Male impotence

Did you know that male impotence will affect a good proportion of the men in the UK at some point during their lives? Suprisingly, the figure is as much as 65% by age of 70 years old.

Therefore there is a need for concise and informative male impotence information to help you understand fully the facts. It has many different causes and cures.
The symptoms of male impotence are the persistent or recurrent inability to achieve or maintain an erection sufficient for the completion of sexual intercourse or other sexual activity, despite an unaffected desire for sex.


Our male impotence advice will show you that this is a very different, although related, condition to sterility, which is defined as the inability to produce sperm adequate for reproduction.

Penile Vascular Surgery

Isolated stenosis or occlusion of the extrapenile arteries is amenable to surgical repair. Restoration of potency has been reported after surgery of the internal iliac and internal pudendal arteries. Currently, the most commonly used technique for penile revascularization is a bypass from the inferior epigastric artery to the dorsal artery or deep dorsal vein of the penis. This procedure is indicated only in young men with congenital or traumatic arterial insufficiency (_{Hakim et al, 1995}). 

Male Sexual Dysfunction Involving Emission, Ejaculation, & Orgasm

Physiology of Emission, Ejaculation, & Orgasm

Different mechanisms are involved in erection, emission, ejaculation, and orgasm, and these events can be dissociated from one another (eg, a frequent complaint of impotent patients is ejaculating through a “limp penis"). Except for nocturnal emissions, or “wet dreams,” emission and ejaculation require stimulation of the external genitalia. Impulses traveling from the pudendal nerves reach the upper lumbar spinal sympathetic nuclei.

Erectile Dysfunction Surgical Therapies

Current surgical treatments for erectile dysfunction consist of correction of venous leak, arterial revascularization for inflow insufficiency and implantation of penile prostheses. Only the last of these, however, may truly be described as resulting in a reliably satisfactory outcome. In addition, patients with considerable deformity due to Peyronie’s disease may be helped by surgery designed to correct the penile curvature.

Correction of venous leak
Wespes originally described venous leak as a cause of erectile dysfunction. It was hoped that simple excision/ligation of the deep dorsal vein would be curative (Figure 70). However, leakage points are usually multiple and, unfortunately, the improved function resulting from this procedure, even when combined with bilateral plication of the corpora or embolization of pelvic veins, is usually only temporary. This procedure should only occasionally be performed in fully informed consenting patients.

Male Sexual Dysfunction Epidemiology

In the Massachusetts Male Aging Study, a community-based survey of men between 40 and 70 years of age, 52% of respondents reported some degree of ED: 17% mild, 25% moderate, and 10% complete. Although the prevalence of mild ED remained constant (17%) between the ages of 40 and 70, there was a doubling in the number of men reporting moderate ED (from 17% to 34%) and a tripling in the number of men reporting complete ED (from 5% to 15%). Among the major predictors of ED are diabetes mellitus,heart disease, hypertension, and decreased high-density lipoprotein level. There is a higher prevalence of ED in men who have undergone radiation or surgery for prostate cancer. The psychological correlates of ED include depression and anger (Feldman et al, 1994). In the National Health and Social Life Survey in men aged 18-59, other male sexual dysfunctions were also found to be highly prevalent: premature ejaculation (28.5%), lack of sexual interest (15.8%), anxiety about sexual performance (17%), and lack of pleasure in sex (8.1%) (_{Laumann et al, 1994}).

Medication Causing Erectile Dysfunction

Although it is believed that certain medications can cause sexual function issues such as erectile dysfunction, it is very difficult to determine whether a specific medication is the cause of erection problems.

The main problem is that many disease themselves can cause erectile dysfunction. Another problem is that a medication side effect such as erectile dysfunction often goes unreported due to embarrassment – as a result that actual rate of erectile dysfunction caused by a specific medication may be much higher than is officially reported.

Drugs That Cause Impotence

Recreational drugs are a major cause of erection problems and the number one problem drug is tobacco. Experiments show that even two cigarettes will markedly decrease the blood flow to the penis if smoked before sex. Marijuana, cocaine and alcohol are also big causes of erection problems. Prescription drugs are also big culprits, especially blood pressure drugs.

Diagnosis of erectile dysfunction

The proper goal-oriented evaluation of a man proactive and complaining of erectile dysfunction requires a sympathetically elicited history, a focused physical examination and various carefully selected special investigations.

