Phapang ea li-organic-psychogenic le mathata a amanang le eona ho khetholla ho se sebetse ha erectile (2013)

International Journal of Impotence Research (2003) 15, 72-78. Doi: 10.1038 / sj.ijir.3900952

Benjamin D Sachs1

1Univesithi ea Connecticut, Storrs, Connecticut, USA

Bongoli: BD Sachs, PhD, Lefapha la Psychology, U-1020, Univesithi ea Connecticut, Storrs, CT 06269-1020, USA. Lengolo-tsoibila: [imeile e sirelelitsoe]

E amohetse 8 Phato 2002; E amohetse 16 September 2002.

Ka holimo ho leqephe

inahaneloang

Phapang ea moetlo lipakeng tsa ho se sebetse ha 'mele le psychogenic erectile dysfunction (ED) e ile ea bolokoa tlalehong ea morao-rao ea Komiti ea Nomenclature ea Mokhatlo oa Machabeng oa Patlisiso ea Thobalano le Bofokoli. Har'a mathata a maholo a khethollo ena ke hore e ipapisitse le pono e siiloeng ke nako ea phapang ea kelello le 'mele, ha e nahane ka tsebo ea methapo ea mafu ea' kelello ', e sa natse moelelo oa mantlha oa' psychosomatic, 'hangata e fumanoa ka ho qheleloa ka thoko, mme ho ka fana ka maikutlo ho mokuli hore ED ea hae ke 'tsohle tse kelellong.' Ka lebaka leo, phapang e se e se na thuso ho fumanoeng, tlhophiso le kalafo ea ED, le lipatlisisong tsa lisosa tsa ED. Mofuta o mong oa lekhetho o ipapisitseng le o hlahisitsoeng ke Komiti ea Nomenclature o hlophisa likarolo tse 'maloa tsa lisosa tsa ED tseo hona joale li nkoang e le tsa kelello,' me o nka tse ling e le maemo a ED, sehlopha se boloketsoeng liketsahalo tsa nakoana tsa ED ka ho hlaka ka lebaka la litšobotsi tse itseng tsa thobalano ho kopana le.

Keywords:

classified ea erectile dysfunction, organic erectile dysfunction, psychogenic erectile dysfunction, maemo a erectile dysfunction, erectile physology

Morero oa pampiri ena ke ho felisa phapang ea moetlo e entsoeng lipakeng tsa 'organic' le 'psychogenic' lisosa tsa ho se sebetse ha erectile (ED). Phapang ena e kanna ea ba e bile molemo, empa e bonahala e na le liphoso ka litsela tse 'maloa, mme mohlomong ha e na thuso mabapi le ts'oaetso, kalafo, lipatlisiso esita le sesebelisoa sa thuto. Pele o hlahisa khang ena, semelo se seng se kanna sa sebetsa.

Mekhatlo e meng ea bongaka e na le li-taxonomies tse hlakileng tsa tlhahlobo ea mafu. Mohlala, Mokhatlo oa Amerika oa Psychiatric Association o se o qalile le ho phatlalatsa tse fetang mashome a lilemo Buka ea ho hlahloba le ea Statistical ea Mathata a kelello (DSM), hajoale e le Mofuta oa IV.1 DSM e bile teng ka liphetoho tsa eona tse latellanang, ho kenyelletsa le liphetoho tse 'maloa tsa bohlokoa tokollong, athe liphetoho tse ling li kentse mabitso a maemo maemong. Mekhatlo e meng ea bongaka ha e bone ho hlokahala hore e nke li-taxonomies tse joalo ka semmuso, leha li ka li sebelisa e le taba ea kopano, mohlala, tlhahlobo ea lihlooho tsa hlooho ke litsebi tsa methapo.2 Le ha e sa amoheloe ka molao ke mokhatlo oa bongaka, hangata lits'ebetso tsa ho khetholla li hlakile mecheng ea lipotso kapa liforomong tsa litefiso tse sebelisoang ke ba fanang ka tlhokomelo ea bophelo bo botle le insurers, 'me li kentsoe khatisong ea lingoloa tsa bongaka.

