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Penis
Impotence
Impotence is
a consistent inability to sustain an erection sufficient
for sexual intercourse. Medical professionals often
use the term "erectile dysfunction" to describe
this disorder and to differentiate it from other
problems that interfere with sexual intercourse,
such as lack of sexual desire and problems with
ejaculation and orgasm. This fact sheet focuses
on impotence defined as erectile dysfunction.
Impotence can be a total inability to achieve
erection, an inconsistent ability to do so, or a
tendency to sustain only brief erections. These
variations make defining impotence and estimating
its incidence difficult. Experts believe impotence
affects 10 to 15 million American men. In 1985,
the National Ambulatory Medical Care Survey counted
525,000 doctor-office visits for erectile dysfunction.
Impotence
usually has a physical cause, such as disease, injury,
or drug side-effects. Any disorder that impairs
blood flow in the penis has the potential to cause
impotence. Incidence rises with age: about 5 percent
of men at the age of 40 and between 15 and 25 percent
of men at the age of 65 experience impotence. Yet,
it is not an inevitable part of aging.
Impotence
is treatable in all age groups, and awareness of
this fact has been growing. More men have been seeking
help and returning to near-normal sexual activity
because of improved, successful treatments for impotence.
Urologists, who specialize in problems of the urinary
tract, have traditionally treated impotence--especially
complications of impotence.
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How does
an erection occur?
The penis
contains two chambers, called the corpora cavernosa,
which run the length of the organ (see figure 1). A spongy
tissue fills the chambers. The corpora cavernosa
are surrounded by a membrane, called the tunica albuginea.
The spongy tissue contains smooth muscles, fibrous tissues,
spaces, veins, and arteries. The urethra, which is the channel
for urine and ejaculate, runs along the underside of the
corpora cavernosa.
Erection
begins with sensory and mental stimulation. Impulses
from the brain and local nerves cause the muscles of the
corpora cavernosa to relax, allowing blood to flow
in and fill the open spaces. The blood creates pressure
in the corpora cavernosa, making the penis expand.
The tunica albuginea helps to trap the blood in the
corpora cavernosa, thereby sustaining erection. Erection
is reversed when muscles in the penis contract, stopping
the inflow of blood and opening outflow channels.
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What
causes Impotence?
Since an erection requires
a sequence of events, impotence can occur when any of the
events is disrupted. The sequence includes nerve impulses
in the brain, spinal column, and area of the penis, and
response in muscles, fibrous tissues, veins, and arteries
in and near the corpora cavernosa.
Damage to arteries, smooth
muscles, and fibrous tissues, often as a result of disease,
is the most common cause of impotence. Diseases--including
diabetes, kidney disease, chronic alcoholism, multiple sclerosis,
atherosclerosis, and vascular disease--account for about
70 percent of cases of impotence. Between 35 and 50 percent
of men with diabetes experience impotence.
Surgery (for example, prostate
surgery) can injure nerves and arteries near the penis,
causing impotence. Injury to the penis, spinal cord, prostate,
bladder, and pelvis can lead to impotence by harming nerves,
smooth muscles, arteries, and fibrous tissues of the corpora
cavernosa.
Also, many common medicines
produce impotence as a side effect. These include high blood
pressure drugs, antihistamines, antidepressants, tranquilizers,
appetite suppressants, and cimetidine (an ulcer drug).
Experts believe that psychological
factors cause 10 to 20 percent of cases of impotence. These
factors include stress, anxiety, guilt, depression, low
self-esteem, and fear of sexual failure. Such factors are
broadly associated with more than 80 percent of cases of
impotence, usually as secondary reactions to underlying
physical causes.
Other possible causes of
impotence are smoking, which affects blood flow in veins
and arteries, and hormonal abnormalities, such as insufficient
testosterone.
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How
is Impotence Diagnosed?
Patient History
Medical and sexual histories
help define the degree and nature of impotence. A medical
history can disclose diseases that lead to impotence. A simple
recounting of sexual activity might distinguish between problems
with erection, ejaculation, orgasm, or sexual desire.
A history of using certain
prescription drugs or illegal drugs can suggest a chemical
cause. Drug effects account for 25 percent of cases of impotence.
Cutting back on or substituting certain medications often
can alleviate the problem.
Physical Examination
A physical examination can give
clues for systemic problems. For example, if the penis does
not respond as expected to certain touching, a problem in
the nervous system may be a cause. Abnormal secondary sex
characteristics, such as hair pattern, can point to hormonal
problems, which would mean the endocrine system is involved.
A circulatory problem might be indicated by, for example,
an aneurysm in the abdomen. And unusual characteristics of
the penis itself could suggest the root of the impotence--for
example, bending of the penis during erection could be the
result of Peyronie's disease.
Laboratory Tests
Several laboratory tests can
help diagnose impotence. Tests for systemic diseases include
blood counts, urinalysis, lipid profile, and measurements
of creatinine and liver enzymes. For cases of low sexual desire,
measurement of testosterone in the blood can yield information
about problems with the endocrine system.
Other Tests
Monitoring erections that occur
during sleep (nocturnal penile tumescence) can help rule out
certain psychological causes of impotence. Healthy men have
involuntary erections during sleep. If nocturnal erections
do not occur, then the cause of impotence is likely to be
physical rather than psychological. Tests of nocturnal erections
are not completely reliable, however. Scientists have not
standardized such tests and have not determined when they
should be applied for best results.
Psychosocial Examination
A psychosocial examination, using
an interview and questionnaire, reveals psychological factors.
The man's sexual partner also may be interviewed to determine
expectations and perceptions encountered during sexual intercourse.
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How
is Impotence Treated?
The number
of treatment options has increased in recent years and below
we have listed a few.
VIAGRA: The most common treatment used now for impotence
is the drug sildenafil (Viagra) and is effective in about
7 out of 10 men who use it. The pill is taken one hour before
intercourse and, when effective, allows a normal erection
with stimulation. It is not to be used by men who take any
kind of nitroglycerin or nitrate drugs because the combination
can result in severely low blood pressure.
SELF INJECTIONS: An erection can also be produced
by self-injection of papaverine or prostaglandin before
sex; these drugs may also improve long-term potency and
penile blood flow. Prostaglandins can also be inserted directly
into the urethra to produce erections. Medically administered
testosterone shots help some men, but no specific level
of the hormone guarantees potency.
PENILE IMPLANTS: When none of these therapies work,
some men choose a penile implant. The least expensive is
a semi-rigid type that produces a permanent erection. More-sophisticated
and expensive implants are inflated by a pump mechanism
placed beneath the skin of the scrotum.(See Figure 3)
PENIS
PILLS: Many of the companies selling penis pills are
using a combination of herbs that are known to improve blood
flow to the penis, enhance sex drive by increasing the production
of sex hormones such as testosterone or act as stimulants
that boost energy levels. Several are used as effective
treatments for impotence. Most penis pills will enable the
erections to be harder and with more frequency depending
on the quality of herbs. Many companies use the same ingredients
but the qualities of herbal extracts are quit different.
This is the key when dealing with Penis Pill products.
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Points
to Remember
- Impotence is a consistent
inability to sustain an erection sufficient for
sexual intercourse.
- Impotence affects
10 to 15 million American men.
- Impotence usually
has a physical cause.
- Impotence is treatable
in all age groups.
- Treatments include
psychotherapy, drug therapy, vacuum devices, and
surgery.
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