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According to the research conducted by the Polish Society of Sexual Medicine, about 1.5 million Poles suffer from erectile dysfunction. It is a myth that this problem affects mainly elderly men. People under the age of 30 also visit sexologists' offices more and more often. We talk to a well-known specialist in the field of sexology, Dr. n. med. Stanisław Dulko.

Erectile dysfunction is a common problem today. Why is it so widespread in modern society?

Stanisław Dulko, MD, PhD:It should be unambiguously stated that in the sphere of male intimate life, erectile dysfunction is the leading problem next to ejaculation disorders. There are a number of factors contributing to this. Firstly, the social awareness of this area of ​​human life has increased, it is publicized in the media and included in education, and therefore more and more attention is being paid to it.

Second, it is influenced by the pace of modern life. The number one public enemy today is stress. If it does not appear as individual incidents, but accumulates over the years, it leads to exhaustion of our nervous system. Then the condition drops, we have problems with sleep, hypertension, depression and other ailments may appear. In many disease syndromes, the first symptoms appear in the sexual sphere, as it is the most sensitive and responsive area of ​​our lives. That is why it is so important not to neglect it and look for the cause of ailments, e.g. by performing medical tests.

Third, ED can be affected by a task-oriented approach to sex. This is due to the transfer of the non-sexual area to the intimate sphere, which is guided by completely different laws. If, for example, we make it a point of honor to be successful at work, we probably want to achieve such successes also in our bedroom. However, when we treat a successful intercourse as an exam, our body will react completely opposite to what we expect. It is also worth mentioning the negligence in the field of preventive he alth care, which affects our sexual performance. Improper diet,Lack of physical activity, addiction to stimulants or improper use of electronic devices are other culprits of our problems. Laptops, smartphones and tablets increase the ambient temperature, radiate and generate an electromagnetic field. A man must remember that the temperature around his testicles should be 4 ° C lower than the temperature of the whole body. However, if we constantly lift it by holding the computer on our lap, tight shorts or a long car ride, we hurt ourselves.

You mentioned the doctor that stress can contribute to erectile dysfunction. What exactly happens in a man's body that makes him no longer responding properly to sexual stimuli?

Stanisław Dulko, MD, PhD:The essence of erection is the interaction of the nervous and vascular systems. When an impulse is generated in the headquarters - i.e. in our brain - that an erection is to occur, it is transferred to the vascular system, which must move the right amount of blood to the penis. In the resting state, the male member contains 30 to 70 ml of blood, while in the erectile state - from 180 to 250 ml. Blood must not only flow there, but also remain there, as the erection mechanism is based on the accumulation of blood in the corpus cavernosum. The smooth muscle lining them must therefore be relaxed, go into a relaxed state to be able to fill it. However, when we are in a state of stress and anxiety, our body - regardless of our will - reacts differently. Our sympathetic nervous system decides whether to prepare for fight or flight. This requires the transfer of huge amounts of blood from the head, digestive tract and genitals to the muscles of the arms and legs. This is where our brain thinks they will be most needed to fight off an attack. In a state of stress, the member is not the best reservoir for blood, so it does not get erect.

Are we able to somehow counteract it? What to do to have a successful sexual relationship despite the stresses of everyday life?

Stanisław Dulko, MD, PhD:A sexual event must be prepared by an appropriate atmosphere. We must also be aware that sex is joy, pleasure, a reward for the hardships of the day, and not another task to be performed. The behavior of the partner plays an important role. An evaluative attitude can block a man, despite his best intentions. However, it is also influenced by other psychological factors. Sex - brutally and figuratively speaking - is like a sport. Practice makes perfect.

Any form of inactivity - illness, lack of time, divorce, loneliness - makes it difficult to recover. Therefore, let us not expect too much from ourselves when we enterin a relationship with a newly met partner. Let's treat sex as part of a larger whole, not the only area where we need to prove ourselves. Nature programmed it in such a way that women, often delaying the decision to start intercourse, protect us from failure. Remember that the stages of mutual sexual relations build up gradually, so don't rush.

You have discussed the psychological factors that influence male erection. And how is it with our physiology? Are there situations when the conditions are fully conducive to a successful intercourse, and the body refuses to obey anyway?

Stanisław Dulko, MD, PhD:Naturally, the right mental attitude is only one side of the coin. For men, the linear type of reaction is very important. The first thing that comes up is desire, libido. Problems may arise in this respect as it may be excessively developed or, on the contrary, lowered compared to the partner. The second link in the cycle is excitement, i.e. erection in men. Then there is a plateau phase, that is, maintaining the excitement. Erectile dysfunction affects both of these stages. It happens that during foreplay you get an erection, but at the time of intercourse or during sex, it disappears. This situation often arises in patients who have other he alth problems and who are taking certain medications. These include therapeutic therapies used, inter alia, in in hypertensive and coronary diseases, diabetes, atherosclerosis, Alzheimer's disease, Parkinson's disease, post-stroke conditions, depression, as well as anti-anxiety or anti-compulsive drugs. The doctor who prescribes them should warn the patient that erectile dysfunction may appear and inform that it is worth using the advice of a sexologist. More and more often, such information is also placed on leaflets alongside the shelter. Another link in sexual intercourse is orgasm, which in men is synonymous with ejaculation. Disturbances may also appear in this phase. When the patient reacts too vigorously, the duration of intercourse is very short. When it happens several seconds to a minute after the penis is introduced, it is called ejaculation disorders. The last link that sums up the relationship is, of course, satisfaction.

