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After a few years in the market, and their emergence has led to prejudice and false beliefs, which were eliminated. In the early stages of research and clinical use, has proven highly effective with few side effects. Today, sildenafil citrate, known as Viagra has become one of the most used drugs, and that in recent years, its worldwide sales rose a dizzying manner. Commotion by the appearance of the famous pill, which was originally developed Viagra (sildenafil citrate) as a treatment for heart problems. However, later studies showed that this pill also increased blood flow to the penis, so quickly was considered effective for the treatment of erectile dysfunction (impotence). Viagra was approved by the Agency of food and medicine in the United States in 1998. Since then it has become popular, and today is available in over 90 countries.  Has proven effective in treating impotence.

This may be caused by aging, vascular disease, diabetes, prostate operations, spinal cord injuries and even have psychological origins. Sildenafil, which is marketed under the name Viagra, favors the increase of blood supply to the penis, causing erection. But this drug only works when the man is sexually aroused. Despite the upheaval that brought the advent of Viagra, in the medical, media and popular at first sales were not expected and the acceptance by the patients was with some trepidation and reluctance. However, sildenafil is a drug, both in the stages of research and in clinical use, has proven highly effective with few side effects. It is important to note that this is a drug for a specific medical and psychological condition: erectile dysfunction. Although there are people who use it to improve sexual performance, and is even being considered for use in women.

Erectile dysfunction is the inability of a man to achieve and / or maintain an erection sufficient for satisfactory sexual intercourse. While formerly known as impotence, is now considered that the term "erectile dysfunction" is more appropriate, given the negative connotations with some people associated the word impotence. Many men have or will have an occasional erection problem at some point in their lives, while for others it will become a common problem. Currently, this condition affects more than 100 million men worldwide.  Erectile dysfunction should not be something shameful, does not mean it is sterile or that it can have an orgasm or ejaculation. Given the evidence that erectile ability is not related to orgasm and ejaculation, men with erectile dysfunction should no longer be haunted by the myth that lack of power and virility. Erectile dysfunction is treatable in most cases and although not a life threatening condition "still remains severe, can have a major impact on man's self esteem and their relationships.

Approaching sexual response .-  The sexual responses of men and women transform their genitals in an effective inert playback equipment. "The urinary flaccid penis becomes erect phallus reproductive dry while the potential space of the vagina becomes an open receptacle, greased and congested" (Kaplan, 1974). In men an erection until ejaculation moves, but instead in women, the swelling and lubrication of the genitals culminating in orgasm, is how in the first part of the sexual response is genital vasocongestion. The second orgasm is basically a series of clonic contractions involuntary genital musculature. (Encarta, 1997).

In the male erection is caused by congestion of blood vessels in the penis. Penile vessels expand and closing Special venous channels. The blood is enclosed in "caves" special, and this mechanism basically hydraulic, enlarge the organ. The autonomic nervous system is involved in this reaction to nerves - sympathetic produce dilation of arterioles, whereas the sympathetic control probably closing the venous valves (Kaplan, 1983). Orgasm in men is a different reaction and consists of the issue (that men perceive as a sense of inevitable ejaculation) and ejaculation (contractions of 0.8 seconds duration of striated muscles at the base of the penis bulb cavernosum and the ischium - cavernous) (Kaplan, 1983).

In women like two things happen: in response to sexual arousal occurs vasocongestion blood vessels of the mouth and the tissues around the vagina, which also causes vaginal lubrication. Moreover, unlike men, female orgasm is just a phase (no phase-in capital) consisting of 0.8 seconds contractions bulb and hamstring muscles - cavernous, and also of the pubococcygeus. (Kaplan, 1983)

When these reactions of men and women, or any of its component, suffer a decline, the result is a sexual dysfunction.

Stages of sexual response .-

In what has been exposed, it is possible to see clearly that sex is a highly complex activity, which should be viewed as a unit. However, in order to analyze the many aspects of it have been several divisions. One of them is referred to the stages of the sexual act, namely:

Excitement phase (Figure 1)

The first sign of arousal in men is penile erection. A marked increase in its size and growth angle relative to the body. This erection may be due to stimulation of the penis as such or by a chain of erotic thoughts.

Masters and Johnson have called primary response to sexual stimuli, changes in vascularity that occur at that stage. The secondary reaction would be the contraction of several fibers and muscle groups. We found other changes in arousal in man appears voluntary muscle tension across the board and there may be some involuntary contraction of muscle groups. Receive an increase in heart beats and blood pressure increases, the testicles become more firm, they rise and approach the body.

For there to the stage of excitation is required minimum degree of sexual tension. Erection to completion, this phase may extend for a few seconds or even up to many minutes, this depends on the variations in affective sexual stimulation.

In the study by Masters and Johnson the erection was maintained in subjects over long periods carefully controlling the variation and intensity of stimulation techniques. During a prolonged excitement phase, it was possible to make an erection to intentionally lose and win again on several occasions. So with such situations, the erection is maintained without obtaining the glass - complete expansion or total loss of it.

Psychosensorial Various stimuli have been tested experimentally in the laboratory during the excitement phase. The erection can easily suffer by the introduction of a sexual stimulus maintained despite concomitant sexual stimulation. This can cause partial loss or even complete, penile erection, while maintaining the somatic stimulus.

The Pontic steppe of "Plateau" (Figure 2)

The increase of female genitalia in humans occurs in the excitement phase. However, one can say that there is a gradual increase in the corona of the glans penis at the base, which occurs at the stage of plateau or plateau. That may be accompanied by an increased reddening of the region. At that stage, in addition, the diameter of the testes increased by 50% and more channels are shortened sperm. The elevation of the testes shows that man has reached the "point of no return" and that his orgasm is imminent.

