What is impotence in men and how to treat it?

Impotence or erectile dysfunction is a violation of the ability to have full sexual intercourse due to the physiological inability of the penis to come and maintain erected state for the time necessary for sexual intercourse (coitus). This pathological condition is accompanied by a change in tension, shape, and volume of the penis. Since in most cases there is a decrease in the quality of an erection, and not its complete absence, the term "impotence" is used as the highest degree of erectile dysfunction (ED).

Short information about impotence

To date, there are many treatments for this disorder; they are divided into two main groups: conservative and surgical methods of therapy.

Since various processes are involved in the occurrence and maintenance of an erection, failure at any stage can lead to the development of disorders. The diagnosis of “erectile dysfunction” is applied only if more than 25% of sexual intercourse was unsuccessful.

Congenital or primary impotence is rare and is characterized by a complete absence of an erection throughout life (due to an abnormality in the development of the testicles or penis). Acquired or secondary impotence can develop under the influence of many factors of lifestyle changes or various diseases.

So, it is reliably known that physical inactivity significantly worsens the quality and duration of an erection, since local blood flow and the balance of outflow/blood flow to the genitals are disrupted. ED can also develop against the background of psychoemotional and physical overload, uncontrolled intake of sports supplements (steroid anabolics) or certain medications (antipsychotics). Regular high doses of alcohol have a negative effect on the glands of the endocrine system (including the genital), preventing the onset of an erection.

Causes of impotence

In contrast to factors contributing to the emergence of sexual impotence, the basis of the mechanism for the development of impotence are pathological changes at the level of the organ.

A healthy erection occurs due to the synthesis of nitric oxide (NO) by endothelial cells (a layer of tissue in the arterial wall). This substance helps to relax the muscles of the blood vessels, which leads to their expansion. Through the dilated vessels of the pelvis, blood reaches the cavernous bodies, filling them. In turn, small local venules contract, preventing the outflow of blood, and thus stimulation of the penis is supported.

Among the most common reasons for ED development are:

- Diseases of the cardiovascular system (atherosclerosis, coronary heart disease, etc.);
- Endocrine disorders (diabetes mellitus, thyrotoxicosis, etc.);
- Mental disorders (clinical depression, asthenia, etc.);
- Neurological diseases (insomnia, Alzheimer's disease, tumors of the nervous system, etc.);
- Liver damage and liver failure (and as a result, a deficiency in the synthesis of testosterone precursor);
- Diseases of the urogenital tract (prostatitis, prostatic hyperplasia, orchitis, renal failure, etc.);
- A combination of psychogenic and physiological factors, etc.

Various causes of the development of pathology as a result lead to arterial or venous insufficiency, sclerosis of cavernous tissue and inflammatory processes that prevent the onset, maintenance of arousal and erection.

The likelihood of an erectile dysfunction increases significantly with age, which is associated with a decrease in the secretory function of the glands of the body, the presence of chronic diseases and the use of medications that eliminate them. Antihypertensive drugs, sedatives, or hypnotics have an effect on the incidence and maintenance of penis arousal.

What are the signs of impotence?

Manifestations of ED largely depend on the nature of the cause of the pathology.

So, vascular disorders often cause an uncontrolled and untimely release of seminal fluid (ejaculation), and also lead to the inability to maintain persistent erection of the penis. In this case, spontaneous erections can be still maintained.

Pathological changes of a neurogenic nature provoke a decrease in the rigidity (sensitivity) of the organ and significantly reduce the incidence of an erection.

The lack of an adequate erection (in response to stimulation) with the presence of spontaneous erection indicates the psychogenic nature of the pathology.

Organic damage leads to the absence of both adequate and spontaneous erections, and is the most difficult clinical situation.

Thus, the main signs of impotence are:

- Lack of an erection or a critical decrease in its duration (decrease in erectile ability);
- Lack of spontaneous (morning and night) erections;
- Premature ejaculation.

Symptoms that should also alert and prompt you to seek qualified medical help from a doctor, such as:

- An increase in the size of the penis, but not enough to complete sexual intercourse;
- Decrease in penis tension in the absence of ejaculation;
- Frequent episodes of premature ejaculation in mature men;
- Sexual impotence caused by a decrease or absence of sexual desire, etc.

However, there are a number of similar symptoms, the appearance of which cannot indicate the development of impotence. Their temporary or regular nature is mediated by physiological changes in the functioning of the male body (course of taking certain drugs, age-related androgen deficiency).

So, erectile dysfunctions that are not impotence are:

- Deterioration in quality or lack of erection due to excessive sexual activity (temporary resistance to stimuli develops);
- Untimely ejaculation against the background of irregular sexual activity;
- Gradual decrease in erection beyond reproductive age, etc.

In order to objectively assess the danger of the symptoms of erectile dysfunction that has arisen, you need to contact a specialist. Timely diagnosis and therapy allow quickly establishing the nature and cause of the disorder, as well as accelerating the restoration of impaired function.

What doctor treats impotence?

Since processes at different levels (physiological, mental) are involved in the mechanism of impotence development, the most effective treatment is achieved by the interaction of specialists in different medical sectors. First of all, it is recommended to consult a therapist to prescribe a comprehensive examination of all body systems.

