Erectile dysfunction in young men (up to 40 years old). What does organic or psychogenic predominate?
Ion, D1; Iurie, A1; Adrian, T1; Boris, B1
1: “Nicolae Testemitanu” State University of Medicine and Pharmacy of the Republic of Moldova, Moldova
Erectile dysfunction tends to affect a growing number of men aged up to 40 years. It is usually thought that in the young men, the main causes of erectile dysfunction are psychological. At the same time, a number of organic diseases that cause erectile dysfunction in aged men tend to rejuvenate.
Objectives: Evaluation of the causes and evolutive peculiarities of erectile dysfunction in men up to 40 years.
Material and methods: The study included 198 consecutive patients up to 40 years old, out of a total of 586 patients with erectile dysfunction examined in the Urology Clinic of the “Nicolae Testemitanu” State University of Medicine and Pharmacy of the Republic of Moldova, in the period 2012-2016. The standard review protocol included completing the IIEF, NIH CPSI, IPSS questionaries, complex physical examinations: BMI and blood pressure inclusive, and laboratory examinations. Optionally, we performed complex microbiological analyzes, total and free testosterone, 25OH vit D levels, prostate ultrasound, or penile doppler ultrasound.
Results: The average age of patients was 35 + -3.9 years. The average value of the IIEF-5 index was 16 + -4.2. The known organic etiology have had 54 (27%) patients. Among organic causes was reported: obesity, hypercholesterolemia, or dyslipidemia in 21 (11%) patients, diabetes mellitus 8 (4%) patients, penile diseases, Peyrony disesase and phimosis in 12 (6%), hypogonadism 6 (3%) neurological diseases in 4 (2%) patients, and other diseases - 3 (1.5%) patients. Penile doppler ultrasound confirmed vascular causes of erectile dysfunction in 20 (10%) patients. In 145 patients (73%) the cause was psychological or mixed. Among them we mention the 66 patients with chronic prostatitis (33%) in 18 (27%) type II, 27 (40%) Type IIIA and 21 (33%) Type IIIB, in which psychological issues have had obvious organic substrate caused by pain or premature ejaculation, as well as 8 (4%) patients with short frenulum with similar causes.
Discussions and conclusions: In our study the prevalence of organic causes of erectile dysfunction in men aged up to 40 years is about 27%. At the same time without the psychological factors as the cause of the organic substrate, was only 36%. In 37% of cases, erectile dysfunction was associated with an organic disease. Contrary to traditional opinion, our study data show that in about 65% erectile dysfunction in the young man can be caused by an organic factor. Treatment of young patients with organic or mixed erectile dysfunction will include not only PDE5 inhibitors but also other specific measures including surgical interventions when needed.
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