Impotence - Causes and Solutions
Impotence affects about one out of every
ten American men, yet many of them don't seek help because they're
embarrassed, they think there's no solution or they believe the
problem is "all in their minds." Unfortunately, these men are
missing out on a wide variety of treatment options.
Impotence, the persistent inability to achieve and maintain an
erection for intercourse, affects as many as 18 million men in
the United States between the ages of 40 and 70. Until recently,
doctors thought impotence was mainly rooted in psychological causes.
Now it is believed that 50 to 70 percent of all cases are caused
by physical problems. Erection difficulties tend to increase with
age, but that is not the only or even the most important factor.
Your general physical and psychological health, as well as lifestyle
habits and certain medications, can all cause impotence, but you
don't have to live with this problem. In most cases, impotence
can be successfully treated.
How Does an Erection Occur?
In order to get an erection, several parts of
the body must work together. The brain sends a message of sexual
arousal through the nervous system to the penis. This message
causes the muscles along the penis to relax. At the same
time, the artery to the penis dilates to twice its diameter, increasing
the blood flow sixteen-fold, and the veins which carry blood away
from the penis are blocked. As a result, the two spongy-tissue
chambers in the shaft of the penis fill with blood and the penis
becomes firm. A breakdown in any of these systems makes getting
or keeping an erection difficult.
How is Impotence Diagnosed?
Virtually all men occasionally fail to get an
erection. That's normal. But if a man has trouble getting or maintaining
an erection about 25 percent of the time, he should see an urologist.
These physicians specialize in disorders of the kidneys, bladder,
prostate, penis and urethra.
|
To
Help Prevent Impotence
Exercise regularly
Limit
the amount of fat and cholesterol in your diet
Drink
only in moderation
Don't
smoke
|
Usually, after asking questions about when and
how the impotence developed, the urologist will give the patient
a complete physical exam to determine if his hormone levels are
normal and if the blood vessels, nerves and tissues of his penis
are working properly. If this initial work-up doesn't pinpoint
the cause of the problem, a nocturnal penile tumescence test
can be done.
Men with no physical abnormalities almost invariably
have nightly erections during sleep. The patient may spend a few
nights in a sleep laboratory where a gauge that measures the frequency
and duration of nocturnal erections is attached to the base of
the penis. A home version of this, the snap-gauge test,
can also be used. Before going to sleep, the patient attaches
the gauge to the base of his penis. During the night, the gauge
will break at different degrees of penile rigidity and show whether
a partial or full erection has taken place during sleep. If nocturnal
erections do not occur, the impotence is most likely physical.
Additional testing is then required to identify the precise cause
of the problem.
What Are the Physical Causes of Impotence?
Physical impotence occurs when there is a problem
with any of the systems needed to get or maintain an erection.
The good news is that potency can usually be restored when a man
is treated for underlying medical conditions, when medications
are adjusted or when lifestyle habits are changed.
Here are some of the top causes of impotence:
- Vascular Disease. Hardening of the arteries can
affect the artery leading to the penis so that it cannot dilate
enough to deliver all the blood necessary for an erection.
Impotence can also occur if the nerves that control blood
flow to the penis are damaged.
-
Diabetes. One out of every four
impotent men has diabetes, which can cause nerve deterioration
(diabetic neuropathy). Impotence may result if nerves
or blood vessels that control the flow of blood to the penis
are affected. In some cases, keeping the diet and blood sugar
under control can decrease impotence. But permanent nerve
damage can result in a chronic problem.
-
Disease of the Nervous System.
Some conditions, such as multiple sclerosis, Parkinson's disease
and spinal cord injuries, can affect or cause impotence.
-
Cancer Surgery. Surgery to remove
cancer from the prostate, bladder, colon or rectal area can
cause impotence if the nerves and blood vessels that control
erections are damaged in the process of removing cancerous
tissue.
