Impotence
Are you unable to perform sexually
on a regular basis?
Do you have negative thing or sexual beliefs?
Do you have a total inability to maintain an erection?
Or only a partial or semi
erection?
Or you can maintain an erection but just before sexual intercourse
you become flaccid?
Or you are not able to perform with a particular
person?
Do you somehow feel guilt?
Or perhaps you somehow feel
anger?
If it is psychological we may be able to help you
Impotence is sexual dysfunction
characterized by the inability to develop or maintain an erection of the
penis during sexual performance.
A penile
erection is the hydraulic effect of blood entering and being retained in
sponge-like bodies within the penis. The process is often initiated as a result
of sexual arousal, when signals are transmitted from the brain to nerves in the
penis. Erectile dysfunction is indicated when an erection is difficult to
produce. There are various circulatory causes, including alteration of the
voltage gated potassium channel, as in arsenic poisoning from drinking water.
The most important organic causes are cardiovascular disease and diabetes,
neurological problems (for example, trauma from prostatectomy surgery),
hormonal insufficiencies (hypogonadism) and drug side
effects.
Psychological impotence is where erection or penetration fails
due to thoughts or feelings (psychological reasons) rather than physical
impossibility; this is somewhat less frequent but often can be helped. Notably
in psychological impotence, there is a strong response to placebo treatment.
Erectile dysfunction, tied closely as it is about ideas of physical well being,
can have severe psychological consequences.
Besides
treating the underlying causes such as potassium deficiency or arsenic
contamination of drinking water, the first line treatment of erectile
dysfunction consists of a trial of PDES inhibitor drugs (the first of which was
sildenafil or Viagra). In some cases, treatment can involve prostaglandin
tablets in the urethra, injections into the penis, a penile prosthesis,
a penis pump or vascular reconstructive
surgery.
The Latin
term impotentia coeundi describes simple inability to insert the penis
into the vagina. It is now mostly replaced by more precise terms. The study of
erectile dysfunction within medicine is covered by andragogy, a sub-field within
urology.
Signs and symptoms
Impotence is characterized by the regular or repeated inability to obtain or maintain an
erection. It is analyzed in several ways:
Obtaining full erections at some
times, such as when asleep (when the mind and psychological issues, if any, are
less present), tends to suggest that the physical structures are functionally
working.
Other factors leading to erectile
dysfunction are diabetes mellitus (causing neuropathy).
Causes
Drugs (anti-depressants (SSRIs)
and nicotine are most common)
Neurogenic
disorders
Cavernosal disorders (peronei's
disease)
Psychological causes: performance
anxiety, stress, mental disorders, psychological problems, negative
feelings.
Surgery
Aging. It is four times higher in
men in their 60s than in men in their 40s.
Kidney failure
Diseases such as diabetes and
multiple sclerosis (MS). While these two causes have not been proven they’re
likely suspects as they cause issues with both the blood flow and nervous
systems.
Lifestyle: smoking is a key cause
of erectile dysfunction. Smoking causes impotence because it promotes arterial
narrowing.
A few causes of impotence may
be iatrogenic (medically caused).
Surgical intervention for a
number of conditions may remove anatomical structures necessary to erection,
damage nerves, or impair blood supply. Complete removal of the prostate gland or
external beam radiotherapy of the gland are common causes of impotence; both are
treatments for prostate cancer.
ED can also be associated with
bicycling due to both neurological and vascular problems due to compression. The
increase risk appears to be about 1.7 fold.
A recent study suggests an
epidemiological association between chronic periodontitis (periodontal
inflammation) and erectile dysfunction, similarly to the association between
periodontitis and coronary heart diseases and cerebrovascular diseases In all
the three conditions (erectile dysfunction, coronary heart disease and
cerebrovascular diseases), despite the epidemiological association with
periodontitis, no causative connection has proved yet.
February 2011: Men who use
non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3
months are at a 22 percent increased risk of erectile dysfunction. A link
between NSAID use and erectile dysfunction still existed for different age,
race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary
diasease and other health problems. But due to benefit of NSAID, it's too early
for men to avoid NSAIDs based solely on the research stated at Journal of
Urology.
