Impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.
Causes
To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this engorgement. They prompt the blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.
The following factors can cause erectile dysfunction:
Venous Leak
If a leak in the blood vessels in the penis allows blood to escape, an erection may not be attainable, or may not last long. This can be caused by injury or disease.
Neurovascular Function
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Erection cannot be attained if nerve signals do not prompt blood vessels to expand or if blood flow to the penis is reduced.
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Nerve dysfunction can also diminish feeling in the penis resulting in impotence.
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Diabetes can interfere with nerve signals.
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Arteriosclerosis (hardening of the arteries) can cause reduced blood flow.
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Peripheral neuropathy, spinal cord injury, and surgery can also damage nerves.
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Many medications also cause erectile dysfunction.
Psychological Factors
The brain initiates many of the nerve signals required for a successful erection.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
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Age: 65 and older
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Medical conditions:
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Traumatic conditions:
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Behaviors:
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Medications:
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Symptoms
Symptoms include:
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A less firm penis
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Fewer erections
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological or physical factors are causing your impotence.
The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, the doctor may order laboratory tests.
Treatment
Treatment options include:
Sildenafil (Viagra)–taken orally up to once a day, 30-60 minutes before sexual activity
Alprostadil–either injected into the penis or inserted into the urethra as a suppository
Oral Testosterone–only for men whose impotence is caused by low testosterone levels
Vacuum Devices
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Plastic cylinder for the penis
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Hand pump for pumping air out of the cylinder
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Elastic band for holding the erection after removal of the cylinder
Vascular Surgery–repairs venous leaks, and has been shown to be effective in some cases
Penile Implants–semirigid, malleable, and inflatable implants that are surgically inserted into the penis
Sex Therapy–may help impotence resulting from:
Prevention
To reduce your chances of becoming impotent:
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Take medications to manage blood pressure, diabetes, or depression.
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If medications may be the problem, ask your doctor about changing the medication or adjusting the regimen.
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Maintain a healthful lifestyle and diet.
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Do not smoke. Smoking is significantly associated with erectile dysfunction in middle-aged and older men.
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Try ongoing communication and relationship counseling to prevent or manage interpersonal conflict.
RESOURCES:
American Urological Association
http://www.auafoundation.org
UrologyHealth.org, American Urological Association
http://www.impotence.org
References:
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html.
American Urological Association website. Available at:http://www.auafoundation.org.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/.
