IMPOTENCE: causes, symptoms, and treatment options

Dysfunction of the genital organs in men can cause a serious decrease in the quality of life and depression. Often we are talking about impotence that occurs against the background of primary diseases. Impotence can even occur in young men and adolescents, and in patients of this age group, sexual problems have a more severe effect on mental and emotional state. Modern methods of treatment can eliminate the root cause of impotence or temporarily restore an erection with a single dose of the drug, but not all forms of this pathology can be corrected.

Until the early twentieth century, doctors did not know how to cure impotence. Several centuries ago, in some countries, this pathology was even considered a crime and was a legal basis for divorce. In the 1930s, the first methods of correcting the disease using expensive implants and injections were developed in the United States, but these methods did not become widespread. The prerequisites for the discovery of modern therapy for impotence appeared in 1983, when an English physiologist demonstrated the effect of a nonspecific vasodilator on the function of the penis.

More about the disease

Impotence is a dysfunction of the male penis manifested by insufficient erection. In medical literature, pathology is also called erectile dysfunction. Patients suffering from such an ailment are unable to perform intercourse due to insufficient organ hardness. The disorder itself does not affect vital functions and does not block urination, however, sexual impotence has a negative effect on the psychological state of a man and is often the cause of infertility.

Depending on the etiology (cause), impotence can be reversible or irreversible. Doctors list cardiovascular diseases, diabetes mellitus, hormonal disorders, and various neuropathies as common organic causes of impotence. A common cause of reversible impotence is a psychological disorder manifested by anxiety and emotional instability. Instrumental diagnostic methods can quickly exclude the psychogenic etiology of the disease.

Erectile dysfunction is found in 50% of men over 40. Age-related diseases of the heart and blood vessels play an important role in the development of pathology. In addition, bad habits can also adversely affect the physiology of a man's sexual life. In recent years, scientists have been actively studying the possible genetic basis for the onset of impotence, since the improper formation of proteins necessary to maintain erectile function may be the main cause of sexual impotence.

Anatomy and physiology

The penis is the main male genital organ necessary for intercourse, urine flow, and ejaculation. The functions of the penis are also related to the prostate gland, urinary tract, testes, and the nervous system. Anatomically, the organ is formed by the cavernous bodies, capable of filling with blood during an erection, and by the spongy body, in the thickness of which the urethra is located. The numerous lacunas that form the basis of the cavernous bodies of the penis provide effective blood flow to the organ and a significant enlargement in the size of the penis during intercourse.

Erectile function is associated with the activity of nerve fibers, smooth muscle cells, and blood vessels. During sexual arousal, the muscle structures of the vessels are relaxed due to the influence of the parasympathetic nerves and the release of nitric oxide. The cavernous bodies are passively filled with arterial blood, and the venous outflow is weakened. After the end of intercourse, sympathetic fibers provoke the release of norepinephrine, which promotes the outflow of blood from the organ parenchyma. All of these functions are due to the activity of the cerebral cortex and neurotransmitters, therefore psychogenic factors are of particular importance in the cause of impotence.

Causes of occurrence

Impotence is usually a polyetiological disease, i.e. can be caused by a variety of causes, since the functions of the penis depend on a wide variety of factors. Violations of even an insignificant physiological component of an erection can cause pathology. Experts identify psychological and physiological causes of sexual impotence, since these categories include all possible sources of pathogenesis.

The main reasons for the violation of potency:

1. Vascular disorders: atherosclerosis, arterial hypertension, myocardial infarction, vascular injury and side effects of drugs used for cardiovascular diseases.
2. Systemic disorders: scleroderma, diabetes mellitus, liver cirrhosis, renal failure, dyslipidemia and hemochromatosis.
3. Neurological diseases: epilepsy, multiple sclerosis, Alzheimer's disease, trauma to the central or peripheral nervous system.
4. Disorders of the respiratory system: chronic obstructive pulmonary disease and sleep apnea.
5. Endocrine pathologies: hypogonadism, insufficient or excessive thyroid function.
6. Psychological problems: depression, anxiety disorder and post-traumatic stress disorder.
7. Postponed surgical treatment of pelvic organs, large vessels, brain and spinal cord.
8. Taking drugs for the treatment of hypertension, antidepressants, antipsychotics, 5-alpha-reductase inhibitors, as well as drugs for gastrointestinal ulcers and lowering cholesterol levels.

Pathological conditions, characterized by dysfunction of the vascular endothelium and nerve bundles, most often cause impotence in older men. These pathologies lead to an imbalance in the relaxation and tension of smooth muscle cells, as a result of which the patient does not have an effective blood supply to the corpus cavernosum of the penis.

Difference in symptoms of physiological and psychogenic impotence

Risk factors

Doctors are not always able to determine the specific cause of impotence, therefore, it is necessary to take into account the role of various forms of predisposition to the disease. First of all, these are the features of the patient's lifestyle.