Pathophysiology
Penile erection is managed by two
mechanisms: the reflex erection, which is achieved by directly touching the
penile shaft, and the psychogenic erection, which is achieved by erotic or
emotional stimuli. The former uses the peripheral nerves and the lower parts of
the spinal cord, whereas the latter uses the limbic system of the brain. In
both conditions, an intact neural system is required for a successful and
complete erection. Stimulation of the penile shaft by the nervous system leads
to the secretion of nitric oxide (NO), which causes the relaxation of smooth
muscles of corpora cavernosa (the main erectile tissue of penis), and
subsequently penile erection. Additionally, adequate levels of testosterone
(produced by the testes) and an intact pituitary gland are required for
the development of a healthy erectile system. As can be understood from the
mechanisms of a normal erection, impotence may develop due to hormonal
deficiency, disorders of the neural system, lack of adequate penile blood supply
or psychological problems. Restriction of blood flow can arise from impaired
endothelial function due to the usual causes associated with coronary
artery disease, but can also be caused by prolonged exposure to bright
light.
Diagnosis
There are no formal tests to
diagnose erectile dysfunction. Some blood tests are generally done to exclude
underlying disease, such as hypogonadism and prolactinoma. Diabetes is
considered a disorder, but is also a risk. Impotence is also related to
generally poor physical health, poor dietary habits, obesity, and most
specifically cardiovascular disease such as coronary artery disease
and peripheral vascular disease.
A useful and simple way to
distinguish between physiological and psychological impotence is to determine
whether the patient ever has an erection. If never, the problem is
likely to be physiological; if sometimes (however rarely), it could be
physiological or psychological. The current diagnostic and statistical
manual of mental diseases (DSM-IV) has included a listing for
impotence.
Duplex
ultrasound
Duplex ultrasound is used to
evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or
calcification of erectile tissue. Injecting prostaglandin, a hormone-like
stimulator produced in the body, induces erection. Ultrasound is then used to
see vascular dilation and measure penile blood pressure.
Penile nerves
function
Tests such as the
bulbocavernosus reflex test are used to determine if there is sufficient nerve
sensation in the penis. The physician squeezes the glans (head) of the penis,
which immediately causes the anus to contract if nerve function is normal. A
physician measures the latency between squeeze and contraction by observing the
anal sphincter or by feeling it with a gloved finger inserted past the
anus.
Nocturnal penile tumescence
(NPT)
It is normal for a man to have
five to six erections during sleep, especially during rapid eye movement (REM).
Their absence may indicate a problem with nerve function or blood supply in the
penis. There are two methods for measuring changes in penile rigidity and
circumference during nocturnal erection: snap gauge and strain gauge. A
significant proportion of men who have no sexual dysfunction nonetheless do not
have regular nocturnal erections.
Penile
biothesiometry
This test uses electromagnetic
vibration to evaluate sensitivity and nerve function in the glans and shaft of
the penis.
Dynamic infusion cavernosometry
(DICC)
technique in which fluid is
pumped into the penis at a known rate and pressure. It gives a measurement of
the vascular pressure in the corpus cavernosum during an
erection.
Corpus
cavernosometry
Cavernosography measurement
of the vascular pressure in the corpus cavernosum. Saline is infused under
pressure into the corpus cavernosum with a butterfly needle, and the flow rate
needed to maintain an erection indicates the degree of venous leakage. The
leaking veins responsible may be visualised by infusing a mixture of saline and
x ray contrast medium and performing a cavernosogram.; Digital Subtraction
Angiography: In DSA, the images are acquired digitally.
Magnetic resonance angiography
(MRA)
This is similar to magnetic
resonance imaging. Magnetic resonance angiography uses magnetic fields and radio
waves to provide detailed images of the blood vessels. Doctors may inject a
"contrast agent" into the patient's bloodstream that causes vascular tissues to
stand out against other tissues. The contrast agent provides for enhanced
information regarding blood supply and vascular
anomalies.
Treatment
Treatment depends on the
cause.
Exercise, particularly aerobic
exercise is an effective treatment for erectile dysfunction.[
When pharmacological methods
fail, a purpose-designed external vacuum pump can be used to attain erection,
with a separate compression ring fitted to the penis to maintain it. These pumps
should be distinguished from other penis pumps (supplied without
compression rings) which, rather than being used for temporary treatment of
impotence, are claimed to increase penis length if used frequently, or vibrate
as an aid to masturbation. More drastically, inflatable or rigid penile implants
may be fitted surgically. Medications carry risk of
priapism.
All these mechanical methods are
based on simple principles of hydraulics and mechanics and are quite reliable,
but have their disadvantages.
Medication
Phosphodiesterase type 5
inhibitors
The cyclic nucleotide
phosphodesterases constitute a group of enzymes that catalyze the
hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in
different molecular forms and are unevenly distributed throughout the
body.
One of the forms of
phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors
sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are
prescription drugs which are taken orally. They work by blocking the action of
PDE5, which causes cGMP to degrade.
