Boston University Sukulu ya Zamankhwala
Kusokonekera kwa Erectile ndi vuto lalikulu komanso lachidziwitso lachipatala. Kafukufuku wamakono wamakono akusonyeza kuti pafupifupi 10% ya amuna a zaka za 40-70 ali ndi vuto lalikulu kapena lokwanira la erectile, lotanthauza kuti sangathe kukwaniritsa kapena kusunga zokwanira zokwanira kugonana. Zina 25% za amuna omwe ali m'gululi ali ndi mavuto ovuta kapena osakaniza a erectile. Matendawa ndi odalirika kwambiri, popeza kuchulukana kwapadera kwa kumaliza kusokonekera kwa erectile kumawonjezeka kuchokera pafupifupi 22% pa zaka 40 mpaka 49% ndi zaka 70. Ngakhale kuti ndi ochepa kwambiri kwa anyamata, kutsegula kwa erectile kumakhudzabe 5% -10% ya amuna ochepera zaka 40. Zomwe zafukufukuwa zikuwonetsa kuti kuwonongeka kwa erectile kumakhudza kwambiri pa chikhalidwe cha chisokonezo, ntchito zogwirizana, komanso khalidwe labwino.
Kusagwirizana kwa Erectile kumagwirizana kwambiri ndi thanzi labwino komanso labwino. Zina mwazikuluzikuluzikulu zimayambitsa matenda a shuga, matenda a mtima, kuthamanga kwa magazi komanso kuchepa kwa ma CDL. Mankhwala a shuga, matenda oopsa, matenda a mtima ndi kuvutika maganizo angayambitse mavuto a erectile. Kuonjezera apo, pali kuwonjezeka kwakukulu kwa matenda osokoneza bongo pakati pa amuna omwe adzizidwa ndi ma radiation kapena opaleshoni ya kansa ya prostate, kapena omwe ali ndi zochepetsetsa zamtsempha pamtunda kapena matenda ena a ubongo (monga Parkinson's, multiple sclerosis). Zomwe zimayambitsa moyo, kuphatikizapo kusuta, kumwa mowa komanso khalidwe lokhala yekha ndizo zina zowonjezera. Kugwirizana kwa maganizo a erectile kupweteka kumaphatikizapo nkhawa, nkhawa ndi mkwiyo. Ngakhale kuti anthu okalamba akukula, kuwonongeka kwa erectile sikungokhala mbali yachibadwa kapena yosapeŵeka ya ukalamba. Ndikochepa (osachepera 5% ya milandu) chifukwa cha hypogonadism yokhudzana ndi ukalamba, ngakhale kuti ubale pakati pa kuwonongeka kwa erectile ndi kuchepa kwa zaka zakubadwa mu androgen kumatsutsanabe.
Kuwonongeka kwa Erectile ndi chikhalidwe chomwe chimakhala ndi zotsatira zokhudzana ndi maganizo komanso zingasokoneze mgwirizano wa munthu, kudzilemekeza komanso kugwirizana. Ziwerengero zosamala za chiwerengero chake zakhala zikuchitika pakati pa amuna 10-20 miliyoni. Komanso, tawonetsa kuti mavuto a erectile amawerengera madokotala odwala 400,000, omwe amalandira chipatala cha 30,000 ndipo amalandira ndalama za pachaka ndi malonda athu a madola mamiliyoni a 146.
Lipoti la Kinsey ku 1948 ndilo phunziro loyambirira lothandizira kuthetsa kugonana kwa anthu ambiri. Zotsatira zochokera kumzindawu, zomwe zakhala zikufotokozedwa mwachidule ndi amuna a 12,000, omwe ali ndi zaka, maphunziro ndi ntchito, zikuwonetsa kuchuluka kwa kusowa kwa umoyo ndi msinkhu. Kufala kwake kunatchulidwa kuti ndi osachepera 1% mwa amuna omwe ali pansi pa zaka 19, 3% ya amuna pansi pa zaka 45, 7% zosakwana zaka 55 ndi 25% pa zaka za 75. Mu 1979, Gebhard anafotokozeranso deta ya Kinsey komanso chokwanira cha amuna oposa zikwi zisanu, 42% adavomereza ku mavuto a erectile.
