Modern diagnostic methods detect organic erectile dysfunction disorders of varying severity in about 80% of all cases of ED; the remaining 20% are patients whose ED is triggered mainly by psychological problems. According to some authors, PDE-5 inhibitors for ED treatment of psychogenic nature demonstrate considerable efficiency in about 80% of cases.
The reason for such poor indicators lies in the mechanism of action. Thus, ED medications are able to potentiate the relaxing effect of NO on smooth muscle cells of the trabecular tissue. However, the starting point for the release of not on nerve impulses coming from the central nervous system, but on the patient’s response to sexual stimuli expression of sexual desire or libido.With a sharp decrease in libido PDE5 inhibitors monotherapy is ineffective due to lack of substrate for their actions. If the psychological factors that contribute to ED are not associated with decreased libido (situational, behavioral), a decent effect due the application of these drugs can be expected. Unfortunately, the number of disorders that weaken the sex drive increases so fast that it was necessary to create a special term for them hypoactive sexual desire disorder.
According to a number of studies, 14-17% of males between the ages of 18 and 59 years have a marked decline in interest in sex. Among the psychological factors of this phenomenon the most common one is asthenia. According to some authors, asthenia (from Greek impotence, weakness) is a real scourge of modern society.Asthenia syndrome is polymorphic. In addition to fatigue and lack of motivation, it is characterized by loss of appetite, memory, attention, physical endurance. Among the causes of functional asthenia the following are typically mentioned: isolated mental illness (depression), fatigue, stress, post-infarct, alcohol withdrawal, and others. An important role in the development of fatigue also play violations ofbiological rhythms that occur during rapid change of time zones, when working in different shifts in the elderly. It is believed that the basis of fatigue is a violation of the regulation of the use of energy resources of the body, leading to the failure of the recovery processes.
Particular importance in the development of asthenic syndrome belongs to the function of the reticular activating system (RAS). This system governs the control the coordination of voluntary movements, autonomous and endocrine regulation,sensory perception, memory and cerebral cortex activation. Unlike fatigue, which is a physiological process and disappears after a period of rest, asthenia is a pathological process, chronic and poorly reversible. Inherent symptoms persist after relaxation treatment and require specific approaches.