Mokhatlo oa machaba oa boithuto ba thobalano le Impotence (ISSIR) o qetile lilemo tse ngata o nka ho amohela thekiso e hlophisitsoeng ea ED. Qetellong, ho ile ha thehoa Komiti ea Nomenclature, 'me haufinyane e hatisitse sehlopha sa eona se khothalelitsoeng,3 e akaretsitsoeng ho Lethathamo 1. Le ha komiti e ile ea ngangisana hore na ho tla lula ho na le phapano lipakeng tsa organic le psychogenic ED, qetellong li nkile qeto ea ho boloka boits'oaro ba eona ho lekhetho le khothalelitsoeng.4 Lerotholi lena ha lea ka la tšohloa kapa ho amoheloa ka molao ke setho sa ISSIR; mohlomong e ka se be teng. Leha ho le joalo, phatlalatso ea likhothaletso e fana ka likotsi le menyetla. E 'ngoe ea likotsi ke ho hasanya lekhetho ipso facto e khothaletsa tšebeliso ea eona mme e sebetsa e le tumellano e hlophisitsoeng ea likarolo tsa eona le polelo ea mantsoe, ho kenyelletsa le phapano e tsoelang pele pakeng tsa organic le psychogenic ED. E 'ngoe ea menyetla eo re e filoeng (mme mohlomong e lebelletsoeng ke komiti) ke ho bonts'a mathata a mang le taxonomy e boletsoeng. (Mohato ntlheng eo o nkuoe nakong ea neheletsano mabapi le litaba tsa taxonomic kopanong ea haufinyane ea ISSIR.5)

Tafole ea 1 - Kemiso ea ho se sebetse hantle ha erectile ho khothaletsoa ke Komiti ea Nomenclature ea Mokhatlo oa Machabeng oa Patlisiso ea Matla.

Tafole 1 - Tlhahlobo ea ho se sebetse hantle ha erectile e khothalelitsoeng ke Komenclature Komiti ea Mokhatlo oa Machaba oa Lipatlisiso tsa Impotence [ast] - Ka bomalimabe ha re khone ho fana ka sengoloa se fumanehang bakeng sa sena. Haeba u hloka thuso ea ho fihlela setšoantšo sena, ka kopo ikopanye le thuso@nature.com kapa sengoliTafole e feletseng

 

Pele sena kapa sistimi e 'ngoe ea tlhophiso ea ED e hlophisoa ka khetho ea semmuso kapa ka moetlo, mathata a' psychogenic 'ED e le sehlopha, ka hona ka phapang ea organic-psychogenic, a lokela ho hlahlojoa haufi-ufi. Har'a mathata ana ke hore sehlopha sa 'psychogenic' ED (a) se ipapisitse le pono e felileng ea phapang ea kelello le 'mele, (b) e hlokomoloha tsebo ea methapo ea kutlo ea mafu a' kelello ', (c) e hlokomoloha moelelo oa mantlha oa' psychosomatic, '(d) hangata e fumanoa ka ho qheleloa ka thoko,' me (e) e ka fana ka maikutlo ho mokuli hore ED ea hae ke 'tsohle tse kelellong.'

Ka holimo ho leqephe

Mathata ka mohopolo oa psychogenic ED

(a) 'Psychogenic' ED e ipapisitse le pono e siiloeng ke nako ea phapang ea kelello le 'mele

Phapang lipakeng tsa organic le psychogenic ED e bonts'a karohano ea nalane lipakeng tsa 'mele le kelello, karohano e nkang tlaleho e sa lekanang ea lipatlisiso tsa sejoale-joale tsa' mele le tseo e leng taba ea hore maikemisetso ohle a kelello a na le motheo o itseng. Ha ho hlokahale ebile ha re na taba ea hore pampiri ena e hlahlobe nalane ea filosofi ea seo ho thoeng ke bothata ba kelello. Ho lekane ho re motho a ka khetholla likampo tse peli tsa batšehetsi. Kampong e 'ngoe ho na le ba fokotsang matla, ba lumelang hore kelello e joalo haese letho boko bo sebetsa, ke hore, lits'ebetso tsohle tsa kelello li ka hlalosoa ho latela lits'ebetso tsa boko. Maikutlo a bona a kentsoe setšoantšong sa Venn ho Setšoantšo sa 1a. Mohlala oa pono ena ke oa rafilosofi JR Searle, ea hlokometseng hore: 'Hang ha re bona tsebo eo ke ntho ea tlhaho joalo ka tse ling, re ka e batlisisa ka methapo ea mafu. Temoho e bakoa ka ho felletseng ke lits'ebetso tsa methapo ea kutlo 'me e fumaneha libopehong tsa boko.'6,7 Ba bang ba lumela hore kelello e joalo ntho e 'ngoe hape ho feta boko bo sebetsang, ke hore, ho na le 'lits'ebetso tse hlahang' tsa kelello tse ke keng tsa hlalosoa ka botlalo ka ho sekaseka ts'ebetso ea boko. Pono ena e hlahisoa ho Setšoantšo sa 1b. Empa ho tsebo ea ka, bohle ba lumela hore kelello hase ntho e felletseng tse ling ho feta ts'ebetso ea boko; ke hore, ba hana Setšoantšo sa 1c joalo ka khetho e sebetsang. Litsebi tse ngata tsa liteko tsa kelello, litsebi tsa lipuo, litsebi tsa thuto ea bophelo, le bo-rasaense ba bang ba boitsoaro ba hlahlobisisa ts'ebetso ea kelello ntle le ho nahana ka tšebetso ea boko, empa leha ho le joalo ba ka lumela hore lits'ebetso tsohle tsa kelello li laoloa ke ts'ebetso ea boko. Ho latela hore ho ka ba sieo psychogenic ts'ebeliso e sa kenyeleng manyolo lits'ebetso. Ha ho na ED eo e leng 'tsohle kelellong.' (bona Karolo (e), ka tlase.) Ts'ebetso ea boko le eona e bohlokoa molemong oa ho hlasimolla le ho thibela ho ts'oaroa ho tloaelehileng.8,9,10,11 Ha ho na 'psychogenic' erection kapa 'psychogenic' ED e ka hlahang ntle le ka ho kena lipakeng ha tšebetso ea boko.

