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Impotence: Causes and Treatments

  • Posted 05.12.98
  • NOVA

Erectile dysfunction, known commonly as impotence, is defined as the consistent inability to obtain or maintain an erection of sufficient quality for satisfactory sexual intercourse. Impotence is a symptom not a disease, however erectile dysfunction can herald a serious medical problem.

Although impotence is not a necessary consequence of aging, its incidence increases with age because the condition is often a side effect of other medical problems that come with age, such as vascular disease or diabetes. Recently it has been recognized that women may also experience sexual dysfunction, but problems regarding diagnosis remain, and the field is in its infancy. Only male impotence is addressed here. There are many causes and treatments, and the listings below, organized alphabetically, do not necessarily cover all of them. If you think you suffer from impotence, you should seek medical advice from a primary care physician or a urologist. It is estimated that 30 million men in the United States suffer from impotence, and that 95% of those cases can be treated.

Causes

Chronic tobacco use: Smoking has been shown to affect arterial blood flow and may also affect the arteries in the penis, reducing the blood flow necessary to maintain an erection.

Diabetes: This is one of the most common causes of impotence, because diabetes can cause changes in blood flow through narrowing of the arteries, or damage to nerve endings in the penis.

Hormonal Imbalance: Only a small percentage of cases of impotence are due to hormonal problems, such as insufficient testosterone.

Neurologic Impairment: Injuries to the spinal cord or brain, or neurological diseases, such as Alzheimer's Disease, can lead to impotence. Erectile dysfunction is commonly associated with multiple sclerosis and Parkinson's disease.

Pelvic Surgery: Surgery or radiation to the prostrate, bladder, rectum or colon can cause nerve damage in the surrounding area. The damage may interfere with signals that must pass between the brain and the sexual organs to allow erection and orgasm.

Pelvic Trauma: Injuries caused by accidents, particularly accidents associated with bicycle riding, water sports, gymnastics and horseback riding, can cause impotence.

Prescription Drugs: Many prescription drugs, especially blood pressure or anti-depressant medication, can cause impotence, as well as some over-the-counter medications.

Psychological: Depression, anxiety, problems with self-esteem, anger, fear, and other mental conditions may lead to impotence.

Vascular Disease: Vascular diseases such as hardening of the arteries, or heart disease, can lead to reduced blood flow, thereby impairing the ability of the penis to become sufficiently engorged to maintain an erection.

Treatments

NOTE: For up-to-date information, visit this page, sponsored by the National Institutes of Health: http://health.nih.gov/topic/Impotence

Intra Urethral Pellets: The patient uses an applicator to insert a small pellet of medication into the opening at the end of the penis (the urethra). The medication causes blood vessels to relax, so the penis fills with blood and becomes erect.
Common Side Effects: Pain, burning sensation

Oral Medications: The FDA-approved medication Viagra works directly on the blood vessels, allowing the arteries to expand. It will only cause an erection when the man is sexually aroused. For information about other oral medications, see the NIH website listed above.
Common Side Effects: Headache, facial flushing, backache, upset stomach, bluish tinge to vision

Penile Implants: This is an irreversible surgical intervention. Two inflatable balloons are implanted into the penis, a pump into the scrotum, and a reservoir near the bladder. When inflated by the pump, fluid from the reservoir flows into the inflatable balloons, creating an erection.
Common Side Effects: Swelling, potential infection/malfunction

Penile Injections: The patient or his partner uses a small needle to inject a powerful muscle relaxant into the base of the penis. The relaxation of muscle tissue allows blood to flow into the erection chambers in the penis, creating an erection.
Common Side Effects: Pain, bleeding, scarring, and rarely, prolonged erection

Vacuum Therapy: By placing a cylinder over the penis and withdrawing air, a vacuum is created, mechanically enhancing the flow of blood into the penis. A rubber ring placed on the base of the erect penis traps the blood inside the penis and maintains the erection.
Common Side Effects: Bruising, pain, diminished ejaculation

This feature originally appeared on the site for the NOVA program The Truth About Impotence.

Further Reading

Online Articles

Impotence: A Woman's Perspective
This article, written by a doctor associated with the Impotence Resource Center, discusses fears and issues of women with impotent partners.

Books

Reclaiming Male Sexuality: A Guide to Potency, Vitality, and Prowess
by George Ryan
M. Evans and Co., 1997

Diagnosis and Management of Male Sexual Dysfunction (Topics in Clinical Urology)
by John J. Mulcahy
Igaku-Shoin Medical Publications, 1997

Male Infertility and Sexual Dysfunction
by Wayne J. G. Hellstrom (Editor)
Springer Verlag, 1997

Male Sexual Health
Consumer Reports Books, 1991

Miraculous Breakthroughs for Prostate and Impotency Problems: Advice on Prevention, Self-Treatment, Medication, Testing
by William L. Fischer
1994

Organizations

"Chart a New Course For Your Health" Campaign
1-800-835-9021
This confidential toll-free number established by the American Foundation for Urologic Disease provides information for individuals interested in learning more about erectile dysfunction.

Impotence Information Center
P.O. Box 9
Minneapolis, MN 55440
(800) 843-4315

Impotence Institute of America
8201 Corporate Drive
Suite 320
Landover, MD 20785
(301) 577-0650

Sexual Function Health Council
American Foundation for Urologic Disease
300 West Pratt Street
Suite 401
Baltimore, MD 21201
(800) 242-2383

Related Links

  • Impotence: Expert Q&A

    In May of 1998, Dr. Irwin Goldstein responded to audience questions about impotence, covering a wide range of issues.