A B C D E F G H I J K L M N O P R S T U V W

IMPOTENCE - MALE ERECTILE DYSFUNCTION

What is Impotence ?

Erectile impotence is defined as a failure of the penis to stiffen, so that sexual intercourse becomes difficult or impossible. Ejaculatory impotence means that although erection and intercourse can occur, orgasm or ejaculation of semen does not take place.

How does Impotence occur ?

The penis becomes erect because a special mechanism causes blood to be trapped, under pressure, within its substance. Blood must therefore be able to flow into the penis through arteries of sufficient calibre. At the same time, the blood must be prevented from leaving the penis through the normal veins. The mechanism which triggers these changes is controlled by the brain. The brain sends messages to blood vessels in the penis via nerves. In order to achieve and sustain an erection, four points in a chain must all be in order: the brain; the nerves which travel to the penis; the arteries taking blood to the penis; and the veins which during erection must stop blood leaving the penis. Emotional and psychological aspects of the brain are often involved in impotence which is then loosely termed psychological. Impotence of this type often comes on suddenly, and tends to improve when on holidays or away from usual surroundings. Fear of failure with intercourse plays an important part. Having failed once, the sufferer may be so anxious not to fail again that a vicious circle develops, with repeated failures. The fear may extend to that of a new relationship or a sense of guilt. Fear of aggravating a recent problem (such as a heart attack) is also a cause. Stage fright and other forms of anxiety, stress and life experience are also common causes. The brain also needs the correct amount of sex hormone flowing through the circulation to help it function properly. Severe hormone deficiencies can therefore also produce impotence. The nerves which travel to the penis can be damaged at any point in their course. Spinal injuries and major pelvic surgery often result in impotence. More commonly, there may be a more generalised damage to the nerves caused by alcohol excess or in some patients with diabetes. The arteries which supply the penis are subject to the same degenerative (arteriosclerosis) processes as are other arteries as a result of age, smoking and other factors. These processes cause narrowing of the arteries and allow less blood into the penis. The veins which carry blood away from the penis can also be faulty through having valves which don't work. These may allow too much blood to leak from the penis during an erection, which is therefore not sustained. The ejaculatory type of impotence is not produced by an abnormality in either the arteries or the veins: it is due either to psychological factors or some type of damage to the nerves which supply the penis with the correct impulses.

Treatment Involved for Impotence

Any underlying hormone deficiency can be tested by doing a blood test and is comparatively easy to treat with tablets or injections. This is, however, an uncommon cause. The background of the problem may suggest a psychological origin for which psychosexual counselling of both partners may be appropriate. Before this, however, it is worth trying to deal with underlying stress yourself. Open discussion with your partner may help, and a little alcohol at bedtime may ease tension. Various approaches using alternative medicine, such as hypnotherapy, have helped some people with this problem. Apart from psychosexual counselling, there are four other treatments for impotence that may be used. These are: oral drugs; injections; mechanical devices and implants.

TABLET TREATMENT The most commonly prescribed treatment which can be used for many types of erectile impotence is oral sildenafil (Viagra). You should probably not use Viagra if you have coronary artery disease (angina), although the risks may be more due to the exertion of intercourse rather than to the drug itself. Viagra can also interact with certain other drugs. It should be used with caution if you are taking the antibiotic erythromycin or any tablets used to treat fungus infections. It is best avoided if you are taking certain drugs used for the treatment of angina as this may result in a fall in blood pressure. At present, Viagra can only be prescribed on the NHS in certain circumstances. These include people who have diabetes, multiple sclerosis and other spinal problems, prostate cancer or prostate surgery, and those on dialysis for kidney failure. In the absence of these physical conditions (but where the impotence is causing severe distress) it may also be prescribed on the NHS by a consultant urologist. If your GP decides to refer you to a urologist further treatment will depend very much on the referral centre. Where there is a special interest in erectile impotence, investigations may be suggested to try to find the exact cause. Special x-rays of both arteries and veins (cavernosagram) and measurement of the pressure within the penis (cavernometry) may identify a particular problem in these blood-vessels. Operations have been devised to deal with such problems, but are not very often successful.

INJECTIONS You can be taught to inject yourself in the base of the penis with a small volume of a drug called prostaglandin, which produces an erection lasting several hours. The dose can be altered and other drugs can be added, depending on the response. The first injection will always be supervised in the clinic. Once you have learned the technique and the effects are successful, you can use the injection at home.

MECHANICAL DEVICES A large range of devices is available which can be applied to the penis to aid erection before sexual intercourse. They work on the principle of producing suction (a vacuum) in a sleeve placed over the penis. Once erect, this is maintained by a band placed around the base of the penis. There are no specific complications of their use, provided the instructions are carefully followed.

IMPLANTS Semi-rigid or inflatable plastic rods can also be implanted into the shaft of the penis. The semi-rigid plastic rods produce a permanent erection which is slightly softer than normal. The inflatable implants produce an erection only when required. A plastic control device has to be implanted into the scrotum. These are both quite major operations and are done under general anaesthesia. They are only undertaken after very complete discussion and after trial of all other approaches.

After Treatment for Impotence

Headache, flushing and dizziness may occur with Viagra, and trying a smaller dose may be necessary. The principal side-effect of injection treatment is that it causes an erection which does not subside. This is potentially dangerous, as an erection which persists for more than 6 hours may damage the penis. You should return to the hospital if the erection persists, so that an injection needle can be used to reduce it. Some pain may occur at the site of injection. This seldom prevents treatment from continuing. Sometimes scar tissue develops at the site of injection the urologist should be consulted if this occurs. It is usually recommended that injections are only used once every week or two. The principal complication of implants is infection. This usually occurs soon after the operation but may be delayed: the implant will then have to be removed. Some implants, particularly the rigid variety, cause pain which may be persistent.

Effects on Family of Impotence

The partner needs to be sensitive to the problems of a man with impotence. It is a demoralising symptom for the patient and does not indicate lack of affection or sexual interest. Variations in sexual technique are worth striving for, to minimise feelings of inadequacy in both partners, whatever the cause.