Setšoantšo sa 1.

Setšoantšo sa 1 - Ka bomalimabe ha re khone ho fana ka mokhoa o mong o fumanehang bakeng sa sena. Haeba o hloka thuso ho fumana setšoantšo sena, ka kopo ikopanye le help@nature.com kapa mongoli

Litšoantšo tsa Venn tsa maikutlo a mararo a lumellanang a kamano pakeng tsa kelello le mmele. (a) Maikutlo a batho ba fokotsehileng ka botlalo: lits'ebetso tsohle tsa kelello li ka hlalosoa ho latela ts'ebetso ea boko. (b) Pono ea ts'ebetso ea maemo a potlakileng: lits'ebetso tse ling tsa kelello li ke ke tsa hlalosoa ka botlalo ka tlhahlobo ea tšebetso ea boko. (c) Maikutlo a boipuso (setsi se tsitsitseng?): kelello ke ntho e felletseng ntle le ts'ebetso ea boko.

Sebopeho se felletseng le litšomo (29K)

 

(b) 'Psychogenic' ED e hlokomoloha tsebo ea neurobiology ea mathata a 'kelello'

Tse ling tsa likaroloana tsa 'psychogenic' ED ho lekhetho la Komiti ea Nomenclature li fana ka mohlala o motle oa khang ea ho hana 'psychogenic' joalo ka sehlopha sa ED. Kahoo, 'maikutlo a mabe' a joalo ka khatello ea maikutlo le 'khatello e kholo ea bophelo' a kenyelelitsoe e le mefuta ea maemo a ED a 'khatello ea kelello kapa phetoho e amanang.' Leha ho le joalo, neurobiology e tsoetse pele haholo ho sibolla metheo ea maikutlo le mathata a maikutlo.12,13 Ka sebele khatello ea maikutlo, khatello ea maikutlo le matšoenyeho ke a mang a maemo a kelello ao ho ona lipatlisiso tsa morao tjena li bonts'itseng ka ho hlakileng liphetoho tse kholo tsa neurochemical le neuroendocrine bokong.14,15,16,17,18 Tse ling tsa liphetoho tsena li ka lebelloa ho kenya letsoho mosebetsing o sitisang mosebetsi oa erectile. (Revelingly, Lue19 hape e khetholla khatello ea maikutlo le khatello ea maikutlo e le lisosa tsa kelello ea ED, empa e bonts'a mofuta oa bona oa tlhaho ka ho fana ka tokollo e sa sebetseng ea nitric oxide e le karolo ea pathophysiology ea mantlha.) Ho feta moo, lits'ibollo tsena tsa methapo ea kutlo li lebisitse phekolong ea lithethefatsi e ka ntlafatsang maemo ana a maikutlo a mabe. ' Ha ho makatse hore litlhare tsena ka linako tse ling li fokotsa ED e amanang le maemo ana, empa maemong a mang lithethefatsi li fetola botsitso ba methapo le ho senya ts'ebetso ea thobalano ka 'litla-morao' tse kang ED, ho lieha ho tsoa peo, kapa takatso e mpe ea thobalano.20 Ka mantsoe a mang, ha 'psychogenic' ED e nkuoa e le mofuta oa boko 'neurogenic' ED, ho tla lebelloa hore lithethefatsi tsa 'psychotropic', ka litlamorao tsa tsona bokong, li ka fokotsa kapa tsa eketsa ED ena ea methapo. Ka mantsoe a mang, methapo ea methapo ea kutlo le methapo ea kutlo ea matšoenyeho le khatello ea maikutlo ha se lisosa tsa manyolo tsa ED ho feta ED ka lebaka la hypogonadism kapa hyperprolactinemia.

