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What is Impotence ?
Impotence (erectile dysfunction, ED) is defined as the inability to achieve or maintain an erection sufficient for mutually satisfying intercourse. Impotence
impacts more than a man's sexual activity. The emotions and uncertainties that coincide with this condition often have a significant effect on a man's self-esteem, as well as, his relationship with his
partner. Although the incidence of impotence increases with age, it is not an inevitable result of aging. Impotence is a secondary condition linked to many medical conditions.
The first step in treating impotence is that the individual understands the psychology, physiology and anatomy responsible for the ability to achieve and maintain
an erection. If we can comprehend these events than we can better understand the factors that are responsible for impotence and address the questions concerning treatment. What causes Impotence ?
Historically, when an individual consulted his physician concerning Impotence he was usually informed there were no known physiological answers concerning his condition.
Today, a generation of research has resulted in significant advances in both the diagnosis and treatment of Impotence. Physicians now understand that approximately eighty-five percent of Impotence is attributable to
physical/organic conditions while only fifteen percent is due to psychological or mixed origin (both psychological and organic). Some important causes of physiological Impotence are as follows:
Vascular Disease is the leading cause of Impotence. Vascular disorders including arteriosclerosis
(hardening of the arteries), hypertension, hypercholestremia and other conditions, which interfere with the blood, flow to the penis. Additionally, "venous leakage" also contributes to poor
erections. This condition occurs when the penile veins are unable to constrict efficiently during an erection. When these veins "leak" blood escapes to the periphery resulting in a poor erection
Diabetes is another common cause of Impotence. Approximately fifty percent of men with
diabetes (insulin dependent) experience some degree of Impotence after the age of fifty-five. Diabetes results in poor circulation and/or peripheral neuropathy. When the nerves are involved sexual stimuli
are not transmitted appropriately to or from the brain and Impotence develops. Prescription medications
often cause ED as a side effect. Some two hundred known medications fall into this category including:
- Antihypertensives
medications significantly:
1. beta-blockers e.g. Atenolol, Propanolol and Tenorium. 2. Diuretics medications e.g. HydroDiuril and Lasix.
3. Ace Inhibitors/Calcium Channel Blockers medications e.g. Vasotec, Lotension, Cardizem, Norvasc periodically cause Impotence, however, they are generally represent an excellent alternative medication
for individuals with drug induced Impotence.
Antidepressant/Antipsychotic medications of almost any label can also result in Impotence e.g. Prozac, Elavil, Zoloft, Thorazine, Haldol. Note: Many other medications in a variety of
classes can periodically cause Impotence. If you are taking a prescription medication or over-the-counter medication, regularly, please consult with your physician. However, never alter a dosage or
discontinue a medication without the advice of your physician. LH-RH Analogs/Antiandrogen medications e.g. Lupron Depot®, Eulexin, Nilandron®, Casodex®, etc. These medications are used in
the treatment of prostate cancer. They function by decreasing the production of testosterone in the testes and adrennal glands. The decrease in testosterone often results in Impotence.
Chemotherapy/Radiation therapy are also significant contributors to Impotence. These drugs/treatments are used in the treatment of cancer.
Substance Abuse can also negatively affect male potency. The chronic use of cocaine,
marijuana, alcohol, steroids etc. often results in Impotence, as well as a decrease in desire. Excessive tobacco use can also attribute to Impotence by accentuating the effects of other risk factor such as
vascular disease or hypertension. Radical Pelvic Surgery also results
in Impotence. Surgical procedures involving the prostate gland, bladder or colon may interfere with the nerves involved in the erectile response. Radiation therapy for cancer may also affect the erectile process.
Neurological diseases
such as multiple sclerosis, Parkinson's disease, spinal cord
injuries, long-term effects of diabetes can also result in the disruption of the normal sequence of events necessary for an erection to occur. Deficiencies in the Endocrine System is another source of Impotence. Low levels of testosterone or thyroid hormone can interfere with
the stimulation process necessary in the erection sequence. Excessive production of prolactin by the pituitary gland may contribute to decreased levels of testosterone resulting in a lack of desire. Diabetes
once again enters the scenario as it is classified as an endocrine disorder. Psychological Impotence is
usually diagnosed when no physical causes can be defined. Pure psychological Impotence usually occurs suddenly without warning as opposed to physical Impotence that may gradually develop over years. Some
common causes of psychological Impotence are as follows:
- Performance anxiety
is one of the most common causes of psychological Impotence. When a man feels pressured to achieve or maintain an erection, he will commonly become anxious and nervous when in a sexually demanding situation. Stress increases the body's production of catecholamines such as adrenaline and nor- adrenaline, which act as erection inhibitors. The release of these inhibitors further contributes to failure resulting in more anxiety. Therefore, the cycle begins, increased stress resulting in increased catecholomines that further inhibits the erectile process.
- Depression
is another cause of psychogenic Impotence. Unfortunately, many of the popular antidepressant medications (for a list see prescription medications in the next section) have side effects,
which include erectile failure.
Anatomical Deviation of the Penis,
Peyronies Disease, may also cause Impotence. This condition usually develops from
an inflammatory process and results in fibrous scaring of the penis. (The cause of this process is not yet understood) However, when an erection does occur, there is a bending of the penis secondary to the
scar tissue. This curvature may interfere with erectile capacity and/or ejaculation. Impotence Treatment Options.
Until recently, individuals who sought medical
treatment for Impotence were told "It's all in your head". Physicians labeled these individuals with a psychological disorder and they were referred to counseling. Today, there are many treatment
options available, the treatment option you choose should be specific and responsive to your needs and expectations as well as your partners.
- Oral Medications
one in particular Viagra (Sildenafil Citrate) has change the course of treatment for Impotence.
- Penile Injection Therapy
uses a hypodermic needle to inject medication (mixture of papaverine, phentolamine and prostoglandin) into the side of the penis.
- Urethral Inserts
consists of a disposable applicator, small enough to fit into the urethra. The applicator is inserted into the urethra approximately one inch and the
medication (prostaglandin E-1) is released.
- Vacuum Therapy
works by placing a cylinder with an attached pump over the penis. The pump creates a vacuum in the cylinder, which pulls blood into the penis tocreate an
erection.
- Hormonal Therapy
is used to treat the small percentage of individuals who have abnormally low levels of testosterone.
- Vascular Surgery
may involve both the arterial and venous systems. Venous ligation has been reported to be effective in patients with venous leakage.
- Penile Implants
requires surgical insertion of a prosthetic device. Three forms of penile prosthesis are currently available flexible, malleable and inflatable.
- Psychotherapy
and/or Behavioral Therapy have been found to be beneficial in treating Impotence. Although the majority of causes of Impotence are physical, there are quite frequently underlying
psychosocial factors involved as well.
Note: All of the above-mentioned treatments only treat Impotence, they do not treat the underlying illnesses or disorders responsible for the Impotence. The prolonged use of some these
treatments in individuals who have conditions such as those listed under causes of Impotence is inappropriate. Please be responsible with your health. Schedule regular appointments with your family physician
and/or your urologist so they may address and treat the underlying conditions responsible for your Impotence. |
