Impotence
What is Impotence?
Impotence is characterized by the failure to attain or maintain an erection when sexually excited. This can be caused by low levels of testosterone, arteriosclerosis, high blood pressure (hypertension), drug abuse (alcohol, nicotine, narcotics, stimulants), medications (blood pressure medication, anticholinergics, antihistamines, psychotherapeutic drugs, narcotics, estrogen), kidney failure, circulatory or heart failure, complications from surgery (prostatectomy, vascular and back surgeries), trauma (disk or spinal cord injuries), endocrine disturbances (diabetes mellitus, hyperthyroidism, Addison's disease), zinc deficiency, neurologic disorders (multiple sclerosis, tumors, peripheral neuropathies), pernicious anemia, or urologic disorders (tight foreskin, Peyronie's disease). Injury or inflammation of the penis may also be a factor. This disorder affects ten million American men. It is age related in that 25% of men over 65 years of age are impotent, but age alone does not predict impotence.
Impotence may be caused by psychological factors or organic causes. The presence of any normal erections indicates a psychological cause since organic causes prevent all erections.
How is it diagnosed?
History: The failure to achieve or maintain an erection is the main physical complaint. Pertinent history includes whether the onset was sudden or gradual, the degree of dysfunction (chronic, occasional, or situational), the presence of any normal erections (such as in the morning, during the night, or with masturbation) and psychological factors including stress, performance expectations, or change in partners.
Physical exam: During a thorough physical exam, the genitalia and secondary sexual characteristics are evaluated, as well as neurological, vascular, and endocrine status. Injury, scarring or abnormalities of the genitals are noted. The prostate will be palpated for any abnormalities.
Tests: Blood tests may include testosterone, gonadotropin, prolactin, follicle stimulating hormone, luteinizing hormone and glucose levels. A complete blood count (CBC), urinalysis, and lipid profile are useful. Tests that help determine the organic cause of impotence include the injection of vasoactive substances into the base of the penis, nocturnal penile tumescence testing, duplex ultrasound, cavernosometry and cavernosography may be performed.
How is Impotence treated?
Treatment depends on the cause of the impotence and may include behavior oriented sex therapy, testosterone injections, use of a vacuum constriction device, injections of vasoactive medication into the penis, penile prosthetic devices surgically implanted in the penis, and vascular reconstruction surgery. If medication is to blame, the medication may be changed, stopped, or the dose altered. Arterial abnormalities may be helped by balloon angiodilation (expanding narrowed artery using an inflated balloon), endarterectomy (removing the lining of an artery narrowed by atherosclerosis), or angioplasty (surgical repair of blood vessels). Hormones, such as testosterone, may be prescribed when the endocrine system is involved.
Medications
What might complicate it?
The presence of more than one causative factor will complicate treatment. A partner who will not participate in therapy will also hinder recovery.
Predicted outcome
Treatment may or may not solve the problem. The individual may retain a strong sexual drive in spite of impotence and this can cause feelings of vulnerability and frustration. Impotence may persist due to underlying conditions. When this happens, penile implants may be considered.
Alternatives
Other possibilities include loss of libido, loss of emission, retrograde ejaculation, loss of orgasm, and premature ejaculation.
Appropriate specialists
Urologist, internist, endocrinologist, vascular surgeon, sex therapist, and psychologist or psychiatrist.
Last updated 4 April 2018