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Impotence

Definition:

Impotence is defined as the consistent inability of a man to obtain or maintain a firm erection long enough to allow satisfactory sexual intercourse.

Medical professionals often use the term "Erectile Dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm.

Chances are you are suffering from impotence or Erectile Dysfunction if,

  • You are consistently unable to achieve an erection
  • Your erections are not firm enough to allow vaginal penetration
  • Your erections have the necessary firmness, but only for a brief period
  • Your erection loses its firmness upon penetration

 

Introduction:

Impotence is one of the most common sexual problems that affect half of all men over 40 years of age, sometime in their lives. Impotence is not a disease, but a secondary condition brought on by other, primary causes. About 85% of impotence problems are due to a physical cause, such as disease, injury, or drug side effects. In around two thirds of cases, there are physical problems affecting the blood supply to the penis or nerve damage.

Once a man fails to become erect a few times, he places more stress on himself to have an erection by sheer will power. When this too fails, he often begins to have a psychological distress that can have an additional effect on erection problems.

 

impotence can be classified as primary or secondary.

  • Primary impotence:A man has never had successful intercourse with a partner but may achieve normal erections in other situations.
  • Secondary impotence: Despite current impotence problems, there is some history of success with completing intercourse in the past.

Most men will experience occasional impotence, usually resulting from stress, tiredness, anxiety or excessive alcohol or other drug consumption. Worrying about impotence may then set the scene for a more persistent problem due to "fear of failure" known as performance anxiety.

5% of men

At age of 40 years

15 to 20% of men

At the age of 65 years

 

Erectile dysfunction may be because of one or more of the following reasons: 

Physical Problems   

Medicines 

Psychological Problems

Lifestyle

The cause may be physical or psychological. For most men the cause is both physical and psychological.

In 75% of cases of impotence there will be a physical cause.

 

Physical causes of ED include:

  • Diabetes
  • High cholesterol
  • Heart disease
  • Post prostate cancer
  • High blood pressure
  • Alcohol or other drug use
  • Some prescribed drugs
  • Disease of the liver and kidney
  • Surgery to the bladder, prostate gland, lower bowel and spine
  • Poor blood flow to the penis resulting from blocked arteries


 

Psychological causes of ED include:

  • Anxiety or stress
  • Anxiety about sexual performance or sexual identity
  • Fear of sexual contact (from issues such as pregnancy or HIV/Sexually Transmitted Diseases)
  • Psychological trauma or abuse
  • Sexual problems with partner
  • Sexual boredom
  • Depression
  • Lack of communication in the relationship or other relationship issues
  • Grief or the effects of illness of self or family member

As men get older, it's common for them to need greater sexual simulation to have a good, sustained erection. Occasional episodes of Erectile Dysfunction, is common and does not mean there will be persistent problems in the future.

Many men feel embarrassed when they first discuss the issue with their doctor. You will be asked about your general health and about your erections. This will include whether or not you wake up with an erection in the morning and the strength of the erection compared with the past. You shall have to inform about any medicines you are on and about any changes in your life that may be having an influence on your sexual health.

The doctor may also want to talk with you and your partner together about any physical or psychological factors that may be contributing to the problem.


Sexual Education

The old saying that sex is natural is not true. Some men experience impotence because of lack of sexual education, in other words, they do not know what to do. Usually, once the man is given correct sexual information and any concerns have been discussed then this difficulty is overcome. Having psychological problems with sex does not mean that there is anything wrong with your mental health. Urologist can assist you in the sex therapy. Urologist will take a sexual history and then tailor a set of exercises or correct misinformation to assist you.


Physical Examination:

A physical examination includes taking the blood pressure and checking the pulses in the legs - an indicator of how healthy the circulation is. The penis and scrotum will be examined. The doctor may request blood tests to look for medical problems, such as anaemia, diabetes, high cholesterol or hormone abnormalities that might be a contributory factor.

 

Treatment:

impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. The simplest treatments are "talking" therapies, tablets and Lifestyle changes.

Treatment options for erectile dysfunction can be divided into four broad categories,

Pharmacological
Surgical    

Mechanical
Psychological

 

Physical Problems

There are many physical causes for temporary or chronic impotence such as,

  • Problems with the blood supply to the penis
  • Side effect of medicines and drugs
  • Disorders of the nervous system
  • Hormonal disorders
  • Other complex or multisystemic diseases

Erection takes place when the arteries of the penis carry blood and engorge the erectile bodies made up of spongy tissue. Medications to treat chronic diseases such as diabetes mellitus, high cholesterol, high blood pressure, renal failure and heart disease destruct of the contractile walls of the veins or provoke hardening, narrowing or blockages of the arteries leading to the penis.

