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.
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.
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.
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.
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 (Arousal Formula ) 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
PUMP: Another option for the treatment of erectile dysfunction
is a vacuum inflation device (See Figure 2). This instrument
draws blood into the penis by creating negative pressure around
it; a rubber ring is then slipped over the base of the penis
to maintain erection. The ring should be removed after 30 minutes
to restore circulation.
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.
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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