The breathing rate increases and continue to increase blood pressure and heartbeat, is raising tensions in voluntary and involuntary muscles

Orgasm: (Figure 3)

Unlike female orgasms, male can be seen as carved in the same mold, while the women are extremely varied. The central fact of the male orgasm are the rhythmic contractions, which they are growing at an accelerated rate and becoming increasingly distant and soft. Anyway, man can identify subjectively the occurrence of orgasm just before you know it.

The ejaculation of semen that occurs during orgasm, is a more or less complicated mechanism. Before orgasm contraction occurs channels that carry sperm fluid containing sperm cells. The prostate gland, is also working with fluids that are routed to the urethra. Such fluids are accumulated in a bulb that is in the urethra, near the base of the penis. These changes occur in the first stage of ejaculation, stage at which it feels that orgasm occurs.

During the second stage, a series of contractions of the bulb, the urethra and penis, projecting the semen out under great pressure. This pressure decreases with age, being lower in older men.

The changes in the genitals during orgasm, are accompanied by other changes in the rest of the body, on blood pressure, respiration, etc.. These muscular contractions are often imperceptible to the subject, but not infrequently complain of muscular pains in various parts of the body.

Figure 1: Status of excitation

Figure 2: Stage of "Plateau" or plateau

Figure 3: Phase orgasmic

2. Sexual dysfunction

2.1. Nature and causes of sexual dysfunctions

The ancients believed that only a deep neurotic conflict could affect sexual reactions, and that the only vectors of the sexual relationship were severely pathogenic conflicts and regressive child-centered fear, illusion and unconscious traumas if they enjoyed sex and it was only possible to cure these symptoms by means of resolution of deep unconscious conflicts. (Kaplan, 1983).

Masters and Johnson suggested that often the roots of psychopathology arise from a land far away. Anxiety about her own performance, the insecurities, tension, anxiety, etc. Can cause (and, indeed, cause) a great deal of sexual difficulties (Kaplan, 1983). And this is quite logical because in physiological terms "destructive sexual anxiety is the same when a man terrified by the possible repetition of an erectile difficulty induced by alcohol, or when due to the return of Oedipal taboos and fear of castration "(Kaplan, 1983).

Furthermore, sexual dysfunctions are closely related to health, so as arteriosclerosis, hypertension, depression, drugs, injuries and diabetes are very common causes of sexual dysfunction.

2.2. Sexual dysfunction features

As previously sexual dysfunction is, broadly speaking, a deterioration in any phase components of sexual response (or reactions), Kaplan (1983) describes six characteristics of sexual dysfunction, three men and three women :

2.2.1. Frigidity

Where the frigid woman does not experience sexual pleasure and erotic sensations and experiences no signs of physiological arousal (eg, lubrication).

2.2.2. Female orgasmic dysfunction

Where the woman has sexual responsiveness, has erotic feelings, and has a good reaction vasocongestiva, but experiences a varying degree of difficulty having an orgasm

2.2.3. Vaginismus

Where the woman's body prevents sexual reactions because the attempted vaginal penetration causes involuntary spastic contraction of the entrance to the vagina.

2.2.4. Delayed ejaculation

Where man has an orgasm involuntary inhibition (a disorder similar to female orgasmic dysfunction), the man with delayed ejaculation may feel sexual arousal and have a normal erection, but even if you receive a stimulus that should be quite sufficient, having trouble to release their ejaculatory reflex.

2.2.5. Premature ejaculation

Where the man reaches climax rapidly due to lack of adequate voluntary control over the ejaculatory reflex.

2.2.6. Impotence

Where the man can not get or keep an erection long enough to develop a satisfactory sexual activity.

2.3 The impotence.

There are several parameters to classify:

A. As to the form:

Erectile impotence: is one in which the inability to perform the sexual act is connected to the difficulty of penile erection.

Ejaculatory impotence: the difficulties are related to premature ejaculation, on the one hand, and the impossibility of ejaculation and orgasm, on the other.

Procreative impotence: the difficulties associated with man's ability to participate in fertilization.

Often they overlap, either as a symptom or as to the etiology.

B. Depending on the degree:

Total impotence: where is the total inability of erection, the penis remains in its state of greater flaccidity.

Partial impotence: where there is a decreased degree of erection which prevents or hinders the penetration of the penis into the vagina.

C. Time criterion:

Permanent impotence: when the subject has ever presented an erection during the course of his life.

Constant Impotence: Impotence occurs when the moment of its inception until its demise.

Occasional impotence: When not on an ongoing, but irregular in time.

D. According to the form of installation:

Impotence insidious episodes gradually appear in a proportional increase in relation to sexual encounters.

Impotence acute episodes occur in a given time, well circumscribed in time, place and situation.

E. According to the object:

Impotence selectively is that in which helplessness episodes occur with a particular partner and in a given situation.

Impotence is not selective: when the behavior occurs in all circumstances and all the partners.

D. According to the etiopathology:

psychogenic impotence

organic impotence order

3. Sexual dysfunction erectile

This is a "persistent and recurrent inhibition during sexual activity, manifested by partial or complete failure of man to achieve or maintain an erection to completion of intercourse (Kaplan. 1987, pp. 473).

3.1 Difference between impotence and erectile dysfunction:

This would be a form of sexual impotence, which can give a classification of different categories including those above. Within this distinguished, then, the primary sexual impotence where man has never been able to get an erection sufficient for vaginal penetration; secondary impotence, in this case the subject has achieved in a time of sexual penetration of the vagina, but later lost.