Maphunziro ena anachitidwa pa maphunziro ochokera kwa anthu ambiri omwe adakumana ndi mavuto akuluakulu awiri, kugwiritsa ntchito njira zopanda malire pogwiritsa ntchito njira ya sampuli komanso mtengo wosagwiritsidwa ntchito wa chida. Ard, mu 1977, adanena za khalidwe la kugonana la 161 okwatira okwatirana zaka zoposa 20 ndipo adawona chiwerengero cha 3% cha mavuto erectile. Mu 1978, Frank anaphunzira mabanja odzipereka odzipereka a 100, akuti anali ozolowereka, omwe anali okwatirana komanso ogonana, ali ndi zaka zoposa 37. Amayi makumi anai a anthu amavomereza kuti ndi zovutitsa ndi kukakamizidwa. Chaka chotsatira, Nettelbladt adapeza kuti 40% ya osankhidwa, amuna opatsirana pogonana (zaka zapakati pa zaka 31) adawona mavuto ena okhudza erectile. Kafukufuku wina wasonyeza kusokonekera kwa erectile impairment, kuchokera ku 3-40%. Phunziro la Baltimore Longitudinal la Kukalamba linatanthawuza kuwonongeka kwa erectile komwe kulipo 8% ya amuna 55 zaka zosachepera, 25% a zaka za 65, 55% a zaka za 75 ndi 75% a zaka za 80. Bungwe la Charleston Heart Study Cohort linalongosola za kugonana m'malo mogonjetsa erectile. Idawonetsa kuti 30% yakhala yosagwira ntchito pakati pa zaka za 66-69 zaka. Muzochitika za zaka za 80 zaka izi chiwerengero chinafikira ku 60%.
Manambala omwe amapezeka kuchokera kuchiwerengero cha zachipatala amathandizidwanso chifukwa cha zovuta za erectile. Pofufuza odwala omwe ali ndi mabanja, Schein adanena kuchuluka kwa mavuto a erectile a 27% mu odwala 212 omwe ali ndi zaka zoposa zaka 35. Mulligan anatchula kuwonjezeka kwa 6 pa mavuto a erectile pakati pa amuna akuluakulu omwe ali ndi zaka zambiri omwe adziwonetsa kuti ali ndi thanzi labwino, ndipo kuwonjezeka kwa 40 kwa odwala omwewo ali ndi zaka 70. Mgulu la amuna a zaka za 50 omwe sakhala ndi thanzi labwino komanso lachilendo, Morley adapeza chiwerengero cha 27% cha kusowa mphamvu. Zomwe akupezazi zikugwirizana ndi ma data ena ochokera kwa Masters ndi Johns ndi Slag, pofotokoza kuti amuna omwe ali ndi matenda ali ndi chiwerengero choposa cha erectile.
Phunziro la Masculin Achikulire la Massachusetts (MMAS) linali losemphana ndi magawo, m'midzi, popanga machitidwe osiyanasiyana, kafukufuku wambirimbiri okhudzana ndi ukalamba ndi umoyo kwa amuna a zaka za 40-70. Phunziroli linkachitika pakati pa 1987-1989, ndi ku Boston. Mayankho a maphunziro a 1290 adayesedwa potsatira kayendetsedwe ka chida chofotokozera, chokhazikika. Ntchitoyi ikuimira ntchito yaikulu kuyambira ku Report Kinsey ku 1948. Kuphunzira kwa MMAS kunasiyana ndi maphunziro apitayi mu kukula ndi zokhutira. Zinaphatikizapo magulu anayi osiyana siyana omwe angakhale okhudzana ndi kugonana: ntchito zaumoyo, kugwiritsa ntchito chithandizo chamankhwala, chidziwitso cha chikhalidwe cha anthu, chikhalidwe cha moyo komanso makhalidwe.
Deta yonse inasonkhanitsidwa kunyumba ya phunziro ndi oyankhulana ophunzitsidwa. Njira zamagulu osiyanasiyana zinaphatikizapo magerontologists, asayansi a makhalidwe, akatswiri a zachipatala komanso ogwira ntchito zachipatala. Mapangidwe ophunzirira amalephera kulingalira moyenera zowonjezera magawo pamene akuwongolera zovuta zowonjezera zofunikira ndi kuzindikiritsa zovomerezeka zazinthu zowonongeka. Gulu lachitsanzoli linali pafupi kwambiri ndi anthu ambiri omwe angakwanitse. Chiwerengero cha anthuwa chinali gulu lokhala ndi ufulu, osati lachidziwitso, gawo limodzi lokha lomwe linali lodwala komanso likugwirizana ndi dongosolo la thanzi.
