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Male
impotence is defined as the inability to achieve or maintain an
erection sufficient for mutually satisfying intercourse.
Per the diagram adjacent diagram one can see that the incidence
of Erectile Dysfunction correlates with an individuals age
effects some 67% of men by the age of 70 years old. Erectile
Dysfunction impacts more than a man's sexual activity.
The
emotions and uncertainties that coincide with with impotence
often have a significant effect on a man's self-esteem, as well
as, his relationship with his partner.
Although the incidence of male impotence increases
with age, it is not an inevitable result of aging.
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Understanding Male Impotence
The first step in treating
male impotence is that you understand the psychology, physiology
and anatomy responsible for the ability to achieve and maintain
an erection.
If you can comprehend these events than we can
better understand the factors that are responsible for male
impotence and address the questions concerning the treatment of
male impotence.
Normal Erectile
Function
For something that appears so
natural, an erection is a rather complicated process involving
the coordination of the psychological, neurological and
cardiovascular systems. The penis becomes erect following
a series of events. First, the nerves are stimulated, a
sensation known as arousal. No matter what the nature of
the stimulus, visual, mental or physical the brain coordinates
the following series of events:
- Nerve impulses transverse the length
of the spinal cord to the pudendal nerve and on to the penis.
Smooth muscle within the walls of the penile arteries respond by
relaxing. Subsequently, the penile arteries dilate allowing up
to eight times more blood to flow into the corpora cavernosum,
(two parallel cylinders that transverse the length of the
penis).
- The cavernosum become engorged with
blood expanding and lengthening the penis. The expanding tissue
then exerts a positive pressure compressing the veins that
normally empty the blood from the penis, maintaining the blood
in the penile tissue. When ejaculation occurs or when arousal is
discontinued the penis returns to its non-erect state.
Causes of Male Impotence
In the past, if you consulted
your doctor concerning any male impotence symptoms he/she would
smile and say "impotence is common in your age group
unfortunately there is not much we can do to reverse your
impotence."
Today, years of research has resulted in significant
advances in both the diagnosis and treatment of male impotence.
Doctors now understand that approximately 85% of male impotence
is attributable to physical/organic conditions while only 15% is
due to psychological or mixed origin (both psychological and
organic).
Some Common Causes of Male Impotence
Are as Follows:
Vascular Disease as a Cause of Male
Impotence
impotence. Vascular disorders include
arteriosclerosis (hardening of the arteries), hypertension,
hyper-cholestremia and other conditions which interfere with the
blood flow to the penis. Additionally, "venous leakage", a
condition occurring when the penile veins are unable to
constrict efficiently during an erection, also contributes to
poor erections. When these veins "leak", blood escapes to
the periphery resulting in a poor erection.
Diabetes as a Cause of Male
Impotence -
is another common cause of male impotence. Approximately 50% of
men with insulin dependent diabetes experience some degree of
impotence after 55 years old. Diabetes results in poor
circulation and/or peripheral neuropathy. When the nerves
are involved, sexual stimuli are not transmitted appropriately
to or from the brain and impotence develops.
Neurological Diseases as a Cause of
Male Impotence - such
as multiple sclerosis, Parkinson's disease, spinal cord injuries
and long term effects of diabetes can also result in the
disruption of the normal sequence of events necessary for an
erection to occur.
Endocrine System as a Cause of Male
Impotence
Deficiencies in the Endocrine System are another source of
Erectile Dysfunction. Low levels of testosterone or thyroid
hormone can interfere with the stimulation process necessary in
the erection sequence. Excessive production of prolactin
by the pituitary gland may contribute to decreased levels of
testosterone resulting in a lack of desire. Diabetes once
again enters the scenario as it is classified as an endocrine
disorder.
Prescription medications
as a Cause of Male Impotence - drugs can
often cause male impotence as a side effect. Some two
hundred known medications fall into this category including:
Antihypertensives medications
specifically:
- Beta-blockers e.g. Atenolol,
Propanolol and Tenorium.
- Diuretics medications e.g.
HydroDiuril and Lasix.
- Ace Inhibitors/Calcium Channel
Blockers medications e.g. Vasotec®, Lotension®,
Cardizem® and Norvasc® periodically cause Erectile
Dysfunction , however, they are generally represent an
excellent alternative medication for individuals with drug
induced impotence.
