Impotence: An Eminently Treatable Problem

Impotence: An Eminently Treatable Problem

Impotence, or the inability to achieve or sustain an erection satisfactory for intercourse, is perhaps one of the most troubling medical conditions a man can face. Though impotence is not a fatal condition, and men do not need sex to survive, try telling this to a man suffering from impotence! See if hearing this 'little bit of good news' will cheer him up or make him feel any better. The truth is, impotence can be devastating from an emotional standpoint -- not only to the man so affected, but also to his intimate partner. For many men, life without sex can be likened to a water color painting that should possess all of the vibrant colors of life, but which has been reduced to sterile black and white. The lack of intimacy that often accompanies impotence is often experienced as a profound loss. It can be very frustrating and upsetting.

In fact, impotence can actually cause or aggravate psychological problems, but we now know that in 80 to 90 percent of cases, impotence results from a physical problem as opposed to an emotional one. While it is true that sexual interest may wane over time, or that decreased libido may manifest itself in couples experiencing marital strife, a passing lack of desire is not to be confused with impotence. Nor should infertility be confused with impotence. A man can achieve an erection, ejaculate, and still be infertile; also, a man who has trouble achieving or sustaining an erection can still often father a child.

Incidence of the disorder

While estimates vary, it is believed that between 25 - 30 million men in the United States suffer from impotence. This may be a conservative estimate, when you consider that only a small percentage of men with this problem come forth seeking medical consultation. As our population as a whole continues to age, the incidence is expected to be even higher. And while impotence is not a normal condition of aging, the disease does tend to hit older men the hardest -- one out of every three men over age 60 will experience impotence problems at least some of the time.

Major causes of impotence

Impotence can result from a wide variety of factors. Some forms of the problem are temporary, such as impotence resulting from stress, fatigue, or certain drugs and medications. Other forms of the problem are more chronic and persistent in nature.

Drugs and medications

Drugs which can cause impotence include medications for heart disease, high blood pressure, and nervous disorders (tranquilizers) as well as muscle relaxants. Alcohol, used to excess, can also have an adverse effect on a man's ability to have an erection, as can some (illicit) so-called 'recreational' drugs. Many perfectly legal over-the-counter drugs can also cause temporary impotence.

Vascular flow problems

Arterial sclerosis (or hardening of the arteries) is very often to blame in impotence. This problem is something that tends to happen as people age. It is related to diet, exercise, and lifestyle choices. Diets high in fatty foods, a sedentary lifestyle, obesity, and unwise behaviors can all take their toll as time goes on.

Penile arterial insufficiency is a leading cause of impotence. This means that not enough blood reaches the areas of the inner penis necessary to produce or sustain an erection. Excessive cigarette smoking, especially over a long period of time, can cause arterial blockage and play havoc with the small blood vessels running through the penis. When you smoke, you constrict these vessels and make it more difficult to achieve an erection. Over time, the toxins in cigarette smoke tend to clog up these micro-passageways. Many men won't see the effects of cigarette smoking on their potency until 20 or 30 years later, when it becomes increasingly difficult to reverse the damage. Anything you do that potentially compromises blood flow in your body can intensify or aggravate an impotence problem.

Diabetes can take its toll

Diabetes, a disease affecting an estimated 13 - 14 million individuals in the USA, is another major cause of impotence. Diabetes -- especially undiagnosed, untreated, or uncontrolled diabetes -- can set the stage for impotence by damaging small blood vessels and nerves essential to the physiological function of achieving an erection.

Other causes of impotence

Impotence can also result from physical trauma, as well as from disorders such as M.S. (Multiple Sclerosis), Alzheimer's disease, Parkinson's disease, or paralysis from an accident or stroke.

Certain forms of surgery, such as prostate cancer surgery or radiation therapy for pelvic cancers, may also cause impotence. In some cases, problems with thyroid or pituitary function, or plummeting testosterone levels, can be responsible.

Evaluation of impotence

Your doctor will want to do a thorough medical history and evaluate your current use of medications. He or she will also want to evaluate possible underlying conditions that might be causing your impotence. Men normally have nocturnal erections each night during sleep. This is an unconscious process that just happens naturally. The doctor may arrange a test for you to help determine if you have normal nocturnal erections, because if you do, physical (organic) causes for the problem can be ruled out. Other studies, or referrals to medical sub-specialists, may be necessary, depending on what your physician finds.