Chida cha MMAS chinali ndi mafunso a 23, 9 omwe amakhudzana ndi erectile. Kufufuza kovomerezeka kwa erectile potency kunapangidwa mosiyana ndi ndondomeko ya erectile yosavomerezeka kwambiri. Phunziro lachidziwitso linayendetsedwa pofuna kusokoneza mauthenga osiyanasiyana. Potency inagawidwa m'masamba a 4: opanda mphamvu, opanda mphamvu, opanda mphamvu komanso opanda mphamvu.
Chiwerengero cha vuto lililonse la MMAS linali 52%, kuphatikizapo 17% yochepa mphamvu, 25% yochepa mphamvu ndipo 10% satha mphamvu.Zonsezi zowonjezereka, m'zaka za 40 zinali 39% ndi pa 70 zaka 67%. Kuwonjezera pa deta iyi, padzakhala amuna 30 miliyoni ku United States ndi mtundu umodzi wa kuwonongeka kwa erectile. Mavuto omwe amaphatikizapo kupatulapo matendawa, matenda a shuga, matenda a mtima, matenda a zilonda zam'mimba, nyamakazi, mankhwala a mtima (kuphatikizapo vasodilator ndi anti-antiperpersive agents) omwe amasuta fodya, antglycemic agents and depression.
Chiyanjano pakati pa matenda a mitsempha ndi erectile dysfuncion chazindikiridwa ndipo chikulembedwa bwino. Zoonadi, kusinthika kwa mphamvu ya hemodynamics (kaya, kuperewera kwa magazi kapena kusemphana maganizo) kumakhulupirira kuti ndilo vuto lalikulu la organic erectile dysfunction. Matenda a mitsempha yotereyi monga opaleshoni yapamtunda, mitsempha ya opaleshoni yowonjezera opaleshoni, ngozi zapachiŵeni, matenda a mitsempha ya mitsempha ndi kuthamanga kwa magazi onse awonetseredwa kuti ali ndi vuto lalikulu kwambiri poyerekeza ndi anthu ambiri popanda vasculopathies. Myocardial infarction (MI) ndi chida chamakono operekera opaleshoni zakhudzana ndi mavuto erectile ku 64% ndi 57% motsatira. Komanso, m'gulu la amuna osapatsa 130, chiwerengero cha MI chinali 8 nthawi zambiri kuposa amuna omwe ali ndi zizindikiro zosaoneka bwino za penile-brachial (PBI) kuposa omwe ali ndi PBI (12% vs 1.5%). Amuna omwe ali ndi peripheral vascular disease (PVD), chiŵerengero cha erectile dysfunction chikulingalira pa 80%. Chiwerengero ichi ndi 10% mwa amuna osatetezeka kwambiri.
Matenda a shuga ndi zokhudzana ndi vasculopathy akugwirizana ndi kuchuluka kwa kusowa mphamvu kwa zaka zonse poyerekezera ndi anthu ambiri. Kufalikira kwa kusowa mphamvu kwa anthu onse odwala matenda a shuga kunkapezeka pakati pa 35 ndi 75%. Matenda a Erectile angakhale a harbinger a shuga, chochitika ichi ku 12% mwa ashuga atsopano omwe ali ndi matenda a shuga. Zomwe zimachititsa kuti anthu odwala matenda a shuga asamakhale ndi moyo wodalirika ndipo ndi apamwamba kuposa amuna omwe ali ndi matenda a shuga poyerekezera ndi achikulire omwe akudwala matenda a shuga. Mwa amuna omwe ali ndi matenda a shuga omwe angakhale opanda mphamvu 505 idzachita izi mkati mwa 5-10 zaka za matenda a shuga. Kuphatikizidwa ndi matenda opatsirana kwambiri a shuga akufala kwambiri.
Pamene chiwerengero cha zinthu zoopsa (monga, kusuta ndudu, matenda oopsa, matenda a mtima, hyperlipidemia, ndi shuga) kumawonjezereka kwambiri zimakhala ndi mwayi woperewera kwa erectile. Zomwe anapezazi zinatsimikiziridwa ndi momwe Virag anafotokozera amuna osapirira a 400, kuwonetsa kuti 80% ya amunawa anali ndi zovuta za thupi komanso kuti zifukwa zoopsa zapadera zimakhala zofala kwambiri mu gulu lino poyerekezera ndi anthu ambiri.