Bothata bona ba 'psychogenic' ED bo boetse bo bontšoa ke ho kenyeletsoa ha Komiti sehlopheng sena sa 'ho theoha ho amanang le botsofali ho tsoheng ea thobalano.' Likarolo tse ngata tsa ts'ebetso ea thobalano lia theoha ha banna ba ntse ba tsofala, mme ba etsa joalo ka mabaka a mangata.21,22,23 Kahoo, ho fokotseha ho amanang le lilemo ts'ebetsong ea erectile ho ka bakoa ke liphetoho tse senyehang tsamaisong ea methapo ea botona, kapa penile collagen, kapa methapong ea methapo, eo kaofela ha eona e neng e ka aroloa e le 'organic' ho fapana le 'psychogenic' lisosa tse amanang le lilemo tsa ED. Empa tse ling tsa liphetoho tsena li kanna tsa kenya letsoho phokolong e amanang le lilemo tsa ho tsosa takatso ea thobalano, joalo ka ha phokotso ea tatso le kutlo ea monko kapa ts'ebetso ea tšilo ea lijo e ka fokotsa takatso ea lijo.24,25 Tahlehelo e ngoe ea ho tsofala le ho tsofala ka ho tsofala le eona e ka hlaha ka lebaka la liphetoho tse amanang le methapo ea kelello bokong. Liphetoho tsena le litlamorao tsa tsona ho ED ha li so ngolisoe hantle kapa hona ho utloisisoa, empa li lokeloa ke ho etsoa lipatlisiso.

Ho thata ho boloka phapang e hlakileng lipakeng tsa psychogenic le organic ED ho bonahala hape lithutong tse tebileng tsa karabo ea thobalano ke John Bancroft le Erick Janssen. Ka nako e tšoanang le litlhahlobo tsa bona tsa tšebetso ea thibelo ea ts'ebetso ea thobalano, le tlatsetso ea bona kutloisisong ea rona ea lits'ebetso tsena,26,27 Bancroft le Jannsen28 o sebelisitse liteko tsa psychometric le lipalo-palo ho etsa lipatlisiso tsa ho tsosa takatso ea thobalano ka lits'ebetso tse tharo tse ikemetseng tse ikemetseng, e le 'ngoe bakeng sa ho tsosa takatso ea thobalano le tse peli bakeng sa thibelo ea thobalano, eo botsitso ba eona bo lekanyelitsoeng ke mathata a banna a erectile. E 'ngoe ea menehelo ea bona e na le sehlooho se reng'Psychogenic ho se sebetse ha erectile nakong ea kalafo ea litlhare: mokhoa oa thuto '(ho totobatsoa), empa Bancroft le Janssen ba bua ka bophara tlhahlobisong ea bona mabapi le taolo ea methapo ea methapo ea ts'ebetso ea thobalano,' me ba botsa potso ena (leq. 86): 'Haeba likhakanyo tsena li ka ts'ehetsoa ke bopaki ba kliniki, seo se tla re joetsa eng ka mohopolo oa 'psychogenic ED'? Phapang lipakeng tsa 'psychogenic' le organic 'e se e ntse e fokotsa boleng ba bongaka. Hangata ho hlahlojoa 'ho tsoakaneng' ho etsoa. ​​' Sebakeng sa ho lahla phapang, Bancroft le Janssen ba fana ka maikutlo a hore teka-tekano ea nakoana lipakeng, ka lehlakoreng le leng, e bohareng le pheriferale ea thibelo ea manyolo 'me ka lehlakoreng le leng,' mathata a kantle 'a etsa qeto ea hore na monna o tloaetse ho ba le ED ka thobalano e itseng. kopana. Leha ho le joalo, Bancroft le Janssen ba hlokomela karohano ea methapo ea kutlo ea tharollo ea mathata a kantle: 'Banna ba nang le tšekamelo e phahameng ea tšitiso ea karabelo ea thobalano ba na le monyetla oa ho lahleheloa ke thahasello ea thobalano le karabelo ea erectile ha ba sithabetse kapa ba tšoenyehile. Sena se kanna sa itšetleha ka ts'ebetso ea ts'ebeliso ea maikutlo haholo-holo empa ka liphetoho tse amanang le biochemical bokong tse amanang le maikutlo le ho tsosa takatso ea thobalano. ' (Leq. 87) Leha ho le joalo haeba lintlha tsee tsa kelello li laoloa ke lihloliloeng, hobaneng li li boloka e le lihlopha tse arohaneng? Le ha ts'ebetso ea ts'ebeliso ea kelello e ameha, ts'ebetso eo ha e fokotsehe ka tsela e tšoanang ke liphetoho tsa methapo ea kutlo bokong ho feta lits'ebetso tse sa tsebeng letho.