These medications prevent sufficient blood from getting into the penis and staying there for long periods and resultantly you get erections that are quickly lost.

Nervous diseases or damage to the nerves that control the erection process can affect the transmission of signals from the brain to the blood vessels in the penis resulting in inability to have an erection. This occurs in conditions including multiple sclerosis, spinal cord injury and Parkinson's disease. The nerves involved in sexual arousal can also be damaged in surgery to the pelvic area, such as removal of the prostate. In a small number of cases, problems with hormone levels, can also affect erection.


Psychological Problems

Psychological problems can also influence the ability to get and maintain erections. Anxiety and guilt are common causes of ED. Unsatisfactory sexual and relationship experiences may lie behind these issues. Stress at work, depression, boredom with current sexual practices, partner conflicts, and unresolved issues about sexual orientation may all cause problems.


Medicines

The side effects of medicines such as some treatments for high blood pressure can cause ED. Medicines can also affect sexual drive and desire (libido), or cause problems with ejaculation and orgasm. These can have a knock-on effect on erections.


Lifestyle

Drinking too much alcohol commonly affects the ability to get and maintain an erection. In the longer term, it interferes with the production of the male hormone testosterone, which can reduce libido. Nicotine damages the circulation, so smoking increases the risk of erection problems. Similarly, being physically inactive, which contributes to poor cardiovascular fitness, may increase the risk of ED.


Lifestyle changes

  • A healthier lifestyle can often be beneficial and can help prevent any further deterioration caused by underlying medical conditions.
  • If you smoke, make a plan to stop.
  • Take moderate intensity exercise (brisk walking for instance) - for half an hour on most days of the week.
  • Eat a balanced diet rich in fruit and vegetables and low in fat.
  • Drink alcohol in moderation.

Aim to reduce stresses in your life by looking at the balance between your work and your home/leisure time. Relaxation techniques may be helpful.


Pharmacological

Pharmacological treatment involves delivering medication that can help restore erections. There are several different types of medication and ways of administering them. In general, medical therapy is the most appealing form of treatment and can be highly successful.

MEDICATION

ROUTE

MECHANISM

EFFECTIVENESS

 

 

 

 

Yohimbine (Yocon)

Oral

Alpha receptor agonist

Poor

Testosterone

Injection, Patch, Oral

 

Good (only in men with
low testosterone levels)

Prostaglandin E1 (Caverject)

Penile injection

Dilates penile arteries

Very good

Papaverine/ regitine/ prostaglandin

Penile injection

Dilates penile arteries

Very good

Prostaglandin E1
(MUSE)

Intraurethral pellet

Dilates penile arteries

Moderate

Sildenafil (Viagra)

Oral

Increases penile blood flow

Very good

Phentolamine

Oral

Increases penile blood flow

Research only (at this time)

 

Mechanical

Mechanical treatment involves the use of a vacuum erection device or "pump" along with a constriction ring. The penis is placed in a vacuum tube and the air is pumped out. This creates negative pressure and allows blood to flow into the penis. Once the penis becomes erect, a rubber ring is placed around the base of the penis to prevent the blood from leaving. The vacuum tube is then removed. This non-invasive mode of therapy is effective in treating erectile problems form most causes although the device can be cumbersome to use.


Surgical

Surgical therapy is the most invasive form of treatment for erectile dysfunction. The penile implant is a very good option for those men who have failed medical therapy or have a severe arterial or venous cause of impotence. The overall results are good in carefully selected patients.


SURGICAL PROCEDURE

CAUSE OF DYSFUNCTION

EFFECTIVENESS

 

 

 

Penile implant

 

 

Semi-rigid

All

Excellent - penis always in semi-rigid state

Inflatable

All

Excellent - penis looks more natural

Arterial Revascularization

Discrete arterial blockage

Moderate to good

Penile Vein Ligatation

Discrete venous leak

Poor to moderate


Psychological

Psychological therapy is very useful in those cases of erectile dysfunction that are a direct result of psychological causes. These patients may also benefit from pharmacologic or combination therapy. Wives and partners are becoming more involved in this treatment process.

 

  • What is impotence?
  • How does an erection occur?
  • What are the causes of impotence?
  • How is impotence diagnosed?
  • Is there any treatment?
  • What will the future bring?
  • impotence At A Glance

 

What is impotence?

impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm.

Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects between 10 and 15 million American men. In 1985, the National Ambulatory Medical Care Survey