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Impotence

Author: Edward F. Group III, D.C., Ph.D, N.D., CCN 

Impotence, now called erectile dysfunction (ED), refers to the inability to obtain an erection for sexual purposes. This affects the lives of 15 million to 30 million American men.

Although erectile dysfunction is more common in men 65 and older, it can occur at any age. An occasional episode of erectile dysfunction occurs to many men and is perfectly normal. In fact, in most cases it's nothing to worry about. As men age, it's also normal to experience changes in erectile function. It may take longer for the man to "get it up" than in the past. In some circumstances, the man may require more direct stimulation to have an erection and to keep it. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections.

When erectile dysfunction proves to be a persistent problem, however, it can interfere with a man's self-image and his sex life. It may also be a sign of a physical or emotional problem that requires treatment.

Men whose erectile dysfunction is of a physical origin often experience a gradual onset of erectile failure which tends to occur with all sexual activities.

Physical causes of erectile dysfunction include:

Psychological causes

An erectile dysfunction with a sudden onset in men who can achieve erections under some circumstances but not others suggest a psychological cause.  Sometimes the triggering factor can be easily identified such as a serious disagreement with the partner; being interrupted while making love or excessive worry at work.

Psychological causes of erectile dysfunction include:

It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively.  Some lifestyle changes are worth considering before medical advice is sought. These include quitting smoking, reducing alcohol intake and trying to reduce stress and anxiety. If such changes do not solve the problem, then the man should seek medical advice.

In the first instance the man with erectile dysfunction should consult his general practitioner. GP’s differ in the services they offer men with erectile dysfunction. At one end of the scale there are some general practitioners who have set up clinics within their surgeries and are able to offer a full range of treatments. Others will not treat erectile dysfunction themselves and will refer patients to specialists. If matters fail to improve, it would be reasonable to ask to see a specialist or contact The Sexual Dysfunction Association. The names of local specialists can be obtained from the Association.

The first one or more appointments at the clinic are generally for assessment. This aims at trying to identify a possible cause for the erectile dysfunction and to check your general health. The doctor will ask you about the problem and questions about your general health and the treatments you may be taking for your medical or psychiatric conditions. You might also be asked about your previous sexual function and, if appropriate, questions about your relationship with your partner. You will then undergo a physical examination during which your blood pressure will be checked, the pulses in your legs palpated and probably a check of your reflexes. Your penis and scrotum will also be examined and you will be asked to provide a specimen of urine for examination. A sample of your blood may also be collected for laboratory tests which will probably include testosterone (male sex hormone) measurement.

If referred to a hospital clinic, at the first visit some doctors inject a small dose of a drug into the shaft of the penis which may induce an erection. Others do this at a subsequent appointment. This is to see whether you can attain and maintain an erection. If the injection does not result in a sustained erection, then larger doses of the drug may be given at subsequent appointments.

In some cases, the doctor may organize further tests which may involve monitoring blood flow in the penis, measuring the pressure inside the penis, and X-rays of the arteries supplying the penis. These tests are not necessary in every sufferer.  At the end of the assessment process, the doctor will be able to offer you treatment which is best suited to your particular case. The doctor may also recommend the changing of prescription medicines.

Yes. There is the old adage that a "problem shared is a problem halved" and this is certainly true in the case of erectile dysfunction. Sometimes partners, unintentionally, put a lot of pressure on men to "perform". If the man has difficulty with his erections this pressure can cause erectile dysfunction. Discussing the problem with his partner may relieve this pressure and restore normal erectile function. It is often helpful for the partner to accompany the man to the general practitioner and specialist.

A leaflet for partners of men with erectile dysfunction is available from The Sexual Dysfunction Association.

Ageing increases the risk of developing erectile dysfunction but it is attitude, not age,  that is the biggest barrier in treating the condition. While some older men and their partners accept loss of erectile function as a part of ageing and do not want treatment, others are unhappy about losing such an important part of their lives. It is now considered acceptable for men and women to continue an active sex life way into old age and no one should be denied treatment for erectile dysfunction solely because they are too old. Men in their 90s are now seeking treatment for erectile dysfunction and generally respond to the types of treatment offered to younger men.

Patterns of erectile dysfunction include:

To understand how erection works we have to look at how the process works. Once we understand the process then we can understand what happens when erectile dysfunction develops.

The penis contains two cylindrical, sponge-like structures that run along its length, parallel to the tube that carries semen and urine (urethra). When a man becomes sexually aroused, nerve impulses cause the blood flow to the cylinders increasing the cylinders to about seven times the normal amount. This sudden influx of blood expands the sponge-like structures and produces an erection by straightening and stiffening the penis. Continued sexual arousal or excitation maintains the higher rate of blood flow, keeping the erection firm. After ejaculation, or when the sexual arousal passes, the excess blood drains out of the spongy tissue, and the penis returns to its non-erect size and shape

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