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What is impotence?

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Impotence is the inability of a man to achieve and maintain an erection. This makes it impossible to complete satisfactory sexual intercourse. The risk of becoming impotent increases with age. It is quite common for men to experience occasional impotence in their lives. Impotence is increasingly referred to as ‘erectile dysfunction’ (ED). It’s important that men with this problem realize the following: The most common cause of temporary impotence is anxiety. Problems gaining an erection can often be helped by medication, sex counseling, mechanical aids or surgical treatment. Impotence may be a symptom of another, as yet undiagnosed disease requiring treatment.

What causes impotence?

An erection is a result of an interaction between the nervous system, the blood circulation system, the hormonal balance and psychological factors. For this reason, erectile problems may be caused by a number of factors, and often several come into play at the same time.

Psychological causes:

  • Problems in a relationship may affect  potency
  • Impotence may also be caused by anxiety and depression
  • Tiredness
  • Stress from work
  • Performance anxiety (worrying about being good in bed)
  • Hang ups
  • Unresolved sexual orientation
  • Sexual boredom

Physical causes:

  • Vascular (blood vessel) disorders are a common physical cause. Patients with arteriosclerosis, other heart or vascular diseases and high blood pressure are at greater risk of developing impotence.
  • Excessive drainage of blood from the penis through the veins (venous leak)
  • Diabetes often creates erection difficulties. Sometimes the disease is only discovered as a result of investigating the possible causes of impotence.
  • Smoking increases the risk of developing arteriosclerosis and therefore of suffering from ED
  • Side effects from certain drugs, e.g. such as some blood pressure treatments, some antidepressants and some ulcer healing drugs
  • Side effects of non-prescribed drugs (tobacco, alcohol, cannabis and others)
  • Chronic alcohol abuse
  • Nervous system diseases, e.g. stroke, MS, spinal cord injuries
  • Major surgery, e.g. prostate surgery
  • Renal (kidney) failure
  • Disease of the tissue of the penis such as a condition called Peyronie’s disease which can cause painful deformity of the penis
  • Hormonal abnormalities (rare)

How is impotence diagnosed?

The first step is to visit your doctor. They may be able to help or may refer you to a specialist. To find out more about the nature and extent of the problems, the doctor will usually ask detailed questions about your relationship and sex life. There will also be questions about your general health and any medications you take, including non-prescription drugs. The doctor may also feel it would be helpful to include partners in the initial discussion. This may provide valuable information and moral support, as many men find the subject difficult. For instance, the doctor may take your blood pressure, examine the condition of your circulatory system or take a blood test or a urine test to see if you have diabetes. Your penis and scrotum will also be examined. The doctor may inject a substance into the penis to make it erect. This test is used to distinguish between different forms of impotence. Other blood tests, such as a hormone test , may be necessary if there are suspicions that the impotence is caused by something specific

How is impotence treated?

If there is an underlying cause for impotence, this may require treatment. It is quite common, for instance, for a man to become impotent because he feels guilt at no longer being sexually excited about his partner. Indeed, some men are impotent with their partners and not tricks!

Other men are so lacking in confidence that their penis does not work to order – this is often exacerbated if the man has a demanding partner who wants lots of sex, or a partner who wants sex because she is desperate to get pregnant. In such a case the man may well feel resentment at being used as a ‘sperm-making’ machine and his penis may just go on strike.

In addition, there are men who have been given very unhelpful messages about sex in their childhood and who feel that sex is dirty or wrong. In these sorts of situations, counseling can help a man reveal and talk about his innermost thoughts and this may be enough to cure his ED. However, ED is a very complex issue. Sometimes it is simply not possible to establish a cause, either medical or psychological. But, whatever its origin, many impotent men are treated successfully by either counseling, medication, assist devices, surgery or a combination of these methods.

What medications are available for treating impotence?

  • Viagra (Sildenafil).. It is effective with many men and needs to be taken one hour before intended intercourse. It does not cause an erection unless the man is sexually stimulated. The preparation can be used for a number of different forms of impotence, but would not be prescribed to patients who have had a recent heart attack or stroke, or patients taking nitrate medicines for angina. Viagra is a very powerful drug and should never be taken recreationally or purchased over the Internet. It is important that any man taking Viagra is under the care of an appropriate doctor. Side effects include flushing of the face or body and a short-term bluish tint to the man’s vision.
  • Injection therapy: The patient is trained to inject a substance into the penis which will cause an erection. The treatment is effective for most men. The injection is given 10 minutes before intercourse and the erection lasts 1-2 hours. Several different preparations are available. There are possible side effects. Prolonged erections (more than 4 hours) are rare but require urgent hospital treatment.
  • Transurethral Therapy: A small pellet containing a drug similar to that used for injection therapy is introduced a few centimetres into the urethra (urine passageway) using a special disposable applicator. The drug is absorbed through the wall of the urethra into the erectile tissue. This treatment may be uncomfortable and is less effective than the injection method.
  • Hormones: rarely, men may have a deficiency of testosterone, and replacement therapy may be helpful in the treatment of ED.

What other mechanical and surgical treatments are available for impotence?

Mechanical aids include the following:

  • Pubic ring: a rubber or bakelite ring that is put around the base of the penis. It is particularly effective for men who can’t maintain an erection for very long.
  • Vacuum pump: a tight-fitting cylinder in which low pressure is created is placed over the penis. When erection is achieved a pubic ring (see above) is put around the penis to maintain the erection. There are possible side effects – which include a penis that feels cold to the touch.

Surgical treatments include the following:

  • Splinting: This treatment involves the insertion of a flexible, synthetic or metal rod (prosthesis) into the penis to cause a mechanical erection. There are several different types of prostheses. It is important to realize that this treatment cannot be reversed without more surgery, so  this treatment will not normally be used unless other methods have failed.
  • Sealing a vein leak: Unfortunately this is not always effective.

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