In the future, it is advisable to schedule a consultation with a sex therapist, especially if there are: violation of ejaculation and a decrease in libido.
In situations where erectile dysfunction has arisen without obvious reasons, it is necessary to visit an andrologist. This specialist appoints a list of studies to identify pathologies of the male reproductive system. Usually, it includes an ultrasound analysis of the kidneys, prostate and testes. Based on the results, the doctor develops a course of therapy to eliminate chronic diseases of the male genital organs and restore sexual and reproductive functions.

Also, in the process of diagnosing and treating impotence, you need to seek qualified help from a urologist, since disturbances in the functioning of the urogenital tract significantly affect erection. Data on the composition of the microflora of the urethra, the clinical parameters of blood and urine allow us to determine the specifics (infection, inflammation, etc.) of the pathway for the onset of the disease, as well as to develop a set of therapeutic measures: conservative drugs, physiotherapy and a course of physiotherapy exercises. A multi-component approach to treatment significantly increases its effectiveness and accelerates recovery.

Symptoms for urgent visit to a urologist are:

- Pain during an erection;
- Pain with coition;
- The presence of blood impurities in seminal fluid, etc.

Interaction with a doctor such as a psychotherapist allows identifying psychological difficulties leading to troubles in the emergence and maintenance of a persistent erection. Stress, physical overload, violations of work and rest regimen often causes erectile dysfunction. Sessions with a psychotherapist help to correct anxieties and fears of a possible failure during sexual intercourse, and normalize the level of aggression and irritation, if necessary.

Where to start treatment of impotence?

Treatment of impotence, like any other disease, begins with a visit to a doctor, at the reception of which a patient is examined, an analysis of complaints and anamnesis, and a diagnosis is prescribed.

At the stage of examination, the severity of secondary sexual characteristics, the external condition of the testicles and penis are evaluated. In the future, data are collected on the presence of chronic diseases, on the composition and duration of medication, on lifestyle.

Based on the information received, the doctor prescribes diagnostic methods, usually they include:

- General and detailed analysis of blood and urine;
- Study of the secretion of the prostate gland;
- Hormonal profile;
- Vasoactive test;
- Arteriography and blood pressure in the vessels of the penis;
- Biotheziometry of the penis (sensitivity and innervation);
- Psychotests, etc.

How is impotence treated?

An effective diagnostic research and identification of the causes of impotence development determine the success of the therapy of the disease. Today, in the treatment of ED, both traditional methods and newly developed methods of treatment are effectively combined.

Among the classical methods of treating impotence, there are:

- A medical course using biostimulants, local microinjections of vasoactive drugs, as well as ointments containing substances for vasodilatation;
- Psychotherapy sessions;
- Vacuum constrictor therapy, which involves the use of special devices that pump blood into the penis. The erection thus caused is retained (about 30 minutes) due to the application of a ring on the penis, which prevents the venous outflow;
- Use of PDE5 inhibitors such as Viagra Gold and others that relax the smooth muscles of the penis and allow it being filled with the blood during stimulation;
- Exercises to strengthen the muscles of the perineum;
- Surgical intervention in case of malfunctioning of the valves of the veins or arterial inflow to the tissues of the penis.

Modern and popular methods of treating impotence are shock wave and cell therapy.

The shock-wave method is based on the property of sound waves to increase the elasticity of blood vessels and stimulate neoangiogenesis (the growth of new blood vessels). Due to the improvement of local blood supply, a positive response to treatment is observed after several sessions of therapy. Acoustic wave treatment has a long-term effect and reduces medications intake. The use of this method has no contraindications, is painless and does not cause complications.

Cell therapy is based on the use of the patient's own blood elements. The introduction into the body of a specially processed biomaterial promotes the replacement of damaged vascular tissue and the synthesis of new vessels. Due to the fact that the physiological blood flow of the pelvic organs is normalized, a long-lasting effect of improving the quality and stability of an erection is ensured.

Can impotence be cured with traditional remedies?

In the event that the occurrence of impotence is not associated with organic lesions or the presence of chronic diseases, traditional remedies can have a therapeutic effect.

The content of highly active biological substances and vitamins provides activation of the blood supply to the penis, replenishment of micronutrient deficiencies and normalization of the psychoemotional background. However, the use of herbal teas and herbal decoctions must be carried out under the supervision and with the approval of the attending physician. Self-medication can cause an exacerbation of existing pathologies or entail the development of new ones (allergic reactions, worsening of the cardiovascular system, hypervitaminosis, etc.).

What is the difference between prostatitis and impotence?

Prostatitis and impotence are independent diseases, however, the presence of one can provoke the development of another.

Prostatitis or inflammation of the prostate gland is most often caused by pathogenic microorganisms, but can develop due to decreased immunity, physical inactivity, or sexual abstinence. Blood stasis in the pelvic organs leads to an inflammatory process in the gland, in which erectile dysfunction can occur. According to the WHO statistics, in 30% of cases of chronic prostatitis there are problems with maintaining an erection and untimely ejaculation.

The secret of the prostate gland is part of the seminal fluid, the prostate promotes the transformation of testosterone from the hormones precursors, it is located near the urethra, all these factors indicate the unconditional effect of prostate health/disease on the norm/dysfunction of penile erection.

Exacerbation of prostatitis causes a number of uncomfortable sensations, especially during ejaculation, which also does not contribute to sexual activity.

However, the presence of ED or its extreme degree - impotence, does not indicate the development of the inflammatory process in the prostate gland. Especially if violations in the sexual sphere are temporary (overwork, stress, vitamin deficiency, etc.) or are caused by psychogenic factors.

Post by: John Avery, General Practitioner, Manchester, United Kingdom