How to self-diagnose if we suffer from erectile dysfunction?

Stanisław Dulko, MD, PhD:We should be alarmed by the situation when our behaviors do not deviate from the norm, no changes have occurred in the area of ​​our life experiences, and yet there is problem. Most of the time this happens for a reason. Erectile dysfunction canappear after a long break in sexual activity, traumas, prolonged exposure to stress, illness, taking certain medications, etc. We are often able to associate certain facts ourselves. In a different situation, we look for the reason during a visit to the sexologist's office.

How to prepare for such a visit? What to take with you?

Stanisław Dulko, MD, PhD:It is worth taking all medical test results with you. Let's even take those that, in our opinion, have nothing to do with ED, but for some reason were made by us. These include, for example, blood, cholesterol, sugar, thyroid hormones, prolactin tests, liver tests, vitamin D tests, EEG, ECG, ultrasound, magnetic resonance imaging, etc. It is very important that you also have a list of your medications with you. For this, let's take information cards from hospitals, if we are hospitalized, e.g. due to a traffic accident, bodily injuries, etc.

How is the first visit to the doctor?

Stanisław Dulko, MD, PhD:During the interview, apart from questions about past diseases and medications used, I am also interested in the type of work of the patient, his diet, sleep, physical activity or drugs. Often it is unhe althy habits that have a huge impact on our condition, and thus - sexual performance. Together with the patient, we determine whether the disorder is psychological or physiological. In the latter case, I order additional control tests, e.g. the level of testosterone, prolactin or thyroid hormones. I follow the rule that in most cases, during the first visit, I prescribe drugs for erectile dysfunction so that the man can start the therapy immediately and be convinced of its success.

You mentioned the doctor about drugs for erectile dysfunction. What is their mechanism of action? Are these measures completely safe?

Stanisław Dulko, MD, PhD:Today we have a huge selection of drugs to counteract this type of disorders. Their selection largely depends on the financial capabilities and preferences of the patient (e.g. as to the frequency of using the agent). Group of the so-called phosphodiesterase type 5 (PDE-5) inhibitors include active substances such as sildenafil, tadalafil, vardenafil and avanafil. Basically they have a similar mechanism of action. Manufacturers try to shorten their absorption time, limit the interaction with other drugs in the case of comorbidities or minimize side effects.

We must remember that all of them are cardiological drugs with a high safety profile. This is evidenced by the fact that they were already used in the second half of the 1970sin infants born with a heart defect. It is logical that no substances that are harmful to the body are used in toddlers. An additional advantage of their application is a positive effect on the entire body, incl. they regulate blood pressure with a tendency to lower it, "thin out" the blood and improve circulation, they affect the oxygenation of the brain, which improves its functions, such as memory or concentration. The essence of their action is to block the enzyme that breaks down nitric oxide. The increased level of nitric oxide contributes to the relaxation of smooth muscles, "exercises" them and relaxes them, therefore they become easily stretchy and create adequate space for accumulation in the blood member. Always remember that each case must be considered individually, and the selection of the appropriate therapy remains at the discretion of the doctor.

When taking drugs from this group, can we expect any side effects?

Stanisław Dulko, MD, PhD:In this group of drugs, any side effects are not bothersome and pass very quickly. During the first applications, for example, you may experience a headache (as there is "gymnastics" and the expansion of the muscles of the blood vessels), redness on the face or heartburn.

What's more, some of the drugs are dedicated to patients with various diseases, e.g. diabetes, while older inhibitors have not worked well in such cases. However, it must not be forgotten that, in addition to taking medication, a man still needs appropriate sexual stimuli and a favorable atmosphere. It is a mistake to expect that at a given time we will take a measure, sit on the couch for some time with a watch in hand, and then have a successful intercourse.

How successful is this therapy? Do all men take it, or maybe they also withdraw from their sex life?

Stanisław Dulko, MD, PhD:With the current state of medical knowledge and the availability of medications, it is unlikely that a patient who follows the doctor's recommendations could not help. Statistically, 2-3 visits to the sexologist's office are enough to restore satisfactory intercourse with your partner. Of course, there are also more complicated cases that require consultations with doctors of other specializations (e.g. a cardiologist), but they belong to the minority.

However, in order to start treatment, it is necessary to be aware of the problem and to be willing to fight it, not to give up this sphere of life. Successful sex activates the entire machinery of neurohormonal reactions in the male body and mobilizes the internal structure for biological regeneration. During these processesdead, weak cells are removed and replaced with new and stronger ones. From an evolutionary point of view, this is to prepare for the production of the highest quality sperm. However, the accompanying effect, when the purpose of intercourse is not for us to procreate, is an extremely intensive regeneration of the body, improvement of the quality of sleep, cravings and appetite, regaining vitality, and even an overwhelming sense of fulfillment and meaning in one's existence.

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Sex problems