Key risk factors for impotence

1. Smoking. Regular penetration of harmful chemicals from tobacco smoke into the body can cause chronic cardiovascular disease over time.
2. Alcoholism. Ethyl alcohol has an adverse effect on blood vessels and the nervous system.
3. Obesity and lack of physical activity.
4. High cholesterol and irregular diabetes therapy.
5. Chronic stress, insomnia and adverse social conditions.

The patient can independently eliminate many risk factors, so timely prevention plays an important role in preventing the onset of impotence. Bad habits are often the cause of poor erection at a young age.

In young men psychological problems induced by stress, problems in relationships, phobia of intimacy due to a negative experience, or mental disorders such as depression, anxiety, and so on are the first risk factors for impotence. This type of disorder without any physiological problems in the body is called psychogenic impotence. It means that there are no physical obstacles for impotence and a man can develop erection while masturbating and has spontaneous morning erections but encounters problems namely being with a partner.

Diagnostics

First of all, you need to be examined by an andrologist. The doctor asks the patient about the complaints, examine the medical history to detect risk factors for the disease, and examine the genitals. During a physical examination, certain disorders associated with the prostate gland, testicles or directly with the penis may be detected, however, to clarify the diagnosis, the specialist will need the results of instrumental and laboratory tests.

Necessary diagnostic manipulations

1. Blood test. With this study, the doctor can detect signs of diabetes, hormonal imbalance, or other pathology.
2. Ultrasound imaging of blood vessels. The use of high-frequency sound waves allows the identification of vascular causes of impotence. Before the examination, the doctor injects an erection stimulating medication into the genitalia. The test results give the andrologist the opportunity to reliably exclude the psychogenic nature of impotence.
3. Examination by a psychotherapist to detect depression, anxiety or other mental pathology.

If necessary, the andrologist can send the patient to a urologist, neurologist or another specialist. Often, a thorough visual and laboratory examination of internal organs is required to rule out frequent causes of erection disorder. After the diagnosis is made, the andrologist will tell the patient about the signs and treatment of the disease causing sexual impotence.

Treatment

The method of impotence treatment depends on the cause, the patient's age and the diagnosed diseases. If there is a physiological cause for the disorder, the doctor appoints surgical or drug treatment of the underlying disease, for instance, hypertension, diabetes, high cholesterol, and so on. The further prognosis for the curing of impotence depends on the severity of the primary disease and the damage it caused to the blood flow. Thus, it is important to treat any diseases timely. For instance, if you suspect that you may have or have a history of hypertension (high arterial tension) or diabetes in your family, once you reach 40 or 50, even if you have no symptoms, you need to start undergoing early medical examinations to catch the disease at an early stage. Besides, sexual health, as well as overall health, greatly depends on the lifestyle. It is impossible to prevent and effectively treat impotence for a man who smokes, abuses alcohol, has a sedentary lifestyle, eats unhealthy food, and so on.

The most frequently used therapy for impotence is drug therapy. There are medicines for the short-term promotion of erection and systemic therapy. The most widespread medicines are Viagra, Cialis, and Uprima. These drugs act differently – Viagra and Cialis promote the blood inflow into the genitalia in arousal relaxing the muscles and helping blood vessels to expand while Uprima acts on the brain areas responsible for arousal and erection. Keep in mind that it is always better to consult a doctor before using these medicines even though you can buy them online without a prescription. Many drugs to stimulate erection have a general effect on the heart therefore, the patient must first learn about the possible adverse reactions of therapy. Also, for the best effect, make sure you better your lifestyle and treat the underlying diseases and only use medicines for erection enhancement as an addition to the main therapy.

Other medicines for impotence include:

- Injection of papaverine or phentolamine into the penis;
- Medicines based on herbs that improve blood flow and libido;

Other treatment methods include:

- Surgery on the penile blood vessels. It is only suitable for the treatment of a specific vascular pathology.
- Use of vacuum devices (pumps) for enhanced blood flow;
- Surgery for the installation of plastic or hydraulic prostheses in the penis;
- Psychotherapy (especially needed for men with psychogenic erectile dysfunction);

Therapy, especially one that implies penile injections or surgeries, can only be appointed by an experienced doctor after a complete examination.

Forecast

The effectiveness of the treatment largely depends on the underlying cause of impotence. Psychological disorders and functional disorders are best corrected. The quality of life of patients always decreases due to the adverse psychological effect of sexual impotence and additional complications.

Negative consequences of the disease:

- Infertility (ejaculation during impotence is not disturbed, but the absence of an erection prevents the penis from penetration of the vagina);
- Stress, anxiety and low self-esteem;
- Relationship problems.
Several studies have identified a relationship between erectile dysfunction and reduced life expectancy in men. Presumably, this indicator is associated with cardiovascular disease. So, elderly men with impotence often have a predisposition to heart attack and stroke.

Post by: John Johansson, M.D., Amsterdam, Netherlands