On the other hand, it is remarkable selective impotence, here the man is capable of engaging in intercourse in certain circumstances but not others. Regarding the etiology of psychological conflicts that occur are related impotence "with an inability to express the reason sexual impulse of fear, anxiety, anger or moral prohibition" (Kaplan, 1987, pp.176).

The use of the term "impotent" not only deepens the stigma, but is completely wrong as a definition. Men with erectile problems are not powerless, they have only diminished the ability to achieve and / or maintain penile rigidity. That's why the term "erectile dysfunction describes the problem in a much more accurate. The dysfunction can present a wide variety of degrees, ranging from men who are "powerless" (in the purest sense negative) to those whose problem is so small that even their partners are aware of their existence.

Among the organic bases include: tolerance to glucose, hormones, liver and thyroid function, determination of prolactin, FH and FSH, among others. It is therefore very important to a good story in determining etiology of dysfunction. As well as diseases: infectious and parasitic diseases, cardiovascular diseases. Disorders: Renal and urologic, hepatic, pulmonary, nutritional, neurological and endocrine. And other factors such as poisoning, drugs, genetics, surgery.

Diagnosis erectile sexual dysfunction:

The diagnosis was made in light of the clinical trial that takes into account the focus, intensity and duration of patient's sexual activity. The criteria involved are:

"Recurrent and persistent inhibition of sexual arousal during sexual activity, manifested by partial or complete failure to obtain or maintain erection to completion of intercourse.

Must coexist clinical trial that the individual engaging in sexual activities that are appropriate in type, intensity and duration.

The disturbance is not caused exclusively by organic factors (physical or drugs). "(Kaplan, 1987, pp.477).

Where tests are done to determine the organic basis or psychological disorder, the inquiry also gaining importance in the history of the subject.

Statistical indicators:

It is estimated that fewer men are impotent at age 35, between 2 to 4%. But at age 80, about 77% are.

The incidence of primary impotence in men of 35 years is 1%. Where the fear of getting it increases from 40 years, which is associated with the stigma attached to middle age where impotence arise with the anxiety and the need to succeed in sexual intercourse. Being in more than 50% of men treated for sexual disorders, impotence as chief complaint.

Importantly, it is estimated that 90% of cases of impotence is a psychological cause.

3.4. General causes of erectile dysfunction

Normally, when a man is sexually aroused, your penis increases in size, becoming erect and rigid, which allows the penetration of the sex of their partner. The penis usually measures between 7 and 10 cm long, erect size increases to about 17 centimeters, in fact, an erect penis contains six or seven times the blood volume of a flaccid penis (Encarta, 1997).

Impotence can have psychological causes. For example, if a man has lost his job his sense of failure can lead to temporary impotence suffer. Often it can also be caused by disorders of the blood system, nervous system, brain or hormones, as well as injury or surgery in the pelvis or penis. However, the most common cause is iatrogenic. That is, impotence can be caused by medications taken to treat other disorders. Diuretics, tricyclic antidepressants, H2 receptor blockers, beta blockers, hormones, etc.. (Encarta, 1997)

You can determine if the cause of the impotence of a man responds only to psychological reasons, if you experience normal erections during REM sleep is unlikely to be any organic cause for impotence when it is in conscious state. (Carlson, 1996). However, in some cases an organic cause is not serious enough in itself to cause impotence can make development more vulnerable if they also have other minor psychological factors. (Carlson, 1996)

The phenomenon erectile

How does an erection?

An erection is the result of a complex process that involves the blood vessels and nervous system. The anatomy of the penis is specially designed to meet this process. The penis is made up of two structures that are initiated within the pelvis and are developed in parallel until the end. These structures are composed of spongy tissue with large amount of blood vessels.

Generally, the walls of these vessels are contracted which prevents excess blood in the flaccid penis and keeps most of the time.
When a man experiences sexual stimulation, blood vessels expand, allowing a greater amount of blood flow quickly into the penis. Thus, the blood entering the penis produces an erection

From the point of view of the erection itself, we can say that this is a more or less durable in which the penis remains firm and elongated, and that this mechanism is due to automatic reactions controlled by the autonomic nervous system.

There are two types of erection:

Cortical and erection

Erection Reflects

In the first stimulations are present primarily with psychic phenomena. In the second, it involves some contact on the male genitalia, especially the glans.

Anatomo - Physiology

The anatomical structure of the penis (Figure 1) is the ideal support for the glass - dilation primary physiological response to sexual stimulation.

The penis consists of three cylindrical bodies of erectile tissue: the corpus cavernosum and corpus spongiosum. The chambers are two (right and left) located in the dorsal plane, parallel to each other, measuring from 15 to 16 inches in flaccid state and 20 to 21 centimeters in erection. The body also contains spongy erectile tissue, the urethra.

The three structures are surrounded by a single fibrous layer, the tunica albuginea and surrounded by thick sheaths.

At the base or root penile corpora cavernosa diverge to attach to the pubic rami and ischium (the pubic arch). Each is surrounded by the hamstring muscle - cavernous, striated nature. The corpus spongiosum, in turn, is encapsulated by a skeletal muscle forming the spongy bulb.

The two corpora cavernosa and corpus spongiosum, are penile erectile tissue receives arterial blood from the internal pudendal arteries. These branches are dorsal penile arteries, which lie near the dorsal surface of the tunica albuginea penis and on the other hand, the cavernosal arteries run longitudinally through each corpus cavernosum, two arteries bulb - are urethral longitudinally through the porous body in a ventral direction with respect to the urethra. These arteries terminate in small capillaries that open directly into the cavernous spaces.