-
Medications. Some prescription
medications for high blood pressure, depression, spinal cord
injury, diabetes and other conditions can cause temporary
impotence by interfering with the nerve impulses or blood
flow to the penis. Doctors may be able to adjust the dosage
of a drug or change the medication to reverse or minimize
the problem.
-
Smoking. A recent study at the
New England Research Institute in Watertown, Massachusetts,
found that impotence was equally common among smokers and
non-smokers in general. However, among men with certain health
problems, those who smoked were much more likely to have potency
problems. For example, 56 percent of smokers with heart disease
were completely impotent compared with only 21 percent of
non-smokers with the disease.
-
Alcoholism. Excessive alcohol
consumption disrupts hormone levels and can lead to nerve
damage. This type of impotence may be reversible or permanent
depending on the severity of the nerve damage. Some clinical
studies suggest about 25 percent of all alcoholics become
impotent--even after they stop drinking.
-
Hormone Imbalance. Abnormal testosterone
levels are rare, but they can cause impotence. In addition,
other illnesses, such as kidney failure and liver disease,
can disrupt the balance of hormones.
What Are the Psychological Causes of Impotence?
A man who is depressed, under stress, or worried about his
"performance" during sex may not be able to have an erection.
Qualified therapists or counselors who specialize in the treatment
of sexual problems can often help diagnose and sort through
these problems. Some impotence problems can be solved when a
man understands the normal changes of aging and how to adapt
to them. For example, as men get older they generally need more
direct stimulation to achieve an erection. They may also have
less firm erections, take longer to ejaculate and need more
time between erections.
Aging and Impotence |
| Men at Age |
Who Are Completely Impotent |
Who Are Moderately Impotent |
Who Are Minimally Impotent |
Who Are Not Impotent |
| 40 |
5% |
17% |
17% |
61% |
| 45 |
7% |
21% |
17% |
56% |
| 50 |
8% |
23% |
17% |
52% |
| 55 |
10% |
26% |
17% |
47% |
| 60 |
12% |
28% |
18% |
43% |
| 65 |
13% |
32% |
18% |
37% |
| 70 |
15% |
34% |
18% |
33% |
Relationship woes can interfere with potency
and so can job stress, depression or financial worries. Impotence
may also be the result of deep-seated emotional trauma, such as
having been sexually abused as a child. Qualified psychotherapists
can diagnose such problems and help men understand and overcome
them.
What are the Treatment Options?
When treatment of underlying physical or psychological
problems fails to restore potency, a man and his sexual partner
can consider one of the following solutions:
1) Viagra. The most recent treatment
for impotence approved by the FDA, this prescription drug is expected
to benefit 70% of men with erectile dysfunction and has revolutionized
the way impotence is treated. All a man needs to do is pop a Viagra
pill an hour before sexual activity and the medication works on
normal body chemistry to allow blood to rush into the penis when
a man is sexually stimulated (men should take no more than one
pill a day).
2) Vacuum Device. With this treatment,
a man slips a hollow, plastic cylinder over his flaccid penis.
He then attaches a hand pump to draw air out of the cylinder,
creating a vacuum that draws blood into the penis. Once the penis
is erect, the man slips an elastic ring over the cylinder onto
the base of his penis and removes the cylinder. The ring will
keep blood from flowing out, allowing intercourse. Note: This
device should only be used when seeing a doctor regularly since
mishandling can damage the penis.
3) Self-Injection. One or more drugs
(papaverine, phentolamine and prostaglandin-E1) can be injected
into the penis to increase blood flow. The injection is nearly
painless and produces a more natural erection than a vacuum device
or implant. However, until the proper dose is worked out, a man
might have a prolonged and painful erection. In rare instances,
an erection that does not go down after ejaculation may require
surgery.
4) Penile Implants. Surgical implants
can be used as alternatives if the above treatments are unsatisfactory.