(c) 'Psychogenic' ED e hlokomoloha moelelo oa mantlha oa 'psychosomatic'

Tšimo e thehiloeng hantle ea psychosomatics e ne e ka bonahala, ka metso ea lebitso la eona, ho kenyelletsa phapang e tšoanang e sa feleng pakeng tsa kelello le 'mele tse seng li nyatsitsoe mona. Leha ho le joalo, ha psychosomatics e shebiloe ho latela litšoantšo tsa Venn ho Setšoantšo sa 1a kapa b, joale e ka bonoa e le mahlale a litšebelisano lipakeng tsa ts'ebetso ea kelello, mesebetsi ea eona ea boithaopo, le lits'ebetso tse ling tsa 'mele tse amanang le bophelo bo botle le mafu. Likamano tsena li hlahisoa ke tse 'maloa tsa li-subdiscipline tse sa tsoa thehwa tsa psychosomatics, ke hore. psychoneuroendocrinology le psychoneuroimmunology, le likoranta tsa bona tse fapaneng, Psychoneuroendocrinology 'me Boko, Boitšoaro le Ts'ireletso ea Ts'ireletso. Litaolo tsena li totobatsa tšebelisano ea tšebetso ea likarolo tsa tsona, ho fapana le karohano ea tsona. Ka mokhoa o ts'oanang, re lokela ho nahana ka lits'ebetso tsa kelello joalo ka ha li tlamiloe ka mokhoa o ke keng oa aroloa le lits'ebetso tsa manyolo tsa ts'ebetso ea erectile le ho se sebetse hantle, ho fapana le li-pigeonholes tse arohaneng tseo ho ka fanoang ka lebaka le itseng. Maikutlo ana a sebetsa ho ED polelo e akaretsang e entsoeng ke HG Wolff puong ea hae ea bopresidente kopanong ea 1961 ea American Neurological Association: 'Ha ho na thuso ho theha sehlopha se arohaneng sa bokuli se ka hlalosoang e le psychosomatic. Ho e-na le hoo, tsamaiso ea methapo ea motho e ameha likarolong tsohle tsa maloetse. '29

Khokahano e le 'ngoe e hlakileng lipakeng tsa kelello le somatic ke ts'abo e phahamisitsoeng mabapi le ho lekana ha ts'ebetso ea thobalano eo maemo a manyolo a atisang ho a qholotsa. Joalo ka ha Bancroft le Janssen, har'a ba bang, ba hlokometse, ho holofala hanyane kapa ka linako tse ling ts'ebetsong ea erectile ho ka hlaha ka lebaka la maemo a mangata, ekaba a sa foleng (mohlala, mathata a methapo, pheriferale ea pelo) kapa a hlobaetsang (tšebeliso e feteletseng ea joala). Ho ka ba le likhaello tse ling haeba monna a tšoenyehile ka bothata bona bo bobebe. Ka mantsoe a mang, karabelo ea kelello e tsoang ho ts'ebetsong e fokolang ea erectile e ka lebisa ho 'khatello ea ts'ebetso,' e ka akaretsang le maemo a mang ho ntšetsa pele ts'ebetso ea erectile. Matšoenyeho a ts'ebetso, joalo ka matšoenyeho afe kapa afe, ho hlakile hore ke lentsoe la kelello bakeng sa boemo ba kelello. Leha ho le joalo ka ha re se re hlokometse, matšoenyeho le ona ke boemo ba 'mele / mmele bo ka alafshoang ka lithethefatsi tsa khatello ea maikutlo. Tse ling tsa lithethefatsi tsena, ka litekanyetso tse ling, ho ka lebelloa hore li sitise maikutlo a matle a mpefatsang ED. Ho joalo, ho noa joala bo bonyenyane ke moriana oa setso oa ho eketsa takatso ea thobalano le ho fokotsa ts'ebetso ea matšoenyeho, ka hona ho ts'ehetsa tšebetso ea erectile. (Bolaoli bo boletsoeng khafetsa mabapi le litekanyetso tse kholo mohlomong ke William Shakespeare, ea hlokometseng (Macbeth Molao oa II, Pono ea 2), joala boo 'bo tsosa takatso, empa bo tlosa tšebetso.')

Mohlala o motle oa kamoo litebello li ka amang ts'ebetso ea erectile li tsoa thutong ke Cranston-Cuebas et al a.30 Ba bapisitse banna ba etsang thobalano le ba sa sebetseng ba shebelletseng erotica kamora ho nka lipilisi tse tharo tsa placebo tse ntlafalitsoeng ho ntlafatsa moralo, ho sitisa ho ikatisa, kapa ho ba teng. Joalokaha ho ka lebelloa, banna ba sa sebetseng hantle ba ne ba e-na le litšebelisano tse fokolang le sehlahisoa seo ho thoeng se senya. Ho makatsang ke hore banna ba neng ba sebetsa ka thobalano ba ne ba e-na le maqhama a matla le motho eo ho nahanoang hore ke mohloekisi, phello e khutlisetsang. Liphetho tsena li ka talingoa e le mehlala ea tšebetso ea sebaka sa erectile (dys), moo ts'ebetso e fapaneng ho latela likarolo tse ling tsa banna, ho kenyelletsa melao ea bona ea boipheliso e bohareng le melao ea bona ea thobalano, nalane ea bona ea thobalano le maemo a haufinyane a kopano ea thobalano.