The venous return is by the superficial dorsal vein and the deep dorsal vein .. The thickness of the corpora cavernosa are many compartments separated by bands or cords of fibrous tissue called tubercles. These compartments are intermixed with intima arterioles which supposedly contains small bumps in the state of contraction of partially occlude the lumen, retaining the blood in the cavernous sinus. When the arterioles dilate, blood flow to the penis increases and sinuses are filled. It is believed that penile veins contain valves that impede the outflow of blood. It is also believed that the contraction of the hamstring muscle - helps the cavernous venous constriction erection secondary to this mechanism is given little value today.

Not all the times it gives the glass - is a cause dilation of erotic type. They are also able to determine the erection of physical effort as lifting a heavy load (partial erection, usually) and have been erections due to irritative processes. There are still kind spontaneous erections that occur on awakening the subject, as well as erections during sleep.

The sexual feelings may stem from internal structures, such as irritated areas of the urethra, bladder, prostate, seminal vesicles, testes and efferent vessels.

One of the causes of "sexual need" is probably the saturation of the sexual organs and secretions. Infection and inflammation of those organs, sometimes causing almost continuous sexual desire. From the sensory standpoint, the glans contains a peripheral sensory system, highly organized, it transmitted to the central nervous system, a type of sensation that can be termed as sexual sensation.

The impulses can enter the spinal cord from areas adjacent to the penis to increase stimulation during sex. For example, stimulation of the anal epithelium, scrotum and perineal structures in general can send impulses to the bone, which increase sexual sensation.

Therefore the male sexual act, resulting from an inherent reflex mechanism integrated in the sacral spinal or lumbar and its mechanisms can be initiated because of mental stimulation or direct sexual stimulation.

Figure 4: anatomical physiology of the penis

The penis is a closed tube, consisting of three bundles of vascular tissue together by connective tissue and covered by loose skin. Two large bundles of tissue, the corpora cavernosa, form the top of the penis and contains numerous compartments that fill with blood during sexual arousal, causing erection and penile rigidity. The sacral nerves control the flow of blood into the corpora cavernosa, below these is the third bundle of tissue, the corpus spongiosum. This beam is perforated by the urethra. The end of the penis holds a widening rich in sensory nerve endings called the glans, which is covered by a layer of skin called the foreskin retractable.

Neurological Aspects

Neurological determinism of sexual function is more than the excitement of the nerve pathways below. Sexual reflexes congestion glass - motor, sensory excitation localized, and so on., Are called short tracks. They are only part of a function more variable and unpredictable amounts of motor responses offers potential and complex excitations emanating from all the senses, emotional impressions and intellectual affinities.

By studying the sexual neurological processes that we ignore the higher areas include associative processes that must be considered when studying the sexual phenomenon in its entirety. In this regard, little is known about the higher neuropsychiatric system of sexual activity, since studies with neurotransmitters are very recent. The results, though somewhat hasty, could indicate that dopamine has a stimulatory action of sexual responses while serotonin exert the opposite effect. Supporters of this theory have shown that high levels of prolactin (high prolactin levels is often accompanied by an underactive dopamine) may cause impotence in men.

Anyway, we must consider the system as a unit anatomical - physiological neural regulation of sexual function.

The excitement produced in any branches spreads throughout the system and therefore a malfunction of an element will be felt in sexual activity in its entirety.

Reflex erections that appear as responses to tactile stimulation of the erogenous zones appear without discrimination between sexual stimulation and sexual stimulus. By contrast psychic erection occurs in response to stimuli mediated by the central nervous system and, therefore, probably depends not only on external factors such as visual, but also the accompanying cognitive processes. Psychological factors often play an important role in male sex and can get started - even if not all - as we must focus our attention, from a neurological point of view, on three factors:

Peripheral device

Marrow

Brain

The sexual act of a man is inherent reflex mechanism integrated in the lumbar and sacral spinal mechanisms can start a direct sexual stimulation.

The erection is induced by nerve stimulation pre - sacral and pelvic. This reaction is the result of the addition of psychic stimuli and impulses carried affronts to central nervous system via the pudendal nerve.

With regard to the sexual organs, the sympathetic system, and for - nice play an important role for which both are in homeostasis. The sympathetic nervous system is composed of fibers emerging from the thoracic - lumbar spinal communications for higher brain centers. The system - sympathetic acts on the same tissues and structures that the sympathetic system, but their action is opposite. It originates in specific brain nuclei associated with certain cranial nerves and sacral spinal cord.

In satisfactory condition for the system - nice plays an important role, while under situations of fear, worry and anxiety, blood directed toward the somatic structures by the action of the sympathetic causes a reduction in the irritability of the sexual organs and resulting decrease activity or sexual desires.

The erection is accused by stimuli for - nice that are originated in the center for sympathetic vasodilator. These stimuli are of the sacral spinal cord to the penis through the erector nerves. This function is influenced by inhibition of sympathetic vasoconstrictor center. As we see, this function, by virtue of being regulated by the autonomic nervous system overrides any individual's effort to dominate the symptom of impotence, leading, conversely, an increase of inhibition.

Usually the man who wants a relationship not it focus on the erection, or to do so, fear of not having it, it affects the point that if this show, is going to be weak. And breaks the harmony of sexual function automatically emerging cortical inhibition, which includes physical and psychological components suggests the existence of a mediation controlled by the temporal lobe.

Despite the limitations to the study of central nervous system action, which relates to "sexual knowledge" and possibly work to integrate, analyze and interpret the various forms of sexual feelings and to initiate a response.

