Erectile dysfunction

Sexual Impotence
Sexual impotence or erectile dysfunction is either unable sustainable to obtain an erection valid or not able to maintain if it is obtained with penile rigidity sufficient for performing the sexual act at specific vaginal penetration. It is a disorder that can affect men or women but for women, we speak rather of frigidity.

When that is not a lack of sexual desire, we speak of aphanisis.

It is difficult to determine because of an underestimation of probable cases reported and the definition impotence (failure in time limited or more extended). The various data are not comparable. In France, a problem of impotence is present in over 30% of men over 40 years. The same order of magnitude is found in the male U.S. population.

Sexual impotence, as its name suggests, always means a great psychological difficulty that remains in the foreground, except in cases of testicular hormone deficiency. But it can be distinguished mainly in two varieties, mixed cases are rare:

* The functional and
* The body.

Moreover, these two essential types, are divided into several origins:

1. 80% of cases are psychological blocks, we can classify a dozen types roughly corresponding to situations reverting to the same in some patients but particularly in relation to marital and sexual history of each.
2. Only 20% of impotence are due to many serious illnesses, the most common are diabetes (50% of diabetic men over 20 years of seniority in the disease are powerless), cardio-vascular diseases, paraplegia, hypertension, the almost complete blockage of arteries genitals (eg smokers), the ravages of alcoholism on the nerves of erection, the consequences of certain actions that require cutting arteries and nerves (radical prostatectomy or after brachytherapy for prostate cancer), defects in hormones, sleep disorders etc.. But, in fact, at least 36 cases of medical and real figures with organic always, in addition, a fall in morale and sense of life deteriorated in the repetitive failure.

To say the kind of impotence, we are sometimes forced to use the recording of nocturnal erections, REM sleep (present and excellent in cases of mental block, poor or null if organic pathology). But this consideration, always essential in case of difficulties in classifying the two major varieties, is more useful nowadays, but if only if the functional cause of impotent Certainly the quality of their erections or diurnal night and said it was the onset of a new partner in his sexual life, which caused the recent failure and total.

The medical causes are often more sensitive, especially the incomplete arterial blockages, new drugs except apomorphine, which improves the performance of powerful men. Viagra, Cialis or Levitra which are based selective inhibitors of phosphodiesterase, have tangible results.

Sexual stimulation causes the release of nitric oxide which is a key mediator in causing an erection. This release is localized and starts from the endothelial cells of the corpora cavernosa on one hand and non-adrenergic neurons and non-cholinergic other. Under the control of specific receptors, P2Y receptors, and within the muscle, nitric oxide activates guanylate cyclase, which results lead to a transformation of guanosine triphosphate into cyclic guanosine monophosphate (cGMP). The accumulation of cGMP leads, among other things, relaxation of the smooth muscle of penile arteries and intra-cavernous tissue, and congestion of the penis and, ultimately, to an erection. This is how the cGMP that is somehow the key to drug therapy by PDE5 in the treatment against sexual impotence, because they "inhibit" PDE5 is responsible for degradation this cyclic nucleotide playing a leading role in the mechanism of penile erection.

The failures of the new oral, either by misuse at the wrong time, or discharge of adrenaline more powerful contraction of the arteries than the drugs get into expansion, are common in old blocks and tight. In this case, the situation is not lost if the person wants to learn, with a tiny needle to prick the corpus cavernosum. Here the failures are not of the order of 50% but only 3%. Professor Israel Levi had already published on this technique, but finally Dr. Marc-Antoine Jacoud that following clinical trials to demonstrate the usefulness of this method.

When the oral route fails, the second-line treatment, there is also the vacuum pump also called vacuum or vacuum erector that is used in conjunction with a ring of constriction: the blood is first drawn into the penis through vacuum exercised in a tube and to maintain the erection on the slides a ring constriction (sort of withers) to the base of the penis to maintain erection. The results are comparable to the intra-cavernous injection but it offers several advantages in terms of cost, tolerance and acceptance.

For many patients, the use of microkinesie or acupuncture has helped to remove the erectile dysfunction.

Legal history
In the Middle Ages and modern times, impotence was one of the few reasons that can be used to obtain the dissolution of marriage, primarily religious sacrament. The proof of this impotence was obviously difficult to establish, and the husband was accused of inability to provide public proof to the contrary (erection, ejaculation in front of witnesses). The most difficult was the proof Congress (Latin congressus can mean "carnal knowledge"), who assumed the full implementation of the "conjugal duty" in the presence of witnesses. Appeared in embryonic form in Spain in the fifteenth century, Congress was introduced in France in unknown circumstances and flourish in the sixteenth and seventeenth centuries. Although it is found traces in Italy of the seventeenth century, it remains in the eyes of contemporaries, a French specificity. For many lawyers, however it is not only scandalous, but especially as no evidence of total and permanent inability of a man. Like many other scandals, the case of the Congress suffered in 1659 by the Marquis de Langey, resulting in its removal. The Marquis de Langey declared incapable of following the negative result of the ordeal with his wife sees his marriage annulled and forbidden to remarry. Defying public opinion, he decides to live as married with a young woman with whom he has seven children in seven years! In 1675, the Marquis de Langey, who proved he was no doubt absolutely powerless, and obtained permission to legally remarry his first wife having died in the meantime. Hostile longstanding procedure of the Congress which he thinks he is no evidence of permanent incapacity, the attorney Christian Francis Lamoignon, following the scandal, received the parliament of Paris, by order of February 18 1677, the final abolition of Congress, to the satisfaction of the vast majority of judges.

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