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Erectile Dysfunction: Endothelial Dysfunction; 115

Emotional Disturbance

Research today has proved that Penis is the barome- and what you do to your body is the crux of our re-
ter of Endothelial function and Erectile dysfunction maining healthy.
7
is the earliest marker of Myocardial ischaemia. The Rishi Vatsayana in Kamasutra says sex is to be used
onset of Coronary artery disease is at least 2 to 3 and not abuse. Sex wasn’t God’s mistake, judging
years after the onset of erectile dysfunction. So, if against it is humanity’s biggest mistake. So, by ad-
we detect erectile dysfunction as early as possible we dressing the physical, psychological and couple fac-
can retard the onset of critical events like Myocardi- tors we physicians can play a major role in helping
al infarction or stroke in an individual, by changing our sex starved patients enjoy by improving their
his life style and reducing the risk factors, like con- sexual functions, increase their self-esteem and
trolling hyperglycaemia, dyslipidemia hypertension, give them good quality of sex life. Sensitivity of the
and smoking.
physician in approaching the problem by just asking
The endothelium plays a vital role in maintaining their patients about their sex life shall make a great
vascular homeostasis in the penis. Endothelial-de- difference. Sympathetic approach along with relevant
8
rived NO plays an integral role in the physiology of treatment to all patients with erectile dysfunction will
erection both in normal and in pathological disease go a long way in improving their sex starved life.
states. The earliest detectable changes in vascular
disease states associated with ED are abnormalities References:
of the endothelium, causing a loss in its normal ho- 1. Masters and Johnson Male Sexual response
meostatic mechanisms that conventionally protect
against disease-related processes. Given the central 2. DSM 1V American Psychiatric Association
importance of the endothelium, it is not surprising 3. International Disabtes Federation Atlas 2016
that conditions that cause endothelial dysfunction, 4. Michael S. Goligorsky: Division of Nephrology and Renal Research In-
such as aging, diabetes, cardiovascular disease, and stitute, Departments of Medicine and Pharmacology, New York Medical
hypercholesterolemia, are closely associated with ED. College,
Indeed, normal penile erection requires coordinated 5. Bonetti P, Lerman L, and Lerman A. Endothelial dysfunction. A marker of
arterial endothelium-dependent vasodilation and si- atherosclerotic risk. Arterioscler Thromb Vasc Biol 2009, 23: 168– 175,
nusoidal endothelium-dependent corporal smooth 6. Maas R., Schwedhelm E., Albsmeier J., Boger RH. The pathophysiology
muscle relaxation. of erectile dysfunction related to endothelial dysfunction and mediators
of vascular function. Vasc Med. 2002;7: 213–225.
Another important aspect of Erectile dysfunction is 7. Taddei S., Virdis A., Ghiadoni L., Salvetti G., Bernini G., Magagna A., Sal-
that it does affect the individual by imbibing in him vetti A.. Age-related reduction of NO availability and oxidative stress in
a feeling of inadequacy, reduces self-esteem, frus- humans. Hypertension. 2001;38: 274–279.
trates a man and makes him anxious and depressed 8. Sullivan ME, Thompson CS, Dashwood MR, Khan MA, Jeremy JY, Mor-
and not to confront the failure in performance in the gan RY, Mikhailidis DP. Nitric oxide and penile erection: is erectile
bed room, he avoids having sex and feels guilty or dysfunction another manifestation of vascular disease? Cardiovasc
tries to blame the partner. Also, the partner gets frus- Res. 1999;43: 658–665.
trated and angry and has low self-esteem and even 9. Hurt KJ, Musicki B., Palese MA, Crone JK, Becker RE, Moriarity JL, Sny-
tries to suspect the husband as he is avoiding having der SH, Burnett AL. Proc Natl Acad Sci U S A. 2002;99: 4061–4066
sex. All these take a heavy toll on the relationships
as there is unhappiness, no communication at times
they quarrel or become violent because of comparing
themselves with other colleagues etc. out of jealou-
sy. Eventually there have been incidence of marital
breakdown and divorces. If this couple is married and
have some children they become poor role models
for their children. All this leads to a mental turmoil
and a disturbed family environment and in fact Emo-
tional disturbance sets in.
Erectile dysfunction is not an option, not for anyone
with metabolic syndrome or any other cause of erec-
tile dysfunction. It is how gracefully we handle the
process and how lucky we are as the process han-
dles us. I believe that to be sexually fit is a choice
and a lifestyle decision. It’s what you put in your body

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