Experts at the Mayo Clinic say there is a 10 to 15 percent chance
that an implant will malfunction within five years, but the problem
almost always can be corrected. Over 90 percent of patients are
satisfied with these devices. The two major types are:
- Malleable Rods. Two long rods (also referred to
as semi-rigid prostheses) are inserted into the outer channels
of the penis through a small incision in the lower abdomen
or scrotum. Each rod is one solid piece and so remains erect
at all times. However, they can be bent close to the body
for concealment. Because there are no moveable or inflatable
parts, malfunctions are rare.
- Inflatable Cylinders. These devices consist of one
or two inflatable cylinders, a finger-activated pump and an
internal reservoir that stores liquid used to inflate the
tubes. All components--the cylinders, pump and reservoir--are
implanted within the penis, scrotum and lower abdomen respectively.
When the pump in the scrotum is manually squeezed several
times, the fluid from the reservoir is released into the cylinders.
They expand and create an erection, which is maintained until
the release valve on the pump is squeezed to return the fluid
to the reservoir.
Viagra: Time to Separate Reality from Hype
When Viagra-the first pill to conquer male impotence-was
approved earlier this year, doctors couldn't keep up with their
patients' demands for prescriptions. All the brou-ha-ha is easy
to understand. If normal sexual function can be restored by simply
swallowing a little pill, why bother with devices, injections
or implants? Still, the wonder drug that can has its limits. And
reports of deaths among men taking the sex pill is causing some
alarm.
Viagra seemed to burst on the scene out of the
blue, but it does have a track record. Sildenafil citrate,
the active ingredient in Viagra, was originally developed to treat
high blood pressure. It didn't work for that disorder, but in
1993, Pfizer Pharmaceuticals, the drug's manufacturer, started
clinical trails of Viagra involving more than 3,000 men with varying
degrees of impotence associated with diabetes, spinal cord injury,
history of prostate surgery, and other illnesses. The results:
48 percent of men with severe impotence were almost always able
to get aroused when using Viagra, and 70 percent of men with milder
problems had success using the pill. Men with diabetes or radical
prostate surgery had somewhat less improvement than did other
groups.
One of the little love pill's major assets is
that men who take it get turned on "naturally." That is, Viagra
does not directly cause erections as do other impotence treatments.
Rather it affects a man's response to sexual stimulation. Taken
one hour before sexual activity, the drug acts by enhancing the
effects of a chemical the body normally releases into the penis
when sexually aroused. This increases blood flow into the penis,
which results in an erection. (Viagra should not be taken more
than once a day.)
On the down side, there have been reports of
deaths and severe side-effects in some men taking Viagra. Men
with a history of heart trouble, heart attacks, and low blood
pressure should be examined carefully before getting a prescription
for the drug, and heart patients taking nitroglycerin or other
nitrate-based drugs must not take Viagra because the mix may cause
a deadly dip in blood pressure. Other adverse effects of Viagra
may include headache, flushing, indigestion, and temporary changes
in vision--including seeing a 'blue haze.' Opthalmologists are
concerned that the long-term effects of Viagra on vision are not
yet known. Men with sickle cell anemia, leukemia, or multiple
myeloma should also avoid Viagra because it is feared that they
may develop priapism--a persistent, painful erection that
can permanently damage the penis. Additionally, men are cautioned
against using other treatments for impotence while taking Viagra
as such combinations have not been tested yet.
Despite problems linked to the sex pill, enthusiasm
for it among patients and doctors is still riding high. But men
are cautioned to use common sense. They should not take it before
having a thorough medical history, including a review of medications,
and a physical examination. Viagra is a drug with potentially
serious heatlh consequences and is meant only for men diagnosed
with impotence. It is not a novelty item for men who achieve normal
erections and simply want to heighten their sexual prowess.
For More Information
American Foundation for Urologic Disease
Provides free information on impotence and how to assess treatment
options.
800-242-2383
Impotence Information Center
Provides free literature on impotence.
800-843-4315
National Kidney & Urologic Disease Clearinghouse
Offers free literature on a number of urological problems, including
impotence.
301-654-4415
Impotence Institute of America
Offers literature on impotence and doctor referrals for a $3.00
shipping charge.
800-669-1603
© Article from "The Health Pages"
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