In a full central nervous system libido level sufficient to overcome the hypothalamic-way through and goes to the centers of the spinal erector, which stimulate an erection. This, feedback through sensory impulses, the temporal lobe, maintaining and increasing the libidinous charge in a process called reverberating circuit, which maintains the sexual and the individual's action.

The region hypothalamic - pituitary (Figure 2) is widely recognized as linked to sexual behavior.

Endocrine and sexual activity

The endocrine system serves to transmit the stimuli through the blood, in the form of specialty chemicals (hormones). In terms of endocrine glands are in constant sexual intercourse with the pituitary gland (or pituitary) as well as environmental and other glands. For an overview of the endocrine problems that relate to sexual activity must remember the pituitary (Figure 2).
Erectile dysfunction is the inability of a man to achieve and / or maintain an erection sufficient for satisfactory sexual intercourse. While formerly known as impotence, is now considered that the term "erectile dysfunction" is more appropriate, given the negative connotations with some people associated the word impotence. Many men have or will have an occasional erection problem at some point in their lives, while for others it will become a common problem. Currently, this condition affects more than 100 million men worldwide.

Erectile dysfunction should not be something shameful, does not mean it is sterile or that it can have an orgasm or ejaculation. Given the evidence that erectile ability is not related to orgasm and ejaculation, men with erectile dysfunction should no longer be haunted by the myth that lack of power and virility. Erectile dysfunction is treatable in most cases and although not a life threatening condition "still remains severe, can have a major impact on man's self esteem and their relationships.

Theoretical framework

1. Approaching sexual response .-

The sexual responses of men and women transform their genitals in an effective inert playback equipment. "The urinary flaccid penis becomes erect phallus reproductive dry while the potential space of the vagina becomes an open receptacle, greased and congested" (Kaplan, 1974). In men an erection until ejaculation moves, but instead in women, the swelling and lubrication of the genitals culminating in orgasm, is how in the first part of the sexual response is genital vasocongestion. The second orgasm is basically a series of clonic contractions involuntary genital musculature. (Encarta, 1997).

In the male erection is caused by congestion of blood vessels in the penis. Penile vessels expand and closing Special venous channels. The blood is enclosed in "caves" special, and this mechanism basically hydraulic, enlarge the organ. The autonomic nervous system is involved in this reaction to nerves - sympathetic produce dilation of arterioles, whereas the sympathetic control probably closing the venous valves (Kaplan, 1983). Orgasm in men is a different reaction and consists of the issue (that men perceive as a sense of inevitable ejaculation) and ejaculation (contractions of 0.8 seconds duration of striated muscles at the base of the penis bulb cavernosum and the ischium - cavernous) (Kaplan, 1983).

In women like two things happen: in response to sexual arousal occurs vasocongestion blood vessels of the mouth and the tissues around the vagina, which also causes vaginal lubrication. Moreover, unlike men, female orgasm is just a phase (no phase-in capital) consisting of 0.8 seconds contractions bulb and hamstring muscles - cavernous, and also of the pubococcygeus. (Kaplan, 1983)

When these reactions of men and women, or any of its component, suffer a decline, the result is a sexual dysfunction.

Stages of sexual response .-

In what has been exposed, it is possible to see clearly that sex is a highly complex activity, which should be viewed as a unit. However, in order to analyze the many aspects of it have been several divisions. One of them is referred to the stages of the sexual act, namely:

Excitement phase (Figure 1)

The first sign of arousal in men is penile erection. A marked increase in its size and growth angle relative to the body. This erection may be due to stimulation of the penis as such or by a chain of erotic thoughts.

Masters and Johnson have called primary response to sexual stimuli, changes in vascularity that occur at that stage. The secondary reaction would be the contraction of several fibers and muscle groups. We found other changes in arousal in man appears voluntary muscle tension across the board and there may be some involuntary contraction of muscle groups. Receive an increase in heart beats and blood pressure increases, the testicles become more firm, they rise and approach the body.

For there to the stage of excitation is required minimum degree of sexual tension. Erection to completion, this phase may extend for a few seconds or even up to many minutes, this depends on the variations in affective sexual stimulation.

In the study by Masters and Johnson the erection was maintained in subjects over long periods carefully controlling the variation and intensity of stimulation techniques. During a prolonged excitement phase, it was possible to make an erection to intentionally lose and win again on several occasions. So with such situations, the erection is maintained without obtaining the glass - complete expansion or total loss of it.

Psychosensorial Various stimuli have been tested experimentally in the laboratory during the excitement phase. The erection can easily suffer by the introduction of a sexual stimulus maintained despite concomitant sexual stimulation. This can cause partial loss or even complete, penile erection, while maintaining the somatic stimulus.

The Pontic steppe of "Plateau" (Figure 2)

The increase of female genitalia in humans occurs in the excitement phase. However, one can say that there is a gradual increase in the corona of the glans penis at the base, which occurs at the stage of plateau or plateau. That may be accompanied by an increased reddening of the region. At that stage, in addition, the diameter of the testes increased by 50% and more channels are shortened sperm. The elevation of the testes shows that man has reached the "point of no return" and that his orgasm is imminent.

The breathing rate increases and continue to increase blood pressure and heartbeat, is raising tensions in voluntary and involuntary muscles

Orgasm: (Figure 3)

Unlike female orgasms, male can be seen as carved in the same mold, while the women are extremely varied. The central fact of the male orgasm are the rhythmic contractions, which they are growing at an accelerated rate and becoming increasingly distant and soft. Anyway, man can identify subjectively the occurrence of orgasm just before you know it.

