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Sex & Health
- Impotence/Erectile Dysfunction -
What is impotence?
Impotence is the failure to achieve an erection, a condition faced by an increasing number of men. In order to diagnose the potential problems that lead to this condition, it is useful to describe what conditions must be present for erection to take place. The first component you need to achieve an erection is a normal, intact male sexual organ. Secondly, a normal amount of circulating hormones is necessary. Third, a man must have an intact nerve supply and blood flow to the male sex organ. Finally, normal erections require a healthy psychological response to the arousing stimuli, coupled with a relaxed state of mind.
Impotence is almost always treatable, a resounding majority of patients will respond to one of the available treatments. Unfortunately, many men (some estimates are as high as 1/3) will not seek treatment due to the nature of this problem. Impotence is an extremely common condition and is very treatable. Please check with your doctor to explore treatment options.
What causes erectile failure?
Neurological disorders
Any neurological disorder which interrupts the nerve supply to the erectile tissues will generally cause an erectile failure. There is little known about the nerves which cause erection and therefore it is difficult to predict how damage to certain nerves will affect erectile capacity.
Blood Flow
If the blood flow to the genitals is halted or impeded, then erectile failure may occur. Vascular disease can cause the blockage or constriction of the arteries in the pelvis and/or penis. The blood that normally rushes to the penis is partially stopped. Vascular disease may also be the cause of leaks in the arteries or veins; this too can cause an erectile problem.
Peyronie's disease
Peyronie's disease is a fibrous scarring which develops from an inflammatory process. The cause of this process is not yet understood. When an erection does occur, there is a bending of the penis which can often be quite painful. It may interfere with ejaculation and in some cases erectile capacity. For more information on Peyronie's disease click here.
Priapism
Priapism is a condition in which a man develops a permanent erection. All of the causes of this condition are not yet known, however some potential contributors are diseases which thicken the blood and certain medications used improperly for achieving an erection. Priapism is an uncomfortable, sometimes painful condition which often requires surgery to relieve. If your erection lasts for an unusual period of time, go directly to the emergency department of the nearest hospital. Although this can be embarrassing, waiting to long to correct priapism can result in permanent damage.
Hormonal Deficiency
Hormonal deficiency is another potential cause for erectile failure. In younger men, this deficiency is typically caused by psychological rather than physical failure to produce androgen. In later life, the pituitary gland may fail to produce the stimulating hormones that encourage testosterone output by the testicles. Furthermore, there may be associated failure of thyroid and adrenal gland hormone production. This may cause impotence and low level of sexual interest. This hormone deficiency in older men can normally be corrected by hormone injections.
Infection
Infection of the penis and surrounding tissues can limit a man's ability to achieve erection. These infections are more pronounced in older men but have caused temporary impotency for men of all ages. A viral infection of the testes may cause discomfort and also prevent a successful erection. As well, bacteria can inflame the urethra and surrounding skin which can interfere with an erection. Finally, the prostate gland can become inflamed during an infection, which causes a lot of pain in the genital region. The prostate can be treated by massage and antibiotics in cases of infection and inflammation. Discomfort in the prostate area may be indicative of more serious illnesses; consult your physician immediately.
Diabetes
Diabetes can also cause erectile failure. Impotence may be closely associated with a high blood sugar level, and if this level is lowered, the patient will see an improvement in sexual potency.
Other possible causes:
- Prostate issues
- High cholesterol
- Vascular disease
- Thyroid problems
- Kidney problems
- Spinal cord injury
Psychological causes
Psychological causes of erectile failure are often mistaken for physiological disorders. The most common of these is performance anxiety. When a man feels pressured to achieve an erection (often spurred by occasional difficulty), he will commonly become anxious and nervous when in a sexually demanding situation. Anxiety conflicts with the ability to achieve an erection, and thus failure results, perpetuating further anxiety.
In some cases, the male is experiencing very normal changes as his body ages. His erection may be less rigid than in the past. Treatment is a process of education, helping the patient understand that these changes are very natural and should not cause any anxiety whatsoever.
A sex therapist can help you overcome these and other psychological issues. Ask your physician for a referral.
Treatment Options
Understanding Viagra
Lately when people think about the treatment options for impotence, their mind naturally wanders to the new "wonder drug" Viagra. Viagra is a good treatment for many types of impotence and it's ease of use is very appealing to most men. What is often not reported however, is that Viagra will work on about 1/3 of new patients. For these men, other treatment options must be explored.
Penile Injection Treatment
Self injection is another option. Prior to intercourse, the male takes a tiny needle and injects it into his penis. Patients learn how to administer this treatment under the direct supervision of their doctor. Shortly after application, a natural-feeling erection occurs.
Some may be hesitant to use a needle. However, the needle is quite small and generally painless. Users are advised to use this treatment no more than 3 times a week. Speak to your doctor to see what s/he recommends.
Penile Implants
A surgical procedure where an implant is inserted into the penis and surrounding region. The most common implant is the Inflatable implant. Tubes are implanted down the length of the penis which are attached to a fluid reservoir. When the male wants to achieve an erection, he uses the pump (typically hidden in the scrotum) which fills the tubes with fluid, creating rigidity.
Speak with your physician as to whether this is a good procedure for you.
Vacuum Erection Devices
This treatment can be used by anyone experiencing any erectile difficulty. Consisting of a clear plastic tube that fits over the penis, the vacuum erection device works by creating a vacuum allowing the engine or pump to draw blood into the penis. Once the penis is sufficiently erect, an elastic is applied to the base of the penis, preventing blood from escaping. The elastic can be left in place for up to 30 minutes.
Urethral Injection
Another form of self injection, whereby a little tube filled with medication, is inserted down the urethra. A plunger acts to dispense the medication into the urethra. This treatment eliminates some of the fear which may be present when dealing with needles, but is considered to be less effective than penile injection treatment.
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