Impotence And Erectile Dysfunction Frequently Asked Questions

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Impotence And Erectile Dysfunction Frequently Asked Questions

What is impotence?

Impotence, or erectile dysfunction as it is correctly known, is the consistent or recurrent inability to attain and maintain a penile erection rigid enough for satisfactory sexual intercourse. Erectile dysfunction relates only to the erectile capability of the penis - excluding problems of libido, ejaculation and orgasm.

How many people suffer from impotence?

It is estimated that 1 in 10 ten males over the age of 21 suffer from impotence at some point in their lives. However, evidence suggests that the majority of sufferers do not currently seek medical help.

What medical conditions create a predisposition for impotence?

Impotence is associated with advancing age, as well as a range of conditions including coronary artery disease, high cholesterol levels, high blood pressure and diabetes mellitus. In the case of diabetes, changes to the arteries and smaller blood vessels supplying blood to the penis and damage to the nerves involved in erectile function predispose 50-75% of men to erectile dysfunction.

What causes impotence - Is it physical or psychogenic?

It is now accepted that the majority of cases of erectile dysfunction (up to 75%) have a physical and not a psychogenic cause. Psychogenic erectile dysfunction is linked to performance anxiety, negative images of internal conflicts while physical causes include anatomic, neurogenic, endocrinologic, drug-related and vasculogenic complications. Vasculogenic problems are the most frequent causes of erectile dysfunction.

What are anatomic causes of impotence?

Anatomic causes of impotence are rare and include men born with inadequate or malformed genitalia, or those with genitalia damaged by physical trauma or accident?

What are neurogenic causes of impotence?

This refers to causes related to nervous system dysfunction - most commonly peripheral neuropathy due to diabetes mellitus or alcoholism; traumatic injury to the spinal cord; multiple sclerosis; and surgical procedures to the pelvic region.

What are drug-related causes of impotence?

Impotence can be a side effect of various classes of drugs. In general, any drug that disrupts local nerve impulses to penile smooth muscle may cause impotence - including antihypertensive, antipsychotic and antidepressant drugs.

What are vasculogenic causes of erectile dysfunction?

Vascular problems affect the normal flow of blood in and out of the penis. Conditions affecting blood inflow to the penis include: hypertension, atherosclerosis, diabetes mellitus and hyperlipidaemia. Smoking can also cause insufficient arterial inflow to the penis. There can also be vascular problems associated with excessive venous outflow from the penis. Excessive blood flow from the penis can be related to several factors, including insufficient relaxation of the smooth muscles of the penis (more likely to occur in anxious patients).

In summary, what are the most common physical causes of erectile dysfunction?

·	side effects of medication; as many as 200 existing treatments can cause impotence in some cases. The main ones include:

·	antihypertensives, antipsychotics, antidepressants,

·	H2 blockers and some major tranquillisers

·	narrowing of the arteries/atherosclerosis

·	diabetes - over 35% of all diabetic men suffer from erectile dysfunction

·	neurological disorders e.g. spinal cord injury, Multiple Sclerosis

·	pelvic injury/surgery

·	Peyronie's disease (fact sheet available)

·	alcoholism and drug abuse

·	heavy smoking

·	hormonal imbalance (e.g. low testosterone levels) can cause erectile dysfunction, but only in a small number (3%) of cases

Is impotence treatable?

Yes, but many men who have impotence do not seek treatment nor do physicians routinely ask questions about sexual function during medical examinations. Such discussions are important because millions of men actually have the condition, and because erectile dysfunction may be the first recognisable symptom of an underlying disease process - diabetes mellitus, cardiovascular disease, prostate cancer, alcohol or other substance abuse.

Why do so few men seek impotence treatment?

They may be unaware of the current availability of varied effective treatments; they may not know who to approach for treatment or they may simply be too embarrassed.

How is impotence diagnosed?

Once it is identified (as opposed to loss of libido, premature ejaculation, etc.), various examinations and tests are available to determine the actual cause of the problem - ie psychogenic or organic/physical. Diagnosis is often aided by injection of intracavernosal vasoactive agents such as prostaglandin E1 into the penis at the physician's office.

