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Impotence

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D E S C R I P T I O N

Men with impotence, or erectile dysfunction, are unable to achieve and maintain an erection long enough to complete satisfactory intercourse. Some men have erectile dysfunction occasionally; others experience it often or always.

There are various causes of erectile dysfunction, including medication, circulatory problems, diabetes and nerve damage, among others.

Sexual arousal is the first step in getting an erection. During arousal, the brain allows opening of certain blood vessels in the penis, causing it to fill with blood and become erect.


R I S K

A number of medical conditions may cause impotence. Many of these conditions are more common in older people; not surprisingly, chances of erectile dysfunctions increase with advancing age.

Medical conditions that increase the risk of impotence include:

1. Vascular diseases and diabetes, which affect the proper functioning of blood vessels.

2. Injuries to the spinal cord or brain, or neurological diseases such as Alzheimer's disease, multiple sclerosis and Parkinson's disease.

3. Surgery or radiation to the prostate, bladder, rectum or colon, which can cause damage to nearby nerves and interfere with signals that must pass between the brain and the sexual organs to allow erection and orgasm.

Approximately 20 percent of all cases are due to psychological causes, including stress, anxiety or depression, anger, fatigue, boredom, fear of failure, fear of infection and problems with self-esteem. In many cases, both psychological and physical reasons lie at the root of the condition.


S Y M P T O M S

Repeated difficulty in sustaining an erection or the inability to achieve an erection.

Looking at medical and sexual histories, as well as a physical examination are the keys to investigating erectile dysfunction. Lab tests may be helpful in some cases.


T R E A T M E N T

Approximately 95 percent of impotence patients find a treatment that works for them. The treatment depends upon the cause and severity of the case, the cost and the preferences of both the patient and his partner. Be aware that there may be side effects with some treatments.

For impotence due to anxiety, the oral medication Viagra has helped many men regain their sexual functioning. Viagra is also very effective for impotence that sometimes follows prostate surgery and is helpful in many other organic conditions.

Men who haven't found success with Viagra can try another drug called Alprostadil. The drug is available in pellets, which are placed into the opening of the end of the penis, or in a liquid that is injected into the penis.

Other treatments include vacuum therapy, penile implants and vascular surgery to repair blood flow to the penis. Testosterone replacement may help a small number of men whose impotence is due to a testosterone deficiency. Psychological counseling can help men with impotence due to psychological reasons.


P R E V E N T I O N

  • Ask a physician to take a second look at your medications. A wide range of drugs, including anti-depressants, anti-histamines, and medications to treat high blood pressure, pain and prostate cancer can cause impotence.
  • Limit alcohol. Mood-altering substances such as alcohol and marijuana play a role in impotence.
  • Stop smoking. Smoking has been shown to affect blood flow in blood vessels and may cause impotence.
  • Get educated. Education may be helpful in preventing a minor case from cascading into a serious one.
  • Be cautious when doing physical activity. Injuries to the pelvic area, particularly those associated with bicycle riding, water sports, gymnastics and horseback riding, can cause impotence.

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