Alprostadil
Alprostadil in combination with
the permeation enhancer DDAIP has been approved in Canada under the brand name
Vitaros as a topical cream first line treatment for erectile
dysfunction.
Another treatment regimen is
injection therapy. One of the following drugs is injected into the penis:
papaverine, phentolamine, and prostaglandin E1.
Surgery
Main
article: penile prosthesis
Often, as a last resort if other
treatments have failed, the most common procedure is prosthetic implants which
involves the insertion of artificial rods into the penis.
Devices
Main
article: penis pump
The device helps draw blood into
the penis by applying negative pressure. This type of device is sometimes
referred to as penis pump and may be used just prior to sexual
intercourse. Several types of FDA approved vacuum therapy devices are
available with a doctor's prescription.
Alternative
medicine
The FDA does not recommend
alternative therapies (ie. those that have not received FDA approval) to treat
sexual dysfunction. Many products are advertised as "herbal viagra" or "natural"
sexual enhancement products, but no clinical trials or scientific studies
support the effectiveness of these products for the treatment of erectile
dysfunction, and synthetic chemical compounds similar to sildenafil have been
found as adulterants in many of these products. The United States Food and Drug
Administration has warned consumers that any sexual enhancement product
that claims to work as well as prescription products is likely to contain such a
contaminant.
History
During the late 16th and 17th
centuries in France, male impotence was considered a crime, as well as legal
grounds for a divorce. The practice, which involved inspection of the
complainants by court experts, was declared obscene in 1677.
Dr. John R Brinkley initiated a
boom in male impotence cures in the US in the 1920s and 1930s. His radio
programs recommended expensive goat gland implants and "mercurochrome"
injections as the path to restored male virility, including operations by
surgeon Serge Voronoff.
Modern drug therapy for ED made a
significant advance in 1983, when British physiologist Giles Brindley, Ph.D.
dropped his trousers and demonstrated to a shocked Urodynamics Society audience
his papaverine-induced erection.The drug Brindley injected into his penis was a
non-specific vasodilator, an alpha-blocking agent, and the mechanism of action
was clearly corporal smooth muscle relaxation. The effect that Brindley
discovered established the fundamentals for the later development of specific,
safe, orally effective drug therapies.
on a regular basis?
Do you have negative thing or sexual beliefs?
Do you have a total inability to maintain an erection?
Or only a partial or semi
erection?
Or you can maintain an erection but just before sexual intercourse
you become flaccid?
Or you are not able to perform with a particular
person?
Do you somehow feel guilt?
Or perhaps you somehow feel
anger?
If it is psychological we may be able to help you
Impotence is sexual dysfunction
characterized by the inability to develop or maintain an erection of the
penis during sexual performance.
A penile
erection is the hydraulic effect of blood entering and being retained in
sponge-like bodies within the penis. The process is often initiated as a result
of sexual arousal, when signals are transmitted from the brain to nerves in the
penis. Erectile dysfunction is indicated when an erection is difficult to
produce. There are various circulatory causes, including alteration of the
voltage gated potassium channel, as in arsenic poisoning from drinking water.
The most important organic causes are cardiovascular disease and diabetes,
neurological problems (for example, trauma from prostatectomy surgery),
hormonal insufficiencies (hypogonadism) and drug side
effects.
Psychological impotence is where erection or penetration fails
due to thoughts or feelings (psychological reasons) rather than physical
impossibility; this is somewhat less frequent but often can be helped. Notably
in psychological impotence, there is a strong response to placebo treatment.
Erectile dysfunction, tied closely as it is about ideas of physical well being,
can have severe psychological consequences.
Besides
treating the underlying causes such as potassium deficiency or arsenic
contamination of drinking water, the first line treatment of erectile
dysfunction consists of a trial of PDES inhibitor drugs (the first of which was
sildenafil or Viagra). In some cases, treatment can involve prostaglandin
tablets in the urethra, injections into the penis, a penile prosthesis,
a penis pump or vascular reconstructive
surgery.
The Latin
term impotentia coeundi describes simple inability to insert the penis
into the vagina. It is now mostly replaced by more precise terms. The study of
erectile dysfunction within medicine is covered by andragogy, a sub-field within
urology.
Signs and symptoms
Impotence is characterized by the regular or repeated inability to obtain or maintain an
erection. It is analyzed in several ways:
Obtaining full erections at some
times, such as when asleep (when the mind and psychological issues, if any, are
less present), tends to suggest that the physical structures are functionally
working.
Other factors leading to erectile
dysfunction are diabetes mellitus (causing neuropathy).