HISTORY
To obtain a clear history, it is important that the patient himself understands the distinction between loss of libido, erectile dysfunction and ejaculatory disturbance. This often may require some preliminary explanation. The onset, consistency and severity of the complaint need to be established. Recently, the development of self-administered symptom scores by O’Leary and colleagues and Rosen and colleagues have facilitated quantitative history-taking for erectile dysfunction.

Erectile dysfunction, sex and cancer

As with erectile dysfunction (ED) in general, when it occurs in association with cancer or other serious illnesses there is usually a mixture of physical and psychological causes.

The two types of cancer most likely to be associated with ED are prostate cancer and cancer of the lower bowel (rectum). It is more common for the treatments for these cancers to cause erectile dysfunction rather than the cancer itself.

Erectile Dysfunction, High Blood Pressure Linked

Men with High Blood Pressure have a new reason to get their condition under control - they may be at risk for erectile dysfunction, medical experts announced today at the American Society of Hypertension’s Twentieth Annual Scientific Meeting.

Two separate studies presented this week uncovered a commonly hypothesized link between the hypertension and erectile dysfunction (ED). One of these studies also demonstrated that of long-term use of sildenafil, a commonly prescribed ED treatment, was effective in improving aortic stiffness in patients suffering from the condition. 

Nonsurgical Treatment of Erectile Dysfunction

Although the penile prosthesis remains one of the most effective treatments for all types of ED, nonsurgical management has replaced prosthetic surgery as the preferred choice in the last decade. Both specific and nonspecific treatments are available. The former include psychotherapy, change of offending medications, and hormonal therapy; the latter include sildenafil, vacuum constriction device, transurethral therapy and intracavernous injection. Although nonspecific therapies appear to be more effective for most cases of ED, the patient should also be made aware of specific therapies.

Mechanisms of erection

Intracavernosal smooth muscle tone is by far the most important determinant of intracavernosal blood flow. Approximately half of the cavernosal volume is composed of smooth muscle, with the remainder consisting of either lacunar spaces or collagen. Collagen fibers are largely responsible for the passive mechanical properties of cavernosal tissue. In contrast, active contraction of cavernosal smooth muscle is dependent upon a number of factors, including the level of agonists (neurotransmitters, hormones and endothelium-derived factors), adequate expression of receptors, integrity of transduction mechanisms, calcium homeostasis, interaction of contractile proteins, and intimate intracellular communication between smooth muscle cells (gap junctions).

Cavernosal smooth muscle cells contain abundant amounts of the contractile proteins, actin and myosin. Following phosphorylation of myosin by adenosine triphosphate (ATP), attachments (crossbridges) form between the light chains of these two proteins and these attachments provide the mechanism for contractile tone of smooth muscle. The expenditure of energy for maintaining this state of tone is almost zero, but there is an absolute requirement for a high concentration of cytoplasmic free calcium.

Guidelines for Treatment of Erectile Dysfunction

Each patient with erectile dysfunction should receive individualized and integrated treatment of his erectile dysfunction, with all indicated modalities applied.
The first step after the thorough evaluation, diagnosis determination, and patient education should be the modification of reversible causes, such as alcohol abuse, smoking, prescription or nonprescription drugs, and cardiovascular risk factors (e.g. hypertension).
 Some authors divide the possible treatment interventions into first-, second-, and third-line ones. According to Goldstein (1999), the first-line interventions include oral erectogenic agents (e.g., sildenafil, oral apomorphine, oral phentolamine), vacuum erectile devices, and psychosexual therapy. These interventions are easy to administer, noninvasive, and reversible. Mobley and Baum (1998) also include all of these modalities in their first-line therapies, with the addition of yohimbine.....

Causes of Erectile Dysfunction

As Schiavi pointed out in the previous edition of this book, “emphasis on specific determinants of erectile disorders has been influenced by prevailing theoretical perspectives as they have shifted over the time”. We have certainly seen a shift from the emphasis on psychological causes or determinants of erectile dysfunction to an emphasis on biological or organic causes of erectile dysfunction. The previous claims that 90%-100% of erectile dysfunctions have psychological origins changed to claims that 90%-100% of erectile dysfunctions have biological or organic causes. However, every experienced clinician in this area knows that the etiology of erectile dysfunction is usually multidetermined, involving a mixture of organic and psychological factors. Even an unequivocally biologically determined erectile dysfunction, such as erectile dysfunction associated with diabetes mellitus, has a psychological component.