Impotence (Erectile Dysfunction) is repeated inability to insert the penis to the vagina or regular inability to maintain an erection of the penis during sexual activity.Physical and psychological issues can cause impotence.Psychological impotence is the failure of erection or penetration due to thoughts or feelings.Male sexual arousal involves the brain, hormones, emotions, nerves, muscles, and blood vessels.A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis.The process is initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis.
Penile erection is managed by two mechanisms
- The Reflex Erection is achieved by directly touching the penile shaft.
- The Psychogenic Erection is achieved by erotic or emotional stimuli.
Symptoms of Impotence or Erectile Dysfunction (ED)
- Problem in getting an erection.
- Reduced sexual desire.
- Trouble in keeping an erection.
Causes of Erectile Dysfunction (ED) or Impotence
I. Physical Causes
- Heart disease
- Diabetes Mellitus
- High blood pressure
- Atherosclerosis (clogged blood vessel)
- Obesity
- High cholesterol
- Parkinson's disease
- Multiple sclerosis
- Peyronie disease (development of scar tissue inside the penis)
- Hormonal disorders, including thyroid conditions and testosterone deficiency (Hypogonadism)
- Smoking, alcoholism, and cocaine use
- Injuries in the pelvic area or spinal cord
- Treatment for prostate disease
- Surgeries, including radical prostatectomy, cystectomy, transurethral resection of the prostate and rectal cancer surgery
- Radiation Therapy to the pelvic region
- Age
- Kidney failure
Medications can cause Impotence or Erectile Dysfunction (ED) :
- Drugs for controlling high blood pressure or antihypertensives, including Beta-Blockers and Clonidine.
- Heart drug, such as Digoxin.
- Antidepressants, including Monoamine Oxidase Inhibitors (MAOIs), Selective Serotonin Reuptake Inhibitors (SSRIs), and Tricyclic Antidepressants.
- Some Sleeping Pills and Amphetamines are drugs that act on the central nervous system or on the brain or spinal cord.
- Opioid painkillers.
- Some diuretics or Water Pills are drugs that increase urine output.
- Peptic ulcer drug, such as Cimetidine
- Some cancer drugs, including chemotherapeutic agents
- Drugs for acting on luteinizing hormone-releasing hormone and Hormone drugs, such as Estrogens.
- Anxiolytics
- Anti-Androgen drugs for treating prostate disease.
- 5a-Reductase Inhibitors are medications for treating cancer and for benign prostatic hypertrophy.
- Antocholinergics are drugs that block a neurotransmitter.
II. Psychological Causes
- Depression or other mental disorders.
- Performance of anxiety shows repeated feeling of doubt.
- Stress can include work, finance, and emotion problems.
- Guilt, anger
- Fear of intimacy
- Poor communication with a sex partner
- Pressure from a sex partner
Diagnosis for Impotence
Some tests and procedures are done to diagnose Impotence.
- Medical history is about patient's health habit and past illnesses.
- Physical exam is an exam of the body to check general signs of health.
- Blood Test is to measure hormone levels, cholesterol, blood sugar, liver, kidney function and thyroid function.
- Urinalysis is to analyze urine for protein (albumin), sugar (glucose), and hormone (testosterone) levels that may indicate diabetes, kidney dysfunction, or testosterone deficiency.
- Postage Stamp Test is used to determine if there is a medical cause of impotence or erectile dysfunction rather than a psychological one.It is to check for the presence of nighttime erections.
- Duplex Ultrasound is to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue.
- Penile Nerve Function-Tests such as the Bulbocavernosus Reflex Test are to determine if there is sufficient nerve sensation in the penis.
- Penile Biothesiometry is a test that uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
- Dynamic Infusion Cavernosometry is a technique in which fluid is pumped into the penis at a known rate and pressure.
- Magnetic Resonance Angiography (MRA) uses magnetic fields and radio waves to provide detailed images of the blood vessels.
- The Nocturnal Penile Tumescence Test is to find out whether the problem of erectile is physical or psychological.Man is normal to have five to six erections during sleep, especially during rapid eye movement (REM).These erections occur about every 90 minutes and last for about 30 minutes.Two methods are used to measure changes in penile rigidity and circumference during nocturnal rection.Snap Gauge involves wrapping three plastic bands of varying strength around the penis.Erection function is assessed according to which bands break.Strain Gauge involves placing special elastic bands at the base and tip of the penis.These bands stretch during erection and register changes in circumference.
Treatment Of Impotence or Erectile Dysfunction
1. Medications
- Oral Medication : Phosphodiesterase (PDE) 5 Inhibitors, including Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), Avanafil (Stendra) are prescription drugs which are taken orally.PDE-5 Inhibitors increase the amount of cyclic guanosine monophosphate (cGMP) available in the blood supply to the penis and increase blood flow.
- Topical Medication : DDAIP is used in the topical drug Vitaros that is an Alprostadil Vasodilator cream to treat erectile dysfunction or impotence.
- Injected Medication : Papaverine, Phentolamine, Prostaglandin E1 are drugs that are injected to the penis.Choose one of these drugs is injected to the penis.
2. Extracorporeal Shockwave Therapy is a new treatment for impotence or erectile dysfunction that is non-drug, non-surgical, and without adverse side effects.
3. Vacuum Erection Devices are a mechanical way of producing an erection for men who do not want or cannot use drug treatments.The men use the devices if Drugs are not found working.They can cause bruising penis, cold penis'tip and damaged tissue.
4. Surgery
- Penile Implants are a final option reserved of men who do not succeed with drug treatments and other non-invasive options.
- Vascular Surgery attempts to corect some blood vessels that cause erectile dysfunction.
- Arterial Reconstructive Surgery is an option limited to only very specific cases of impotence or erectile dysfunction.
5. Gene Therapy involves injection of a transfer gene, calcium-sensitive potassium channel (hMaxi-K) into the penis.It will allow for weeks or months long effect to support erections.
6. Acupuncture is an alternative treatment for impotence or erectile dysfunction.
7. Alternative Therapies are used to treat impotence.
- Korean Red Ginseng (Panax Ginseng) is safe in short-term use.It can cause anemia.
- Dehydroepiandrosterone (DHEA) is safe at low doses.It may cause acne.
- L-Arginine is used in high doses that can dilate blood vessels, stimulate blood flow, and improve erectile function.It should not be taken with viagra.It may cause diarrhea, nausea, and cramp.
Mayo Clinic lists Three Risky Alternative Therapies
- Yohimbe can be dangerous which has many side effects.It should not be used without physician supervision.
- Ginkgo Biloba can increase the risk of bleeding.
- Horny Goat Weed may lower blood pressure.
FDA (Food and Drug Administration) identified several products sold online as so called "Dietary Supplements" for treating erectile dysfunction or impotence and enhancing sexual performance.These products have contained harmful and undeclared ingredients as following :
- Actra-Rx
- Actra-Sx
- Adam Free
- Blue Steel
- Erextra
- 4EVERON
- Energy Max
- Hero
- HS Joy of Love
- Lady Shangai
- Libidus
- Liviro3
- Lycium Barbarum L
- Nasutra
- NaturalUp
- Naturale Super Plus
- Neophase
- Shangai Ultra
- Shangai Ultra X
- Shangai Regular or Shangai Chaojimengnan
- Super Shangai
- Strong Testis
- Vigor-25
- Yilishen
- Zimaxx
- True Man
- Rhino V Max
- V Max
- Xiadafil VIP Tablets (Lots 6K029 and 6K209-SEI only)
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