Antidepressant/Antipsychotic
medications -of almost any label can also result in
Erectile Dysfunction e.g. Prozac®, Elavil®, Zoloft®, Thorazine®
and Haldol®. Note: Many other medications in a variety of
classes can periodically cause impotence. If you take a
prescription medication or an over-the-counter medication,
regularly, please consult with your physician. However,
never alter a dosage or discontinue a medication without the
advice of your physician.
Smoking
as a Cause of Male Impotence -
Smoking as also been linked to
impotence in numerous clinical studies.
The most common causes of the organic
component in impotence are vascular abnormalities associated
with atherosclerosis and diabetes mellitus. Atherosclerosis
causes 40% of cases of impotence, and in cases of diabetes
mellitus the prevalence of erectile dysfunction is 50%. Smoking
is significantly associated with the development of both
atherosclerosis and diabetes mellitus.
The Epidemiology and
Pathophysiology of Erectile Dysfunction.
The Journal of Urology 1999 Jan; 161(1):5-11
After
smoking two cigarettes, the diameter of the internal pudendal
artery narrows and the penile arteries almost completely close.
This evidence suggests that smoking can cause an acute
vasospastic constriction of the arteries in the penis. These
observations are supported by physiological evidence that
nicotine causes acute peripheral vasoconstriction.
Acute Vasospasm of Penile Arteries in Response
to Cigarette Smoking. Urology 2007; 36(1):99-100
Researchers in London concluded that male smokers who suffer
from long standing hypertension are 26 times more likely to be
impotent than those individuals who do not smoke.
January 2007, The Journal of Family Practice.
Aside from impotence, smoking as also
been linked to the following negative effect concerning male
sexual health:
- Reduced volume of ejaculation
- Lowered sperm count
- Abnormal sperm shape
- Impaired sperm motility
Fortunately, there is now an effective
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LH-RH Analogs/Antiandrogen Medications
as a Cause of Male Impotence - e.g. Lupron Depot®, Eulexin®, Nilandron®,
Casodex®, etc. are medications are used in the treatment of
prostate cancer. They function by decreasing the
production of testosterone in the testes and adrennal glands,
which decrease in testosterone often results in Erectile
Dysfunction.
Chemotherapy/Radiation as a Cause of
Male Impotence -
therapy is also a significant contributors to Erectile
Dysfunction. These drugs/treatments are used in the
treatment of cancer.
Substance Abuse as a Cause of Male
Impotence - can also
negatively effect male potency. The chronic use of
cocaine, marijuana, alcohol, steroids etc. often results in
Erectile Dysfunction, as well as a decrease in desire.
Excessive tobacco use can also attribute to Erectile Dysfunction
by accentuating the effects of other risk factor such as
vascular disease or hypertension.
Radical Pelvic Surgery
as a Cause of Male Impotence - also
result in Erectile Dysfunction. Surgical procedures involving
the prostate gland, bladder or colon may interfere with the
nerves involved in the erectile response. Radiation
therapy for cancer may also effect the erectile process.
Psychological Situations as a Cause
of Male Impotence - is usually
diagnosed when no physical causes can be defined. Pure
psychological impotence usually occurs suddenly
without warning as opposed to physical impotence that may gradually
develop over the years.
Some common causes of psychological male
impotence are as follows:
- Performance Anxiety as a
Cause of Male Impotence - - is one of
the most common causes of psychological impotence. When a
man feels pressured to achieve or maintain an erection, he will
commonly become anxious and nervous when in a sexually demanding
situation. Stress increases the body's production of
catecholamines such as adrenaline and nor- adrenaline, which act
as erection inhibitors. The release of these inhibitors
further contributes to failure resulting in more anxiety.
Therefore, the cycle begins, increased stress resulting in
increased catecholomines that further inhibits the erectile
process.
- Depression as a
Cause of Male Impotence - - is another cause of
psychogenic impotence. Unfortunately, many of the popular
antidepressant medications (for a list see prescription
medications in the next section) have side effects which include
erectile failure.
Anatomical Deviation of the Penisas
a Cause of Male Impotence
Anatomical Deviation of the Penis, known as Peyronie's Disease,
may also causeimpotence. This condition usually develops from an
inflammatory process and results in fibrous scaring of the
penis. The cause of this process is not yet understood;
however, when an erection does occur, there is a bending of the
penis secondary to the scar tissue. This curvature may
interfere with erectile capacity and/or ejaculation.
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