(d) 'Psychogenic' ED hangata e fumanoa ka ho qheleloa ka thoko

Ka mokhoa o nepahetseng, ho hlahlojoa ha lisosa tsa ED ho kenyelletsa tlhahlobo e felletseng ea 'mele le tlhahlobo e pharaletseng ea lipotso, mohlomong ho kenyelletsa liteko tse hlakileng tsa kelello, ho theha nalane ea ho se sebetse hantle le maemo ao a etsahalang tlas'a ona. Liteko tse ling li ka kenyelletsa tlhahlobo bakeng sa ho hlaseloa ke penile tumescence, kapa erection-e amanang le boroko, eo bonyane ka nako e 'ngoe e neng e nkuoa e le e hlakileng.31,32 Ka mantsoe a mang, haeba SRE e ne e tloaelehile 'me ho se na bopaki ba "organic pathology", joale ho ile ha nahanoa hore ha ho na bothata ba' mele ho thibela pelehi nakong ea kopano ea thobalano, mme ho ka etsahala hore ho fumanoe lefu la psychogenic ED. Ts'ebetso ena e beha mohlala oa ts'oaetso ka ho khetholoha.

Ho hloka botsitso ha sephetho sena ho tlalehiloe hantle, har'a mabaka a mang hobane maemo a joaloka khatello ea maikutlo le 'ona a ka sitisa SRE.33,34 Ho feta moo, lipatlisiso mabapi le taolo ea boko ea SRE liphoofolong li senotse hore likarolo tse ling tsa boko tse sebetsanang le SRE li fapane le tse laolang ho tsitsa nakong ea thobalano. Haholo-holo, liso tsa sebakeng sa pele sa preoptic sa hypothalamus ea likhoto li thibela ho ts'oaroa nakong ea boroko ba REM ntle le ho ama boroko ba REM ka bobeli, hape ntle le ho ama sebopeho maemong a mang.35 Mohlala ona ke o mong oa ba bangata o bonts'ang hore neural le endocrine mediation ea erection e fapana ho latela taba ea thobalano ho ea ho e 'ngoe, ho ipapisitse le hore ts'usumetso ea thobalano ke ho ts'oaroa ke setho sa botšehali, ho qopitsa, karabelo ho ts'usumetso e hole joalo ka monko kapa pono, kapa boroko bo amanang. .11 Ka hona, likhohlano tse teng sebopeho sa 'mele oa sebopeho ntlheng e le' ngoe li ka 'na tsa se ke tsa hakanyetsoa ke ED maemong a mang.

(e) 'Psychogenic' ED ha se 'tsohle tse kelellong'

United States le lefats'eng ka bophara, sechaba se nka mathata a 'bongaka' le mathata a 'kelello' ka tsela e fapaneng, hangata se nyenyefatsa mathata a morao empa eseng a pele (ntle le mabaka a mang a joalo ka mafu a tšoaetsanoang ka thobalano le lithethefatsi). Ka tshohanyetso, bafani ba tlhokomelo ea bophelo bo botle, indasteri ea inshorense le mmuso ba sebetsana le 'mefuta' e 'meli ea mathata ka tsela e fapaneng ho latela tšireletso le matšeliso. Mathata a 'kelello' hangata ha a koaheloe ke inshorense, 'me haeba ho joalo, ke liketelo tse fokolang tsa lingaka tse lumelloang le ho lefuoa chelete e tlase. Ka lebaka la semelo sena sa sechaba, ha ho makatse hore mathata a bongaka a nang le likarolo tsa psychosomatic hangata a nkoang a le "kelellong eohle" mme ka hona a khesoa. Le ha ho hlahlojoa ha psychogenic ED ho sa reretsoe ho fana ka maikutlo a hore 'tsohle li kelellong ea hau,' ho utloahala hore mokuli a ka etsa joalo, kapa bonyane a fane ka seo ke seo ngaka e se lumelang. Lilemong tsa morao tjena, litsebi li amohetse ka bophara poleloana e reng 'ho se sebetse hantle' ho qoba sekhobo se bakoang ke 'ho hloka matla.' (Hlokomela, leha ho le joalo, 'ho hloka matla' ho ntse ho le teng lebitsong la koranta ena le mokhatlong oa eona oa batsoali.) Mohlomong ke nako ea ho amohela hore ho ba fumanang ts'oaetso ena, 'psychogenic ED' mohlomong ha e na mathata a mangata ho feta 'ho hloka matla ha kelello . ' Haeba lingaka li ka utloisisa hore ho na le motheo oa manyolo bakeng sa seo joale se nkoang e le lefu la kelello le sa foleng, sekhobo se amanang le sona se ka fokotsoa, ​​'me kalafo e ka koaheloa habonolo ke inshorense. Sephetho se seng e kanna ea ba hore banna ba na le monyetla oa ho batla kalafo. Ho joalo, lithethefatsi tse ling tse fumanehang hajoale li bonahala li sebetsa maemong a mangata le a manyolo a ED. Leha ho le joalo, phumaneho ea kalafo e sebetsang ea bongaka bakeng sa maemo a ED ha e ngangisane khahlano le tšebeliso ea mekhoa ea kelello ea bothata. Ho na le bopaki ba hore kalafo ea kelello bakeng sa 'mafu a kelello' a itseng a fetola 'mele oa boko bo khethollang mathata ana.36 Ka hona le hoa utloahala ho fana ka maikutlo a hore 'kalafo ea ho bua' e sebetsang bakeng sa ED e ka nka bohato ka ho fetola fisioloji ea mantlha, mohlala, ka ho eketsa nyakallo kapa ho fokotsa tšitiso.

