HeathWise September 2009
By Doctor Rik Heymans
Calle Angustias 24, NERJA
Telephone: 95 252 6775
Mobile : 619 50 21 51
Impotence
What is Impotence?
The term “Impotence” means that a man is not able to get an erection which is strong enough, or lasts long enough in order to have normal sexual intercourse.
A synonym, and euphemism, for impotence is “Erectile Dysfunction”, which puts the emphasis more on the malfunctioning of the penis: by using the terms impotence/erectile dysfunction, no reference is made to other issues like loss of libido, sterility, the failure to have an orgasm, premature ejaculation, or physical penile abnormalities (which can make penetration impossible) .
It is accepted that every man sometime in his sexual life will have, or has had a temporary episode, or episodes, of impotence. The cause in this case will most often be something minor, like for instance tiredness or exhaustion, illness, tension, or excessive alcohol consumption, and after the isolated episode(s) the erection will return back to normal.
There are three classifications of quasi-permanent impotence:
1. Primary: the impotence has always existed;
2. Secondary: there was normal intercourse before, and the impotence only appeared later;
3. Selective impotence: it depends on the partner(s)
Is it frequent?
Exact figures on the prevalence of impotence are difficult to find; this is attributed to the fact that a lot of men refuse to talk about it, and will not seek help for it: admitting such a problem is often considered to imply a lack of masculinity. There is an interesting phenomenon, namely that the sale of Viagra was disappointing (to the company, at least) in Italy and other Mediterranean countries initially. Perhaps the still present ‘machoism' in these countries forbids admitting that an erectile dysfunction exists?
Thus, exact figures on the prevalence of impotence are hard to find; estimates sometimes put the figure of males, who suffer from impotence either permanently or regularly, as high as 30%! The Viagra-hype shows that it is more common than previously thought, and will hopefully make it easier for men to come forward for help.
What causes impotence?
Psychological factors were for a long time considered the only cause of impotence. Nowadays medical science has found more physical causes, but psychological factors still remain the main culprit for impotence: depression, tension, marital problems and worries ( and especially fear of failure to ‘perform') will often lead to impotence.
Often a physical cause might initially have been the cause of one or a few isolated episodes of impotence; later anxieties and worries take over, and the patient is taken into a downward spiral of impotence.
Sexual activity goes together with the proper functioning of various parts of the body:
not just the sexual organs, but also pathology of the brain, spinal column and nervous system, thyroid, adrenal glands, and cardiovascular system. Certain diseases can impair the ability to maintain an erection: neurological diseases, diabetes mellitus, atherosclerosis, cancer, infections and diseases of the urinary and genital tract. They are responsible for the physical causes, which should always be thoroughly investigated prior to any assessment or treatment.
Impotence however can also be a side-effect of many drugs, taken for a variety of conditions: certain anti- depressants, tranquillisers, anaesthetic drugs, diuretics, vasodilating drugs, and medication used for the control of high blood pressure.
Alcoholism can also cause chronic impotence: long-term abuse of alcohol will disturb the patient's hormonal status .
Impotence can also be due to surgical interventions, or radiotherapy: operations on the prostate, bladder, rectum, or lower back , or radiotherapy for malignancies can cause this condition.
Investigations
Before assuming that the impotence is due to a psychological cause, your doctor should first embark on a quest for a physical cause: a thorough history and physical examination, and eventual determinations of hormonal levels, cholesterol, glucose as well. An important fact to explore is whether the patient still has nocturnal erections ( usually three to four per night), or wakes up with a morning erection: if this is still the case there is more than likely a psychological problem, and might need a different approach.
Treatment.
Obviously a change in lifestyle (smoking, reducing alcohol intake, a diabetic diet, changing medication which is being taken for hypertension,...) is indicated if it is assumed that this could be the cause of the impotence.
Hormonal treatment: if the test results show that the cause of the impotence is a testosterone deficiency, then injections with hormones are the treatment, this very uncommon.
Local treatment: here a medical product is either injected into the penis, or applied into the urinary duct, and a few minutes later an erection happens. This must be done each time the patient wants to have intercourse. It can have serious side-effects, and must only be done on medical advice.
Vacuum-pump: here the patient applies a cylinder over the penis, and by creating a vacuum ‘draws' blood into the penis causing an erection; then a ring is applied over the penile base to keep the blood there, and the erection strong.
Oral treatment: a new group of drugs, like Viagra, which are to be taken orally, can restore a normal erection to the patient. ‘ Normal ' in the sense that there won't be an erection without a sexual stimulus.
A lot has been said and written about this drug, and quite a lot of it nonsense. Without doubt it will help a lot of couples attain sexual satisfaction again; but, although it is a fairly safe drug, some deaths have been linked to Viagra and it seems unwise to use it without proper medical examination. Furthermore, it is an expensive drug, and it happens that it is not effective due to another underlying cause: then a lot of money is wasted.
l Surgical treatment: Here a prosthesis is inserted into the penile tissue; there are several different types of prostheses available. Since it is quite an invasive procedure it is generally reserved as a last option.
It is clear that impotence is a multifactorial phenomenon, with a mixture of physical and psychological factors.
It affects relationships, not just ‘men who want to be young again'', and if the appropriate treatment is taken for the right reasons, it will undoubtedly be beneficial to the relationship. I feel it is therefore always advisable that both partners attend the initial consultation in order to determine the extent of the problem, and the expectations of both the partners involved.
© Dr Rik HEYMANS.
Rik Heymans is a general medical practitioner in Nerja. He writes monthly for Streetwise on topics which a family doctor comes across regularly.
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