The ejaculation of semen that occurs during orgasm, is a more or less complicated mechanism. Before orgasm contraction occurs channels that carry sperm fluid containing sperm cells. The prostate gland, is also working with fluids that are routed to the urethra. Such fluids are accumulated in a bulb that is in the urethra, near the base of the penis. These changes occur in the first stage of ejaculation, stage at which it feels that orgasm occurs.

During the second stage, a series of contractions of the bulb, the urethra and penis, projecting the semen out under great pressure. This pressure decreases with age, being lower in older men.

The changes in the genitals during orgasm, are accompanied by other changes in the rest of the body, on blood pressure, respiration, etc.. These muscular contractions are often imperceptible to the subject, but not infrequently complain of muscular pains in various parts of the body.

Figure 1: Status of excitation

Figure 2: Stage of "Plateau" or plateau

Figure 3: Phase orgasmic

2. Sexual dysfunction

2.1. Nature and causes of sexual dysfunctions

The ancients believed that only a deep neurotic conflict could affect sexual reactions, and that the only vectors of the sexual relationship were severely pathogenic conflicts and regressive child-centered fear, illusion and unconscious traumas if they enjoyed sex and it was only possible to cure these symptoms by means of resolution of deep unconscious conflicts. (Kaplan, 1983).

Masters and Johnson suggested that often the roots of psychopathology arise from a land far away. Anxiety about her own performance, the insecurities, tension, anxiety, etc. Can cause (and, indeed, cause) a great deal of sexual difficulties (Kaplan, 1983). And this is quite logical because in physiological terms "destructive sexual anxiety is the same when a man terrified by the possible repetition of an erectile difficulty induced by alcohol, or when due to the return of Oedipal taboos and fear of castration "(Kaplan, 1983).

Furthermore, sexual dysfunctions are closely related to health, so as arteriosclerosis, hypertension, depression, drugs, injuries and diabetes are very common causes of sexual dysfunction.

2.2. Sexual dysfunction features

As previously sexual dysfunction is, broadly speaking, a deterioration in any phase components of sexual response (or reactions), Kaplan (1983) describes six characteristics of sexual dysfunction, three men and three women :

2.2.1. Frigidity

Where the frigid woman does not experience sexual pleasure and erotic sensations and experiences no signs of physiological arousal (eg, lubrication).

2.2.2. Female orgasmic dysfunction

Where the woman has sexual responsiveness, has erotic feelings, and has a good reaction vasocongestiva, but experiences a varying degree of difficulty having an orgasm

2.2.3. Vaginismus

Where the woman's body prevents sexual reactions because the attempted vaginal penetration causes involuntary spastic contraction of the entrance to the vagina.

2.2.4. Delayed ejaculation

Where man has an orgasm involuntary inhibition (a disorder similar to female orgasmic dysfunction), the man with delayed ejaculation may feel sexual arousal and have a normal erection, but even if you receive a stimulus that should be quite sufficient, having trouble to release their ejaculatory reflex.

2.2.5. Premature ejaculation

Where the man reaches climax rapidly due to lack of adequate voluntary control over the ejaculatory reflex.

2.2.6. Impotence

Where the man can not get or keep an erection long enough to develop a satisfactory sexual activity.

2.3 The impotence.

There are several parameters to classify:

A. As to the form:

Erectile impotence: is one in which the inability to perform the sexual act is connected to the difficulty of penile erection.

Ejaculatory impotence: the difficulties are related to premature ejaculation, on the one hand, and the impossibility of ejaculation and orgasm, on the other.

Procreative impotence: the difficulties associated with man's ability to participate in fertilization.

Often they overlap, either as a symptom or as to the etiology.

B. Depending on the degree:

Total impotence: where is the total inability of erection, the penis remains in its state of greater flaccidity.

Partial impotence: where there is a decreased degree of erection which prevents or hinders the penetration of the penis into the vagina.

C. Time criterion:

Permanent impotence: when the subject has ever presented an erection during the course of his life.

Constant Impotence: Impotence occurs when the moment of its inception until its demise.

Occasional impotence: When not on an ongoing, but irregular in time.

D. According to the form of installation:

Impotence insidious episodes gradually appear in a proportional increase in relation to sexual encounters.

Impotence acute episodes occur in a given time, well circumscribed in time, place and situation.

E. According to the object:

Impotence selectively is that in which helplessness episodes occur with a particular partner and in a given situation.

Impotence is not selective: when the behavior occurs in all circumstances and all the partners.

D. According to the etiopathology:

psychogenic impotence

organic impotence order

3. Sexual dysfunction erectile

This is a "persistent and recurrent inhibition during sexual activity, manifested by partial or complete failure of man to achieve or maintain an erection to completion of intercourse (Kaplan. 1987, pp. 473).

3.1 Difference between impotence and erectile dysfunction:

This would be a form of sexual impotence, which can give a classification of different categories including those above. Within this distinguished, then, the primary sexual impotence where man has never been able to get an erection sufficient for vaginal penetration; secondary impotence, in this case the subject has achieved in a time of sexual penetration of the vagina, but later lost.

On the other hand, it is remarkable selective impotence, here the man is capable of engaging in intercourse in certain circumstances but not others. Regarding the etiology of psychological conflicts that occur are related impotence "with an inability to express the reason sexual impulse of fear, anxiety, anger or moral prohibition" (Kaplan, 1987, pp.176).

The use of the term "impotent" not only deepens the stigma, but is completely wrong as a definition. Men with erectile problems are not powerless, they have only diminished the ability to achieve and / or maintain penile rigidity. That's why the term "erectile dysfunction describes the problem in a much more accurate. The dysfunction can present a wide variety of degrees, ranging from men who are "powerless" (in the purest sense negative) to those whose problem is so small that even their partners are aware of their existence.