Ngakhale mavitomu ndi ofunikira kukula ndi kusiyana pakati pa ziwalo zoberekera za abambo, kukula kwa khalidwe lachiwerewere ndi kukhalapo kwa libido gawo lawo mu ndondomeko ya erectile silidali bwino. Panthawiyi, mtundu wa kufufuza kwa ma hormoni, kaya gulu lonse la ma hormone ndilofunika kwa wodwala aliyense kapena ngati lingaliro la testosterone lokha limakhala loyang'ana bwino lomwe limakhala likutsutsana. Zoonadi, kusagwirizana kumakhalapo ngati ufulu wa testosterone ndi wofunikira kwambiri poyesa mwamuna wopanda mphamvu. Ngakhale zili choncho, endocrinopathies amayimira pakati pa 3-6% ya mitundu yonse ya erectile yosavomerezeka komanso mapulotopathies omwe amachititsa kuti asakhale ndi mphamvu, kuphatikizapo hypogonadism, hypothyroidism, hyperthyroidism, hyperprolactinemia, matenda a shuga, matenda osokoneza bongo, matenda aakulu a chiwindi, kulephera kwa chiwindi ndi AIDS.
Mankhwala osokoneza bongo omwe amagwiritsidwa ntchito ndi erectile ndi osowa kwambiri ndipo mndandanda wa mankhwala omwe angapangitse kuti erectile isagwire ntchito. Mankhwala omwe amachititsa kuti anthu asagwiritsire ntchito mankhwalawa amadziwika kuti amapita ku 25% ya odwala kuchipatala chodziwika bwino. Ma antihypertensive agents akugwirizanitsidwa ndi zovuta za erectile, malingana ndi antchito enieni a 4-40% a odwala. Zimapangitsa kuti anthu azikhala opanda mphamvu pamagulu apakatikati (clonidine), mwachindunji pamagulu a calcium (block calcium channel blockers) kapena mwa kugwilitsila ntchito magazi omwe amachititsa kuti wodwalayo asamayambe kugwiritsira ntchito mankhwala omwe amachititsa kuti wodwala azidalira kwambiri mankhwala omwe amachititsa kuti penile kukhwima.
Mankhwala angapo amachititsa kuti anthu asakhale ndi mphamvu chifukwa cha zochita zawo zotsutsana ndi androgen, mwachitsanzo, estrogens, LHRH agonists, antagonists a H2, ndi spironolactone. Digoxin imapangitsa mavuto a erectile pogwedezeka pamapepala a NA-K-ATPase omwe amachititsa kuti chiwerengero cha ma kapangellarla chisakanike komanso kuti phokoso liwonjezereke m'maganizo. Mankhwala a psychotropic amasintha njira za CNS. Kugwiritsa ntchito mankhwala osokoneza bongo mosalekeza kwagwirizanitsidwa ndi kuwonongeka kwa erectile. Ena amagwira ntchito yokhazikika, monga momwe zilili, njira zosadziwika. Pamapeto pake, ndikofunikira kufotokoza njira ya mankhwala omwe akuyesa kuti amachititsa kuti asakhale ndi mphamvu. Komanso, kuyerekezera kwa mankhwala osokoneza bongo erectile kuwonongeka kumayenera kuwonetsedwera pa kubwezeretsa kwa vutoli ndi kayendedwe ka mankhwala ndi kuthetsa vuto potsalira.
Kusokonezeka kwa majeremusi, makamaka kuvulala kwa perineum ndi kupweteka kwapakhosi, kumagwirizanitsidwa ndi kuwonongeka kwa erectile. Pofufuza odwala omwe amapita ku yunivesite, Goldstein adanena kuti 35 ya odwala imakhala ndi erectile yolephera chifukwa cha zoopsa. Kuwonjezera apo, njira zothandizira kuti pakhale chitukukochi zakhala zikulembedweratu. Zaka zaposachedwapa zadziwika kuti nambala yosawerengeka ya anyamata omwe ali ndi mavuto a erectile ali ndi mbiri ya ngozi za njinga. Kusokonezeka kwa prostatomembranous urethra, monga momwe tawonera m'magazi a nsonga zapakhosi kumatchulidwa kuti akuphatikizidwa ndi chiwerengero cha 50% cha kusowa mphamvu.