Treatment options

Penile self-injection therapy, involves the injection of one or a combination of medications into the side of the penis into the corpus cavernosum. This may sound painful, but patients inject the medication with a very small needle (similar to the type of needle diabetics use to inject insulin), and most men report only minor discomfort with the injections. The most effective and best studied agents are papaverine, phentolamine and prostaglandin E. These injections are safe, when used as directed by your doctor, and can produce satisfactory erections lasting from 30 minutes to one hour. This therapy shows a 75% effectiveness rating. The injections can only be used two times per week, however.

Caverject sterile powder (alprostadil) from The Upjohn Company is the first prescription medication to receive FDA approval for treating erectile dysfunction (impotence).

This medication, packaged as a powder, comes with a syringe which is prefilled with sterile water. The patient mixes the powder with the sterile water, and injects the solution into the side of his penis into the corpus cavernosum. Alprostadil relaxes the penile blood vessels, which allows more blood to flow into the penis, causing an erection.

In some cases, testosterone deficiency can be responsible for an impotence problem. In these cases, hormone replacement therapy can often improve erectile function. However, testosterone injections in a patient with normal testosterone can stimulate prostate growth, liver damage, or tumors, stop sperm production and increase fluid retention -- so such injections must be used with care and only under a physician's supervision.

Oral medications
Oral medications such as yohimbine, trentyl and trazodone can also be helpful. They must be taken every day and require six to eight weeks before improvement is seen.

Yohimbine (Yocon) frequently improves libido and/or sexual desire and many patients report improved erections. Trentyl (pentoxifylline) is used to improve blood flow and is often administered in combination with yohimbine.

Vacuum erection devices
These devices are used to produce negative pressure or suction, which pulls blood into the penis, helping a man achieve an erection. A tight band at the base of the penis holds the blood inside, thereby maintaining the erection. This is a safe and effective technique, but the tight band should not be left in place for more than 30 minutes, as damage to the penis may occur if this happens.

In some cases, penile micro-surgery (revascularization) can help to reverse arterial damage that has occurred inside the penis, resulting in impotence. Such surgery is best performed on carefully selected younger patients without other known risk factors.

Penile prostheses or implants
These are mechanical devices that are surgically inserted inside the man's body. One of today's most popular devices is called the inflatable penile prosthesis. When the man wishes to have an erection, he inflates an internal device that produces the erection. Most physicians will try to find other solutions for their patients before agreeing to such implants. Device failure over time, or the need to perform surgery again to repair or replace such a device, is a very real possibility with penile implants, although the incidence of problems encountered with these devices has decreased appreciably over time.

A treatment option for everyone
Choosing a treatment for impotence is often a decision that must take the patient's needs, preferences, and sexual activity patterns into account. If you are experiencing an impotence problem, realize that help is available. In fact, the range of available treatment options gives most men a choice, and lets them remain in control of the treatment, based on their individual needs.

Accordingly, about the best thing you can do for an impotence problem is find a good physician -- one in whom you have confidence -- and work with this individual in resolving your problem. Urologists are medical sub-specialists who are specially trained to diagnose and treat this and many other problems of the genital and urinary tract. Your family physician may be able to diagnose and treat your impotence problem in the outpatient setting -- or certainly help with a referral to a qualified urologist in your area.

Certainly, long gone are the days when a man had to suffer with an impotence problem in silence, or cause his sexual partner to suffer. Sexual intimacy is one of the joys of living, and its absence can have a devastating effect on a man's self-esteem. It doesn't have to be this way. Remember: impotence is not a failing; it is a medical condition that is highly most cases, without surgery. Help is available, so gentlemen, please...if you have this problem, see your doctor without delay.

For additional information contact:

American Urological Association, Inc 1120 North Charles Street Baltimore, MD 21201 USA Telephone: (410) 727-1100 1-800-242-2383

Impotents Anonymous (IA) 119 South Ruth Street Maryville, TN 37803-5746 USA Telephone: (615) 983-6092

The Impotence Information Center Department A P.O. Box 9 Minneapolis, MN 55440 1-800-843-4315

Or go to American Urological Association website:

About the author: Edward Moss, M.D. is a practicing, board-certified urologist and a Fellow of The American College of Surgeons. He was a lecturer in the Department of Urology, College of Physicians & Surgeons, Columbia University. Dr. Moss is also editor and publisher of the national newsletter, Urology & You, which discusses genito-urinary health information for men and women, and features a variety of articles on the kidneys, bladder, sexual organs, infertility, voiding disorders and more.

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