Among the organic bases include: tolerance to glucose, hormones, liver and thyroid function, determination of prolactin, FH and FSH, among others. It is therefore very important to a good story in determining etiology of dysfunction. As well as diseases: infectious and parasitic diseases, cardiovascular diseases. Disorders: Renal and urologic, hepatic, pulmonary, nutritional, neurological and endocrine. And other factors such as poisoning, drugs, genetics, surgery.

Diagnosis erectile sexual dysfunction:

The diagnosis was made in light of the clinical trial that takes into account the focus, intensity and duration of patient's sexual activity. The criteria involved are:

"Recurrent and persistent inhibition of sexual arousal during sexual activity, manifested by partial or complete failure to obtain or maintain erection to completion of intercourse.

Must coexist clinical trial that the individual engaging in sexual activities that are appropriate in type, intensity and duration.

The disturbance is not caused exclusively by organic factors (physical or drugs). "(Kaplan, 1987, pp.477).

Where tests are done to determine the organic basis or psychological disorder, the inquiry also gaining importance in the history of the subject.

Statistical indicators:

It is estimated that fewer men are impotent at age 35, between 2 to 4%. But at age 80, about 77% are.

The incidence of primary impotence in men of 35 years is 1%. Where the fear of getting it increases from 40 years, which is associated with the stigma attached to middle age where impotence arise with the anxiety and the need to succeed in sexual intercourse. Being in more than 50% of men treated for sexual disorders, impotence as chief complaint.

Importantly, it is estimated that 90% of cases of impotence is a psychological cause.

3.4. General causes of erectile dysfunction

Normally, when a man is sexually aroused, your penis increases in size, becoming erect and rigid, which allows the penetration of the sex of their partner. The penis usually measures between 7 and 10 cm long, erect size increases to about 17 centimeters, in fact, an erect penis contains six or seven times the blood volume of a flaccid penis (Encarta, 1997).

Impotence can have psychological causes. For example, if a man has lost his job his sense of failure can lead to temporary impotence suffer. Often it can also be caused by disorders of the blood system, nervous system, brain or hormones, as well as injury or surgery in the pelvis or penis. However, the most common cause is iatrogenic. That is, impotence can be caused by medications taken to treat other disorders. Diuretics, tricyclic antidepressants, H2 receptor blockers, beta blockers, hormones, etc.. (Encarta, 1997)

You can determine if the cause of the impotence of a man responds only to psychological reasons, if you experience normal erections during REM sleep is unlikely to be any organic cause for impotence when it is in conscious state. (Carlson, 1996). However, in some cases an organic cause is not serious enough in itself to cause impotence can make development more vulnerable if they also have other minor psychological factors. (Carlson, 1996)

The phenomenon erectile

How does an erection?

An erection is the result of a complex process that involves the blood vessels and nervous system. The anatomy of the penis is specially designed to meet this process. The penis is made up of two structures that are initiated within the pelvis and are developed in parallel until the end. These structures are composed of spongy tissue with large amount of blood vessels.

Generally, the walls of these vessels are contracted which prevents excess blood in the flaccid penis and keeps most of the time.
When a man experiences sexual stimulation, blood vessels expand, allowing a greater amount of blood flow quickly into the penis. Thus, the blood entering the penis produces an erection

From the point of view of the erection itself, we can say that this is a more or less durable in which the penis remains firm and elongated, and that this mechanism is due to automatic reactions controlled by the autonomic nervous system.

There are two types of erection:

Cortical and erection

Erection Reflects

In the first stimulations are present primarily with psychic phenomena. In the second, it involves some contact on the male genitalia, especially the glans.

Anatomo - Physiology

The anatomical structure of the penis (Figure 1) is the ideal support for the glass - dilation primary physiological response to sexual stimulation.

The penis consists of three cylindrical bodies of erectile tissue: the corpus cavernosum and corpus spongiosum. The chambers are two (right and left) located in the dorsal plane, parallel to each other, measuring from 15 to 16 inches in flaccid state and 20 to 21 centimeters in erection. The body also contains spongy erectile tissue, the urethra.

The three structures are surrounded by a single fibrous layer, the tunica albuginea and surrounded by thick sheaths.

At the base or root penile corpora cavernosa diverge to attach to the pubic rami and ischium (the pubic arch). Each is surrounded by the hamstring muscle - cavernous, striated nature. The corpus spongiosum, in turn, is encapsulated by a skeletal muscle forming the spongy bulb.

The two corpora cavernosa and corpus spongiosum, are penile erectile tissue receives arterial blood from the internal pudendal arteries. These branches are dorsal penile arteries, which lie near the dorsal surface of the tunica albuginea penis and on the other hand, the cavernosal arteries run longitudinally through each corpus cavernosum, two arteries bulb - are urethral longitudinally through the porous body in a ventral direction with respect to the urethra. These arteries terminate in small capillaries that open directly into the cavernous spaces.

The venous return is by the superficial dorsal vein and the deep dorsal vein .. The thickness of the corpora cavernosa are many compartments separated by bands or cords of fibrous tissue called tubercles. These compartments are intermixed with intima arterioles which supposedly contains small bumps in the state of contraction of partially occlude the lumen, retaining the blood in the cavernous sinus. When the arterioles dilate, blood flow to the penis increases and sinuses are filled. It is believed that penile veins contain valves that impede the outflow of blood. It is also believed that the contraction of the hamstring muscle - helps the cavernous venous constriction erection secondary to this mechanism is given little value today.