Kuchita opaleshoni ya urologic ya mitundu yosiyanasiyana yakhala ikuphatikizidwa mu kutayika kwa erectile. Zochita zomwe zafotokozedwa kuti zimayambitsa matenda a erectile ndi monga, prostatectomy yambiri, retropubic ndi perineal, kaya kutulutsa mitsempha kapena ayi, TURP, mkati mwa urethrotomy, perineal urethroplasty ndi njira zowonongeka.
Mpaka zaka 15 zapitazo zopanda mphamvu zinkakhulupirira kuti ndizo zotsatira zazifukwa zamaganizo mwa amuna ambiri. Ogwira ntchito zosiyanasiyana awonetsa mgwirizano pakati pa kuvutika maganizo ndi kuwonongeka kwa erectile. Kukhalapo kwa erectile kusemphana kumagwirizana ndi kukangana m'banja mu 25% ya mabanja. Mu MMAS, zifukwa zokhudzana ndi maganizo okhudzana ndi mavuto a erectile zikuphatikizapo kupsinjika maganizo, kupsa mtima komanso kuchepa.
Kuwonjezera pa zifukwa zomwe zatchulidwa kale (mavuto opatsirana pogonana, mavuto a endocrinopthies ndi maganizo) omwe angapangitse kukhala opanda mphamvu zinthu zotsatirazi zingayambitse mavuto a erectile:
Kulephera kwa Renal: Kufika kwa 40% ya amuna omwe akudwala matenda osokoneza bongo ali ndi mawonekedwe ena a erectile. Njira yomwe amachititsa kuti matendawa asamayambitse matendawa amatha kukhala opatsa mphamvu, kuphatikizapo matenda a hypocodadism, hyperprolactinemia, neuropathic (matenda opatsirana ndi shuga) komanso zinthu zovuta. Hatzichristou adafufuzira zolemba zomwe zili m'magulu a amuna omwe ali ndi vuto losalekeza lachidziwitso omwe anali ndi undegone hemodynamic kufufuza ndipo adapeza kuopsa kwakukulu kosavomerezeka. Udindo wa kusintha kwa mphutsi pakukula kwa erectile kulephera kwa odwalawa ndizosiyana. Muzitsulo zina zimapangitsa kuti nsomba zizigwira bwino ntchito, makamaka pamene orectile odwala amathandizanso komanso ena, makamaka amuna omwe analandira 2 transplants, ntchito yotchedwa erectile ikhoza kuwonjezereka.
Matenda a Neurologic: Matenda a erectile a neurogenic angayambitsidwe ndi matenda monga stroke, ubongo ndi mimba ya m'mimba, matenda a ubongo, matenda a Alzheimer, matenda a khunyu a msana komanso multiple sclerosis (MS). Agarwal adatchula kuti 85% yafooka kwa gulu la amuna pambuyo pa kupwetekedwa, pamene Goldstein adatchula 71% ya amuna omwe ali ndi MS anakhudzidwa ndi mavuto a erectile. Posachedwa, adziwa kuti AIDS yathandizana ndi matenda a ubongo omwe angayambitse matenda osokoneza bongo.
Matenda opatsirana: Fletcher adatchula kuti 30% yafooka kwa amuna omwe ali ndi matenda osokoneza bongo (COPD), omwe onse anali ndi chizoloŵezi chodziwika bwino ndi penile ndi Doppler kufufuza, kutanthauza kuti COPD ndiye chinthu chofunika kwambiri.
Matenda owopsa: Kuwonjezera pa matenda omwe atchulidwa kale (matenda a shuga, matenda opatsirana, kuperewera kwa chipsinjo cha mphuno) mavuto ena amayambitsidwa ndi kusowa mphamvu. Scleroderma ikhoza kuchititsa kusokonekera kwa erectile chifukwa cha chotengera chaching'ono chotchedwa Vasculopathy chomwe chimayambitsa. Matenda a chiwindi amatha kukhala ndi vuto la erectile mpaka kwa 50% ya odwala omwe ali ndi matendawa. chiwerengero chimenechi chimakhala chogwirizana ndi chiwindi cha chiwindi, chiwindi cha chiwindi chokhala ndi chiwindi choposa chakumwa moledzeretsa.