Causes
Drugs (anti-depressants (SSRIs)
and nicotine are most common)
Neurogenic
disorders
Cavernosal disorders (peronei's
disease)
Psychological causes: performance
anxiety, stress, mental disorders, psychological problems, negative
feelings.
Surgery
Aging. It is four times higher in
men in their 60s than in men in their 40s.
Kidney failure
Diseases such as diabetes and
multiple sclerosis (MS). While these two causes have not been proven they’re
likely suspects as they cause issues with both the blood flow and nervous
systems.
Lifestyle: smoking is a key cause
of erectile dysfunction. Smoking causes impotence because it promotes arterial
narrowing.
A few causes of impotence may
be iatrogenic (medically caused).
Surgical intervention for a
number of conditions may remove anatomical structures necessary to erection,
damage nerves, or impair blood supply. Complete removal of the prostate gland or
external beam radiotherapy of the gland are common causes of impotence; both are
treatments for prostate cancer.
ED can also be associated with
bicycling due to both neurological and vascular problems due to compression. The
increase risk appears to be about 1.7 fold.
A recent study suggests an
epidemiological association between chronic periodontitis (periodontal
inflammation) and erectile dysfunction, similarly to the association between
periodontitis and coronary heart diseases and cerebrovascular diseases In all
the three conditions (erectile dysfunction, coronary heart disease and
cerebrovascular diseases), despite the epidemiological association with
periodontitis, no causative connection has proved yet.
February 2011: Men who use
non-steroidal anti-inflammatory drugs (NSAIDs) 3 times a day for more than 3
months are at a 22 percent increased risk of erectile dysfunction. A link
between NSAID use and erectile dysfunction still existed for different age,
race, ethnicity, smoker, diabetes, hypertension, high cholesterol, coronary
diasease and other health problems. But due to benefit of NSAID, it's too early
for men to avoid NSAIDs based solely on the research stated at Journal of
Urology.
Pathophysiology
Penile erection is managed by two
mechanisms: the reflex erection, which is achieved by directly touching the
penile shaft, and the psychogenic erection, which is achieved by erotic or
emotional stimuli. The former uses the peripheral nerves and the lower parts of
the spinal cord, whereas the latter uses the limbic system of the brain. In
both conditions, an intact neural system is required for a successful and
complete erection. Stimulation of the penile shaft by the nervous system leads
to the secretion of nitric oxide (NO), which causes the relaxation of smooth
muscles of corpora cavernosa (the main erectile tissue of penis), and
subsequently penile erection. Additionally, adequate levels of testosterone
(produced by the testes) and an intact pituitary gland are required for
the development of a healthy erectile system. As can be understood from the
mechanisms of a normal erection, impotence may develop due to hormonal
deficiency, disorders of the neural system, lack of adequate penile blood supply
or psychological problems. Restriction of blood flow can arise from impaired
endothelial function due to the usual causes associated with coronary
artery disease, but can also be caused by prolonged exposure to bright
light.
Diagnosis
There are no formal tests to
diagnose erectile dysfunction. Some blood tests are generally done to exclude
underlying disease, such as hypogonadism and prolactinoma. Diabetes is
considered a disorder, but is also a risk. Impotence is also related to
generally poor physical health, poor dietary habits, obesity, and most
specifically cardiovascular disease such as coronary artery disease
and peripheral vascular disease.
A useful and simple way to
distinguish between physiological and psychological impotence is to determine
whether the patient ever has an erection. If never, the problem is
likely to be physiological; if sometimes (however rarely), it could be
physiological or psychological. The current diagnostic and statistical
manual of mental diseases (DSM-IV) has included a listing for
impotence.
Duplex
ultrasound
Duplex ultrasound is used to
evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or
calcification of erectile tissue. Injecting prostaglandin, a hormone-like
stimulator produced in the body, induces erection. Ultrasound is then used to
see vascular dilation and measure penile blood pressure.
Penile nerves
function
Tests such as the
bulbocavernosus reflex test are used to determine if there is sufficient nerve
sensation in the penis. The physician squeezes the glans (head) of the penis,
which immediately causes the anus to contract if nerve function is normal. A
physician measures the latency between squeeze and contraction by observing the
anal sphincter or by feeling it with a gloved finger inserted past the
anus.
Nocturnal penile tumescence
(NPT)
It is normal for a man to have
five to six erections during sleep, especially during rapid eye movement (REM).
Their absence may indicate a problem with nerve function or blood supply in the
penis. There are two methods for measuring changes in penile rigidity and
circumference during nocturnal erection: snap gauge and strain gauge. A
significant proportion of men who have no sexual dysfunction nonetheless do not
have regular nocturnal erections.