Not all the times it gives the glass - is a cause dilation of erotic type. They are also able to determine the erection of physical effort as lifting a heavy load (partial erection, usually) and have been erections due to irritative processes. There are still kind spontaneous erections that occur on awakening the subject, as well as erections during sleep.

The sexual feelings may stem from internal structures, such as irritated areas of the urethra, bladder, prostate, seminal vesicles, testes and efferent vessels.

One of the causes of "sexual need" is probably the saturation of the sexual organs and secretions. Infection and inflammation of those organs, sometimes causing almost continuous sexual desire. From the sensory standpoint, the glans contains a peripheral sensory system, highly organized, it transmitted to the central nervous system, a type of sensation that can be termed as sexual sensation.

The impulses can enter the spinal cord from areas adjacent to the penis to increase stimulation during sex. For example, stimulation of the anal epithelium, scrotum and perineal structures in general can send impulses to the bone, which increase sexual sensation.

Therefore the male sexual act, resulting from an inherent reflex mechanism integrated in the sacral spinal or lumbar and its mechanisms can be initiated because of mental stimulation or direct sexual stimulation.

Figure 4: anatomical physiology of the penis

The penis is a closed tube, consisting of three bundles of vascular tissue together by connective tissue and covered by loose skin. Two large bundles of tissue, the corpora cavernosa, form the top of the penis and contains numerous compartments that fill with blood during sexual arousal, causing erection and penile rigidity. The sacral nerves control the flow of blood into the corpora cavernosa, below these is the third bundle of tissue, the corpus spongiosum. This beam is perforated by the urethra. The end of the penis holds a widening rich in sensory nerve endings called the glans, which is covered by a layer of skin called the foreskin retractable.

Neurological Aspects

Neurological determinism of sexual function is more than the excitement of the nerve pathways below. Sexual reflexes congestion glass - motor, sensory excitation localized, and so on., Are called short tracks. They are only part of a function more variable and unpredictable amounts of motor responses offers potential and complex excitations emanating from all the senses, emotional impressions and intellectual affinities.

By studying the sexual neurological processes that we ignore the higher areas include associative processes that must be considered when studying the sexual phenomenon in its entirety. In this regard, little is known about the higher neuropsychiatric system of sexual activity, since studies with neurotransmitters are very recent. The results, though somewhat hasty, could indicate that dopamine has a stimulatory action of sexual responses while serotonin exert the opposite effect. Supporters of this theory have shown that high levels of prolactin (high prolactin levels is often accompanied by an underactive dopamine) may cause impotence in men.

Anyway, we must consider the system as a unit anatomical - physiological neural regulation of sexual function.

The excitement produced in any branches spreads throughout the system and therefore a malfunction of an element will be felt in sexual activity in its entirety.

Reflex erections that appear as responses to tactile stimulation of the erogenous zones appear without discrimination between sexual stimulation and sexual stimulus. By contrast psychic erection occurs in response to stimuli mediated by the central nervous system and, therefore, probably depends not only on external factors such as visual, but also the accompanying cognitive processes. Psychological factors often play an important role in male sex and can get started - even if not all - as we must focus our attention, from a neurological point of view, on three factors:

Peripheral device

Marrow

Brain

The sexual act of a man is inherent reflex mechanism integrated in the lumbar and sacral spinal mechanisms can start a direct sexual stimulation.

The erection is induced by nerve stimulation pre - sacral and pelvic. This reaction is the result of the addition of psychic stimuli and impulses carried affronts to central nervous system via the pudendal nerve.

With regard to the sexual organs, the sympathetic system, and for - nice play an important role for which both are in homeostasis. The sympathetic nervous system is composed of fibers emerging from the thoracic - lumbar spinal communications for higher brain centers. The system - sympathetic acts on the same tissues and structures that the sympathetic system, but their action is opposite. It originates in specific brain nuclei associated with certain cranial nerves and sacral spinal cord.

In satisfactory condition for the system - nice plays an important role, while under situations of fear, worry and anxiety, blood directed toward the somatic structures by the action of the sympathetic causes a reduction in the irritability of the sexual organs and resulting decrease activity or sexual desires.

The erection is accused by stimuli for - nice that are originated in the center for sympathetic vasodilator. These stimuli are of the sacral spinal cord to the penis through the erector nerves. This function is influenced by inhibition of sympathetic vasoconstrictor center. As we see, this function, by virtue of being regulated by the autonomic nervous system overrides any individual's effort to dominate the symptom of impotence, leading, conversely, an increase of inhibition.

Usually the man who wants a relationship not it focus on the erection, or to do so, fear of not having it, it affects the point that if this show, is going to be weak. And breaks the harmony of sexual function automatically emerging cortical inhibition, which includes physical and psychological components suggests the existence of a mediation controlled by the temporal lobe.

Despite the limitations to the study of central nervous system action, which relates to "sexual knowledge" and possibly work to integrate, analyze and interpret the various forms of sexual feelings and to initiate a response.

In a full central nervous system libido level sufficient to overcome the hypothalamic-way through and goes to the centers of the spinal erector, which stimulate an erection. This, feedback through sensory impulses, the temporal lobe, maintaining and increasing the libidinous charge in a process called reverberating circuit, which maintains the sexual and the individual's action.

The region hypothalamic - pituitary (Figure 2) is widely recognized as linked to sexual behavior.

Endocrine and sexual activity

The endocrine system serves to transmit the stimuli through the blood, in the form of specialty chemicals (hormones). In terms of endocrine glands are in constant sexual intercourse with the pituitary gland (or pituitary) as well as environmental and other glands. For an overview of the endocrine problems that relate to sexual activity must remember the pituitary (Figure 2).







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