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Other Names:
Erectile Dysfunction, ED, Sexual Dysfunction, Male Sexual Dysfunction
Impotence

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Definition

Impotence is the persistent inability to get or maintain an erection of the penis that is firm enough to have intercourse. There may not be an erection at all or the erection may be lost during intercourse. The word "impotence" may be used to describe problems that interfere with sexual intercourse and reproduction such as lack of sexual arousal or desire and problems with ejaculation or orgasm.

The are some requirements for a satisfactory erection:

  • A responsive and healthy state of mind
  • A normally functioning pituitary gland
  • Adequate testosterone
  • A healthy nervous system
  • Adequate penile blood supply

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Causes

An erection requires the interaction of brain, nerves, hormones, muscles and blood vessels. Anything that interferes with the normal process can potentially cause erectile dysfunction. Erectile dysfunction tends to be more common amongst older men. Physical causes are more common in older men while psychological causes are more common in younger men. A penis that won't rise to the occasion could be a warning to something more serious or it could be a temporary malfunction. Some diseases cause abnormal blood flow to the penis and hamper the person's ability to have an erection. There are several

  • Some diseases and health conditions including:
    • Diabetes
    • Hypertension (High blood pressure)
    • Heart Disease
    • Thyroid conditions
    • Poor blood circulation
    • Atherosclerosis (the hardening of the arteries in the body)
    • Low testosterone (can be caused by problems with pituitary gland, thyroid abnormalities, the liver and the testes)
    • Depression
    • Problem with the nerves carrying signals from the brain to the penis
    • Spinal cord injury
    • Nerve damage (from prostate surgery)
    • Neurologic disorders (multiple sclerosis or Parkinson´s disease)
    • Neuropathy (Nerve damage) caused by poorly managed diabetes
    • HIV-induced Neuropathy (Either from the HIV or from the antiviral medications)

  • Some medications like:
    • Blood pressure medication (beta-blockers)
    • Heart medications (digoxin)
    • Peptic ulcer medications
    • Sleeping pills
    • Antidepressants

  • Tobacco Smoking
  • Alcohol abuse
  • Substance abuse
  • Stress and anxiety
  • Sexual Performance Anxiety
  • Fear or anger
  • Poor communication with sex partner
  • Vascular Surgery or other treatments for your blood vessels

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Symptoms

The repeated inability of a man to have an erection or keep an erection long enough and firm enough for sexual intercourse. The man's sexual desire may be normal or reduced. The man's ability to reach an orgasm and ejaculate may also be normal or reduced.

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Implications

Impotence can be treated in most cases. Leaving it untreated can lead to social withdrawal, anxiety, depression and stress in the marriage. It can even affect one's self-respect and performance at work.

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What You Can Do

Oral medication Sildenafil (Viagra) These drugs increase the amount of blood flow thereby creating an erection in response to sexual stimulation. They do not automatically produce an erection. Physical and psychological stimulation is needed. Many men experience improvement in erectile function after taking these medications regardless of the cause of their impotence. They vary in dosage, duration of effectiveness and possible side effects. It is not yet known which drug is best for certain types of men. Although these medications can help many people, not all men can or should take them to treat erectile dysfunction. If you've had a heart attack, stroke or life-threatening heart rhythm during the last six months, don't take these medications. If you've been told that sexual activity could trigger a cardiac event, discuss other options with your doctor. In addition, don't take Viagra, Levitra or Cialis with nitrate medications, such as the heart drug nitroglycerin. The combination of these medications, which work to widen (dilate) blood vessels, can cause dizziness, low blood pressure, and circulation and heart problems. Always consult your physician before taking any medication.
Oral medication Tadalafil (Cialis)
Oral medication Vardenafil (Levitra)
Needle-injection Prostaglandin E (alprostadil) This is a synthetic version of the hormone prostaglandin E. The hormone helps relax smooth muscle tissue in the penis, which enhances the blood flow needed for an erection. With injection, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. It normally produces an erection in 5 to 20 minutes and lasts about an hour. Since the injection goes directly into the spongy cylinders that fill with blood, alprostadil is an effective treatment for many men and the needle is so fine that pain from the injection is usually minor. Other side effects may include bleeding from the injection, prolonged erection and formation of fibrous tissue at the injection site. Cost per injection can be expensive. Injecting a mixture of alprostadil and other drugs such as papaverine and phentolamine (Regitine) may be a less expensive and more effective option.
Intraurethral Therapy Prostaglandin E (alprostadil) This Self Administered method's trade name is Medicated Urethral System for Erection (MUSE). It involves using a disposable applicator to insert a tiny suppository, about half the size of a grain of rice, into the tip of your penis. The suppository, placed about two inches into your urethra, is absorbed by erectile tissue in your penis, increasing the blood flow that causes an erection. Although needles aren't involved, you may still find this method painful or uncomfortable. Side effects may include pain, minor bleeding in the urethra, dizziness and formation of fibrous tissue.
Injectible Testosterone Depo-Testosterone®

If low testosterone is the only cause of a man's erectile dysfunction, it can be treated with testosterone replacement therapy.

Delatestryl®
Testosterone Patch Transdermal Testoderm®
Androderm®
Gel Testosterone AndroGel® 1%
Testim®
Buccal Striant®
Oral Testosterone Andriol Pill®
Mechanical Penile Vacuum This treatment involves the use of an external vacuum and one or more rubber bands (tension rings). To begin you place a hollow plastic tube, available by prescription, over your penis. You then use a hand pump to create a vacuum in the tube and pull blood into the penis. Once you achieve an adequate erection, you slip a tension ring around the base of your penis to maintain the erection. You then remove the vacuum device. The erection typically lasts long enough for a couple to have adequate sexual relations. You remove the tension ring after intercourse.
Surgical Penile Implants This treatment involves surgically placing a device into the two sides of the penis, allowing erection to occur as often and for as long as desired. These implants consist of either an inflatable device or semirigid rods made from silicone or polyurethane. This treatment is often expensive and is usually not recommended until other methods have been considered or tried first. As with any surgery, there is a small risk of complications such as infection.
Surgical Vascular Surgery This is usually reserved for men whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery may also be used to correct erectile dysfunction caused by vascular blockages. The goal is to correct a blockage of blood flow to the penis so that erections can occur naturally. But the long-term success of this surgery is unclear.
Counselling Psychological Counseling If stress, anxiety or depression is the cause of your erectile dysfunction, your doctor may suggest that you, or you and your partner, visit a psychologist or psychiatrist with experience in treating sexual problems.
Nutrition Supplementaion If we nourish the body correctly, we can alleviate or reduce the intensity of some causes of erectile dysfunction (ED) and thus treat the condition or at least reduce the severity of the problem. For example nutrition has a profound effect on diabetes, hypertension, anxiety and depression. Naturopathic treatment of ED requires that we manage the underlying causes of ED, remove irritating foods from the diet, add nutritional supplements and use herbal extracts.

Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

  • Pay Attention to your Nutritional needs
  • Eat healthy fresh foods, adequate proteins and nuts
  • Limit or avoid the use of alcohol and other drugs.
  • Stop smoking.
  • Exercise regularly.
  • Reduce stress.
  • Get enough rest
  • Take time to relax.
  • Get adequate deep sleep in a dark room.
  • Deal with anxiety or depression by psychological counseling and/or medication.
  • Use safe sex practices if the problem is caused by fear of contracting a sexually transmitted disease.
  • Communicate openly to your partner about sex and your relationship.
  • Counseling should be sought if open communication is not possible.
  • See your physician for regular checkups and medical screening tests.

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Impotence