10 mg and should be adjusted according to the patient’s response and side effects.

Avoiding or administering drugs that may contribute to ED is also helpful. When ED is advanced, oral agents are considered first-line treatment. Sildenafil (Viagra) works by preventing the catabolism of cGMP, which has led to an increase in nitric oxide. Sixty-six percent of men are diabetic

Improving the ED experience with Tadarise Pro 40 mg, compared to ~ 70% of underweight men with ED. Tadarise Pro 40 mg should be taken 1-2 h before sex. It is important to tell patients that the effectiveness of the drug requires sexual rehabilitation.

The initial dose of sildenafil is 50 mg, and the dose can be increased to 100 mg. (Pills can also be divided by the pill manufacturer). The Tadarise Pro 40 mg pill costs $ 8-10, and patients can easily buy it at a good price online.

The side effects of sildenafil are similar to those from taking niacin or any vasodilator, i.e., headache, lightheadedness, dizziness, and dizziness. Some people have a blue tinge of their cornea, which makes them feel like they are wearing blue sunglasses.

This effect may last for several hours. Syncope and myocardial infarction, the most serious side effects, are seen in men who also take nitrate for heart disease. Sildenafil also has side effects in people with hypertrophic cardiomyopathy because a decrease in pre-loading and cardiac output can increase blockage, leading to hemodynamic instability.

Sildenafil is highly contraindicated in men taking nitrates. Some men who are used to taking potential risks include:
• with active coronary ischemia (eg tests to tolerate exercise without nitrate) • with congestive heart failure (CHF) and low blood pressure or low volume
• with complex anti-hypertensive drugs
• Drug users who increase the half-life of sildenafil by blocking CYP3A4

Another oral treatment used with very little success is yohimbine (Yocon, Yohimex). This is an alpha 2 adrenergic receptor blocker that increases cholinergic and reduces adrenergic tone.

It stimulates the midbrain and increases libido. Good results appear when used in men with psychogenic ED. Side effects include anxiety and insomnia. For those patients who are not allowed oral treatment, intracavernosal injections are an acceptable option. Injections containing alprostadil (Caverject) and papaverine (Genabid) have been used to make the formulation.

The conclusion

ED is a rare, rarely mentioned condition, as well as a common treatment for diabetes. But it is also one of the most treatable diabetes problems. It is a disease of “couples,” that affects the patient and his partner.

Awareness of sexual dysfunction is growing rapidly, and new effective therapies are now available, including oral contraceptives, injectable drugs, cleansers and implants. It is therefore important that both doctors and patients are educated and know the causes and treatment of ED.