Your Health - Impotence

Impotence

(ED; Erectile Dysfunction; Male Erectile Disorder)

Definition

Impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.

Causes

To initiate and maintain an erection, the penis must fill with blood. Nerve signals cause the blood to flow there. The blood vessels expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

The following factors can cause erectile dysfunction:

Venous Leak

A leak in the blood vessels in the penis can allow blood to escape. This means that an erection cannot be made or may not last long. Injury or disease can cause a venous leak.

Neurovascular Function

Problems with nerve signals and blood flow
Nerve dysfunction—can reduce feeling in the penis, resulting in impotence
Diabetes —interferes with nerve signals
Complete loss of nighttime erections
Hardening of the arteries —can cause reduced blood flow
Peripheral neuropathy , spinal cord injury, and surgery—can damage nerves
Side-effects from medications

Blood Vessels and Nerves of Male Pelvis

Psychological Factors

The brain causes many of the nerve signals needed for an erection. Emotional problems may play a role in men who suddenly develop impotence.

Risk Factors

These factors increase your chance of developing impotence. Tell your doctor if you have any of these risk factors:

Age: 65 and older
Race: Hispanic
Obesity
Medical conditions:
- Diabetes
- Hardening of arteries
- Chronic kidney disease
- Liver failure
- Peyronie's disease (bending of the penis caused by scar tissue)
- Endocrine disorders
- Neurological disorders (eg, multiple sclerosis , peripheral neuropathy , stroke )
- Hypertension
- Psychiatric disorders (eg, anxiety , depression )
Traumatic conditions:
- Vascular surgery
- Pelvic surgeries (particularly for prostate cancer )
- Spinal cord injury
Behaviors:
- Alcohol use
- Illegal drug use
- Anabolic steroid use
- Heavy smoking
- Interpersonal conflicts with a sexual partner
Medications:
- Antihypertensives
- Antihistamines
- Antidepressants
- Tranquilizers
- Antipsychotics

Symptoms

Symptoms include:

A less firm penis
Fewer erections

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Expect questions about the frequency, quality, and duration of your erections. Your answers may help the diagnosis.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, you will need lab tests, including:

Hormone levels such as thyroid function tests
Prolactin levels
Testosterone levels

Nocturnal Penile Tumescence Testing

This test can help your doctor determine if the cause is due to emotional problems or physical problems.

Imaging

Sometimes Doppler imaging may be done to look at the blood flow. The test is also done to check for blockage in the arteries or veins that supply the penis.

Treatment

Treatment options include:

Medications

Your doctor may prescribe:

Phosphodiesterase inhibitors, such as:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
Oral testosterone , if you have low testosterone levels
Alprostadil , either injected into the penis or inserted into the urethra as a suppository

Use caution and talk to your doctor before taking any over-the-counter medicines for impotence. Some of them may be unsafe. *¹

Vacuum Devices

Plastic cylinder for the penis
Hand pump for pumping air out of the cylinder
Elastic band for holding the erection after removal of the cylinder

Vascular Surgery

Vascular surgery repairs venous leaks. This has been shown to be effective in some cases.

Penile Implants

There are semi-rigid, malleable, and inflatable implants. They are surgically inserted into the penis.

Penile Implant

Sex Therapy

Sex therapy may help impotence resulting from:

Ineffective sexual techniques
Relationship problems
Anxiety
Depression

Prevention

To reduce your chance of becoming impotent:

Take medications to manage blood pressure , diabetes, or depression.
Ask your doctor about changing medications.
Maintain a healthy weight .
Eat a healthful diet .
If you smoke, quit . Smoking is significantly associated with impotence in middle-aged and older men.
Talk to a therapist or counselor.

RESOURCES:

American Urological Association
http://www.auafoundation.org/

UrologyHealth.org
http://www.urologyhealth.org/index.cfm/

CANADIAN RESOURCES

Canadian Urological Association
http://www.cua.org/

SexualityandU.ca
http://www.sexualityandu.ca/home_e.aspx/

References:

Erectile dysfunction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2008. Accessed July 7, 2008

Erectile dysfunction. Familydoctor.org website. Available at: http://familydoctor.org/online/famdocen/home/men/reproductive/109.html . Updated December 2006. Accessed July 7, 2008

Erectile dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/ . Published December 2005. Accessed July 7, 2008

Non-surgical management of erectile dysfunction (ED). UrologyHealth.org website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=11topic=174 . Accessed July 7, 2008

Last reviewed September 2009 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.