Ka holimo ho leqephe

Lekhetho le leng hape la ED

Mohlomong ha ho na taxonomy ea ED e ka fihlelang mofuta oa lekala la liqeto le leng teng bakeng sa ho khetholla maemo a itseng a bongaka kapa ho khetholla mefuta ea linonyana kapa lifate. Empa, Lethathamo 2 e fana ka mokhoa o fapaneng le tekhetho e khothalletsoang ea komiti ea ISIR e rarollang a mang a mathata a hlahisitsoeng pampiring ena, ha e ntse e boloka likarolo tse 'maloa tsa eona, mareo a eona, mohlomong le mathata a eona. Karolong ena, organic ea ED e abeloa mathata a kahare kapa a bohareng, ke hore, kantle ho kapa kahare ho boko le lesapo la mokokotlo. Mathata a bohareng ha a kenyeletse feela a ka fumanoang ka ho hlahlojoa ke methapo le endocrine, empa hape le maemo a joalo ka khatello ea maikutlo le khatello ea maikutlo, eo bokena-lipakeng ba eona bo tlalehiloeng hantle joalo ka ha bo ile ba hlahlojoa pejana. Hape ho kenyelelitsoe mona ke lintlha tse amanang le botsofali ha bolwetse bo amanang le botsofe bo tlohelloa kantle. Tsamaiso ena ea lekhetho e boetse e lumella phapang lipakeng tsa mathata a endocrine, ka mohlala, hypogonadism ea mantlha kapa ho se mamele ha androgen-receptor liseleng tsa thobalano, le tse tsoang bokong, ka mohlala, gonadotrophin e lokollang hormone kapa mathata a metabolism metabolism bokong. Boemo ba ED bo bolokiloe bakeng sa linyeoe tse hlakileng tsa li-episodic,-sensitive-ED tseo ho tsona balekane ba bang, tikoloho, kapa ts'ebetso e nahanoang e hlokang ho sitisa tšebetso ea erectile, athe maemo a mang a sena mathata.

Tafole ea 2 - Lekhetho le leng la ho se sebetse ha erectile ntle le khethollo ea organic-psychogenic.

Lethathamo la 2 - Lekhetho le lengata la ho se sebetse hantle ha erectile dysfunction ntle le phapang ea organic-psychogenic - Ka bomalimabe ha re khone ho fana ka sengoloa se fumanehang bakeng sa sena. Haeba u hloka thuso ea ho fihlela setšoantšo sena, ka kopo ikopanye le thuso@nature.com kapa sengoliTafole e feletseng

 

Seo re se hlakisang thekisong ena ea thekiso ke hore mathata a mang a tlhaho a ka lumella ho ikamahanya le boroko ha a ntse a sitisa tokisetso maemong a mang. E 'ngoe ea mathata a nang le taxonomy e boletsoeng ke hore e boloka li-dichotomies tse hlakileng vs Sebaka, Peripheral vs bohareng). Karohano ea maemo a ED le organic ea ED ha ea lokela ho nkuoa e le ho bonts'a hore ha ho na motheo o hlakileng oa manyolo bakeng sa boemo ba ED bo ka phekolehang ka lithethefatsi tse sebetsang tsamaisong ea methapo e bohareng (mohlala, anxiolytics) kapa botoneng (mohlala, HA HO na le synthase inhibitors). Ho lekanyetsa karolo ena liketsahalong tse ling tsa nakoana tsa ED ho bolela hore ha ho na mafu a sa foleng a CNS a ka lumellang sehlopha sa ona tlasa organic ED. Leha ho le joalo, tsena li lokela ho nkuoa e le litlelase tse hlophisitsoeng hantle; ha e le hantle, mafu a mangata a kenyelletsa lintlha tse bohareng le tse potileng, 'me polelo ea lintlha tsena hangata e tla angoa ke ho tšoenyeha ha monna ka molekane oa hae, tikoloho le ts'ebetso ea hae ea thobalano. Ho tseba lisosa tsa ED e kanna ea ba taba ea ho beha lintho pele, haholo joalo ka ho beha pele lisosa tsa lefu ho setifikeiti sa lefu.