What is the link between men's age and incidence of impotence?

The following link was established in a major US study*:

·	20-39 years of age - 7.5%

·	40-49 - 11%

·	50-59 - 18%

·	60-69 - 38%

·	70 plus - 57%

Can smoking lead to impotence?

Smoking cigarettes can significantly reduce the quality of a man's erection and is recognised to be a contributory factor in many cases of impotence. This is because smoking - and nicotine in particular - affects the circulatory system, impairing the efficient blood flow in the blood vessels - including those in the penis. Several research studies have concluded that a man who smokes is more likely to develop impotence than a non-smoker. It also concludes that a smoker, diagnosed as impotent, is sometimes more difficult to treat than a non-smoker. This is because smoking increases the likelihood of developing abnormalities in the blood cells in the penis.

What therapies are available to treat impotence?

Available treatments, depending on the cause and extent of the problem, include: pharmacotherapy such as intracavernosal injections, oral therapy, transurethal therapy, systemic drug treatment (testosterone), arterial surgery, venous surgery, implanted penile prostheses, vacuum-constriction devices and psychotherapy.

What are the current treatment options available?

Intracavernosal injections : The drug alprostadil (Prostaglandin E1, a substance occurring naturally in the body) is self-injected into the base of the penis with a small needle (Caverject, Viridal Duo). An erection is brought about by the relaxation of the smooth muscle and dilation of the arteries. Onset of action is 10-20 minutes after injection and the erection lasts for 30-60 minutes.

Intraurethal therapy : A new delivery mechanism for alprostadil allowing patients to administer the medication through the urethra (MUSE). A small pellet of the drug, no bigger than a grain of rice, is inserted into the urethra and released using an applicator. The medication takes about 5-10 minutes to work and the erection lasts 30-60 minutes.

Oral therapy : There are currently four oral drugs licensed for the treatment of erectile dysfunction. Three are tablets taken one hour before sexual activity, the other is a tablet taken sublingually (under the tongue) twenty minutes before sexual activity. All four drugs are effective and do not cause an erection unless the man is sexually stimulated.

Another oral treatment which is not licensed is yohimbine. It is derived from the bark of an African tree and several studies have suggested it has a beneficial effect in enhancing erectile function.

Vacuum therapy : A plastic tube is applied to the penis and a vacuum is created with a pump. The resultant negative pressure causes rapid blood flow into the penis simulating an erection. The base of the penis is constricted by applying a ring to ensure that the blood does not drain away. The ring must be removed within 30 minutes of application.

Sex therapy : In a large number of impotence cases there are significant psychological and/or relationship issues which may need to be addressed before other treatments are instigated. Sex therapy aims enhance the patients sexual confidence and gives advice to couples on increasing sexual stimulation and repertoire of sexual achievements.

Penile implants : A mechanical device is inserted into the erection chambers of the penis via surgery. The device will either be permanently rigid or have a hydraulic action. In the case of the hydraulic action a reservoir of fluid will be implanted in the abdomen with a valve in the scrotum. Activation of the valve directs the fluid from the reservoir into the erection device giving an erection.

Erection-Inducing Drugs - Medical Treatments For Erectile Dysfunction

Drugs which induce and strengthen erections can successfully treat Erectile Dysfunction and problems achieving and maintaining a strong erection. Erection inducing and erectile dysfunction drugs work for the majority of men who want stronger erections and can also help men with neurological and spinal problems.

Cialis : Works in the same way as Viagra, and is popular because the erection inducement effects last so long - often more than 12 hours. The Cialis erections are not blocked by food in the stomach.

Levitra : Works in same way as Viagra. Side-effects and interactions of Levitra are similar to those of Viagra. Levitra erections are not as long-lasting as Cialis.

Viagra : Widens the bloods vessels, so giving an erection provided the penis is rubbed. Viagra usually works within an hour. Effect lasts for about four hours. Easily blocked by food in the stomach. Commonest side-effects of Viagra are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. Viagra is very dangerous with certain heart drugs. Interacts with many medications. Do not drink grapefruit juice on day of use.

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