What medicine is the most effective if you don't force yourself to take it?

Fatigue can also cause impotence, which is caused by depression and tension caused by excessive muscle fatigue or excessive use of the brain, thereby arousing sexual desire, including decreased brain function and inhibition of sexual interest, decreased excitement and libido in the emotional center of the cortical limbic system, and decreased androgen secretion in the pituitary gland and testicles, and decreased sexual excitement. When the nervous system lesions are also caused by impotence, local brain damage caused by hypothalamic pituitary tumors or other parts of the tumor.

The causes of erectile dysfunction can be categorized as:

1. Psychological ED

Refers to erectile dysfunction caused by psychological factors such as tension, stress, depression, anxiety and marital discord.

2. Organic ED

(1) Vascular causes include any disease that may lead to decreased blood flow in the corpus cavernosum arteries, such as atherosclerosis, arterial injury, arterial stenosis, pudendal artery shunt, and abnormal heart function, or penile venous leakage caused by decreased smooth muscle in the tunica albuginea and sinus cavernosum of the penis that obstruct the closure mechanism of venous reflux.

(2) Neurological causes: Central or peripheral nerve diseases or damage can lead to erectile dysfunction.

(3) Surgery and trauma Major vascular surgery, radical prostatectomy, radical abdominoperineal rectal cancer surgery, and other surgeries as well as pelvic fractures, lumbar compression fractures, or straddle injuries can cause damage to the blood vessels and nerves related to penile erection, leading to erectile dysfunction.

(4) Endocrine diseases, chronic diseases and long-term use of certain medications can also cause erectile dysfunction.

(5) Diseases of the penis itself, such as penile induration, penile curvature, severe phimosis and balanitis.

3. Mixed ED

Refers to erectile dysfunction caused by both psychological factors and organic causes. In addition, since organic ED is not treated in time, the psychological pressure of patients increases and they are afraid of sexual intercourse failure, making ED treatment more complicated.

▍Clinical manifestations

Persistent inability to achieve or maintain an adequate erection for more than 3 months.

▍Inspection​

1. Physical examination

In addition to a detailed inquiry into the medical history, especially the sexual history, a physical examination is essential for diagnosing ED, with a focus on examining defects and abnormalities in the nervous, endocrine, cardiovascular systems, and reproductive organs that are related to ED.

1. General

Attention should be paid to body shape, hair and subcutaneous fat distribution, muscle strength, secondary sexual characteristics, and the presence of gynecomastia, etc. This is related to the presence of abnormal gonadal function such as cortisol, thyroid disease, hyperprolactinemia, and testicular dysfunction.

2. Cardiovascular system

Measuring blood pressure and pulse in the limbs, and absence or weakening of femoral and popliteal artery pulses may indicate embolism or stenosis of the abdominal aorta or iliac artery.

3. Nervous system

Pay special attention to the pain, touch and temperature difference sensation in the lower back, lower limbs, perineum and penis, the vibration sensation of the penis and toes, the bulbocavernous body reflex (when the glans penis is stimulated, the finger inserted into the anus should feel the anal sphincter contraction) and other changes in the nervous system.