Ho na le bothata bo boholo ho fumana tlhahlobo le kalafo ea 'meleng oa sebopeho le' mele oa hau. Leha ho le joalo, e lokela ho hopoloa hore leha sesosa sa bothata ba thobalano se sa lemohe, ho ntse ho ka ba le pheko ea kokoana-hloko bakeng sa eona. Mohlala, acetylsalicylic acid (aspirin) e ile ea tšoara hlooho ka katleho nako e telele pele ketso ea eona ea sebopeho sa prostaglandin e utloisisoa. Ho kanna ha ba molemo ho nahana ka tsoelopele kalafong ea bothata bo bong bo tloaelehileng ba thobalano, e leng ho potlakisa (pele ho nako). Ho fihlela haufinyane, bothata bona bo ne bo atisa ho nahanoa hore ke ba kelello bo simolohileng ho mafu a kelello, 'me banna ba ne ba tloaetse ho fuoa kalafo ea kelello ho phekola boemo — haeba ho hlile ho fanoa ka kalafo. Leha ho le joalo, joale kalafo e sebelisoang ka litlhare tsa serotonergic kapa antiadrenergic e fana ka thuso maemong a mangata a joalo,37,38 ho fana ka bopaki ba tharollo ea manyolo a bothata bona ba 'psychogenic'. Motho a ka nahana hore lipatlisiso tse tlang li tla etsa qeto ea hore banna ba nang le bothata bo sa foleng ba ho lieha ho tsoa mali, hammoho le banna ba nang le maemo a ED khafetsa, ba tloaetse ho robala ka thoko ho mefuta e tloaelehileng ea banna mabapi le methapo ea methapo , jj.) tsa libaka tsa boko tse laolang mesebetsi ena. Le 'bokuli bo sa foleng ba thobalano' bo kanna ba mela ka metso khemisteng ea boko: mefuteng e meng lihormone tsa oxytocin le vasopressin, hammoho le liphatsa tsa lefutso tse laolang ponahalo ea lihormone tsena, li laola tloaelo ea banna le basali ho theha maqhama a mabeli.39 Ho bua 'nete, ho itlama ka lenyalo ha ho tšoane le ho ba le likamano tsa botona le botšehali, empa li amana ka ho lekana ho lebella hore liphapang tsa methapo ea kutlo le tsona li thusa ho khetholla liphapang tsa batho ka bomong.

Ho amohela sebaka sa ED joalo ka karolo e bapisoang le sebopuoa sa ED, joalo ka ha ho hlahisitsoe mona, ke mokhoa o mong o fapaneng. Leha ho le joalo, esita le maemo a ED a kopantsoe ke lintho tse phelang. Mohlomong "organic" ea ED e lokela ho lahloa e le karolo e kholo ea ED; ebe boemo ba ED bo ka khethoa e le mofuta oa boraro oa ED, parallel le paripheral le bohareng ba ED, kapa e le mofuta oa bohlano oa ED bohareng. E 'ngoe ea mekhoa ena e bonahala e le hantle ho boloka karohano ea hona joale pakeng tsa psychogenic le organic ED, e etsang phapang e fosahetseng pakeng tsa lits'ebetso tsa kelello le tseo e seng tsa tlhaho le likoluoa. Phapang ena ha ea lokela ho lahloa, eseng feela ho tsoa ho taxonomy ea ED, empa hape le monahanong o hlophisehileng ka lisosa tsa ho fetoha le mathata a ona.

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Ka holimo ho leqephe

Liteboho

Pampiri ena e nehetsoe ho Julian M Davidson, 15 April 1931-31 ea December 2001, mohopolong oa maikutlo. E meng ea mehopolo e hlahisitsoeng mona e hlahile pele ho sengoloa sa pele (Sachs 11) mme li hlahisitsoe sebokeng ho Seboka sa Lefatše sa 9th mabapi le Lipatlisiso tsa Impotence, Perth, Australia, 26-30 November 2000. Papali ena e hlahile ho 14 June 2002 e le mohlophisi oa baeti koranteng ea litaba ea online-linehttp://www.urohealth.org/editorials).