Penile
biothesiometry
This test uses electromagnetic
vibration to evaluate sensitivity and nerve function in the glans and shaft of
the penis.
Dynamic infusion cavernosometry
(DICC)
technique in which fluid is
pumped into the penis at a known rate and pressure. It gives a measurement of
the vascular pressure in the corpus cavernosum during an
erection.
Corpus
cavernosometry
Cavernosography measurement
of the vascular pressure in the corpus cavernosum. Saline is infused under
pressure into the corpus cavernosum with a butterfly needle, and the flow rate
needed to maintain an erection indicates the degree of venous leakage. The
leaking veins responsible may be visualised by infusing a mixture of saline and
x ray contrast medium and performing a cavernosogram.; Digital Subtraction
Angiography: In DSA, the images are acquired digitally.
Magnetic resonance angiography
(MRA)
This is similar to magnetic
resonance imaging. Magnetic resonance angiography uses magnetic fields and radio
waves to provide detailed images of the blood vessels. Doctors may inject a
"contrast agent" into the patient's bloodstream that causes vascular tissues to
stand out against other tissues. The contrast agent provides for enhanced
information regarding blood supply and vascular
anomalies.
Treatment
Treatment depends on the
cause.
Exercise, particularly aerobic
exercise is an effective treatment for erectile dysfunction.[
When pharmacological methods
fail, a purpose-designed external vacuum pump can be used to attain erection,
with a separate compression ring fitted to the penis to maintain it. These pumps
should be distinguished from other penis pumps (supplied without
compression rings) which, rather than being used for temporary treatment of
impotence, are claimed to increase penis length if used frequently, or vibrate
as an aid to masturbation. More drastically, inflatable or rigid penile implants
may be fitted surgically. Medications carry risk of
priapism.
All these mechanical methods are
based on simple principles of hydraulics and mechanics and are quite reliable,
but have their disadvantages.
Medication
Phosphodiesterase type 5
inhibitors
The cyclic nucleotide
phosphodesterases constitute a group of enzymes that catalyze the
hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in
different molecular forms and are unevenly distributed throughout the
body.
One of the forms of
phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors
sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are
prescription drugs which are taken orally. They work by blocking the action of
PDE5, which causes cGMP to degrade.
Alprostadil
Alprostadil in combination with
the permeation enhancer DDAIP has been approved in Canada under the brand name
Vitaros as a topical cream first line treatment for erectile
dysfunction.
Another treatment regimen is
injection therapy. One of the following drugs is injected into the penis:
papaverine, phentolamine, and prostaglandin E1.
Surgery
Main
article: penile prosthesis
Often, as a last resort if other
treatments have failed, the most common procedure is prosthetic implants which
involves the insertion of artificial rods into the penis.
Devices
Main
article: penis pump
The device helps draw blood into
the penis by applying negative pressure. This type of device is sometimes
referred to as penis pump and may be used just prior to sexual
intercourse. Several types of FDA approved vacuum therapy devices are
available with a doctor's prescription.
Alternative
medicine
The FDA does not recommend
alternative therapies (ie. those that have not received FDA approval) to treat
sexual dysfunction. Many products are advertised as "herbal viagra" or "natural"
sexual enhancement products, but no clinical trials or scientific studies
support the effectiveness of these products for the treatment of erectile
dysfunction, and synthetic chemical compounds similar to sildenafil have been
found as adulterants in many of these products. The United States Food and Drug
Administration has warned consumers that any sexual enhancement product
that claims to work as well as prescription products is likely to contain such a
contaminant.
History
During the late 16th and 17th
centuries in France, male impotence was considered a crime, as well as legal
grounds for a divorce. The practice, which involved inspection of the
complainants by court experts, was declared obscene in 1677.
Dr. John R Brinkley initiated a
boom in male impotence cures in the US in the 1920s and 1930s. His radio
programs recommended expensive goat gland implants and "mercurochrome"
injections as the path to restored male virility, including operations by
surgeon Serge Voronoff.
Modern drug therapy for ED made a
significant advance in 1983, when British physiologist Giles Brindley, Ph.D.
dropped his trousers and demonstrated to a shocked Urodynamics Society audience
his papaverine-induced erection.The drug Brindley injected into his penis was a
non-specific vasodilator, an alpha-blocking agent, and the mechanism of action
was clearly corporal smooth muscle relaxation. The effect that Brindley
discovered established the fundamentals for the later development of specific,
safe, orally effective drug therapies.
