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ImpotenceDefinition of impotence Erectile dysfunction (ED) or male impotence is defined as the inability of a man to achieve and maintain an erection sufficient for mutually satisfactory intercourse with his partner. Sexual health and function are important determinants of quality of life. As Americans age, disorders such as erectile dysfunction (ED) or impotence are becoming increasingly more important. Because this subject is discussed widely in the media, men and women of all ages are seeking guidance in an effort to improve their relationships and experience satisfying sex lives. Sexual dysfunction is often associated with disorders such as diabetes, high blood pressure, heart disease, nervous system disorders, and depression. Erectile dysfunction may also be an unwanted side effect from medication. In some men, sexual dysfunction may be the symptom of such disorders that brings them to the doctor's office. The successful treatment of impotence has been demonstrated to improve intimacy and satisfaction, improve sexual aspects of quality of life as well as overall quality of life, and relieve symptoms of depression. Premature ejaculation is often confused with erectile dysfunction. Premature ejaculation is a condition in which the entire process of arousal, erection, ejaculation, and climax occur very rapidly, often in just a few minutes or even seconds, leaving the partner unsatisfied. Premature ejaculation may accompany an erection problem such as ED but is generally treated differently. Although this information focuses primarily on male ED, remember that the partner plays an integral role. If successful and effective management is to occur, any discussion of treatment should include the couple. For a man to have an erection, a complex process takes place within the body. Erection involves the central nervous system, peripheral nervous system, psychological and stress-related factors, local problems with the erection bodies or penis itself as well as hormonal and vascular (blood flow or circulation) factors. The penile portion of the process leading to erections represents only a single component of a very complicated and complex process. Erections occur in response to touch, smell, and visual stimuli that trigger pathways in the brain. Information travels from the brain to the nerve centers at the base of the spine, where primary nerve fibers connect to the penis and regulate blood flow during erection and afterward. Sexual stimulation causes the release of chemicals from the nerve endings in the penis that trigger a series of events that ultimately cause muscle relaxation in the erection bodies of the penis. The smooth muscle in the erection bodies controls the flow of blood into the penis. When the smooth muscle relaxes, the blood flow dramatically increases, and the erection bodies become full and rigid, resulting in an erection. Venous drainage channels are compressed and close off as the erection bodies enlarge. Detumescence (when the penis is no longer in a state of erection) results when muscle-relaxing chemicals are no longer released. Ejaculation causes the smooth muscle tissue of the erection bodies in the penis to regain muscle tone, which allows the venous drainage channels to open and the blood drains from the penis. Sexual dysfunction is extremely common in men. In the Massachusetts Male Aging Study (MMAS) among a community-based survey of men aged 40-70 years, 52% of the men reported some degree of erectile difficulty. Complete ED, defined as the total inability to obtain or maintain suitable erections during sexual stimulation, as well as the absence of nocturnal erections (erections during sleep), occurred in 10% of the men in the study. Lesser degrees of mild and moderate ED occurred in 17% and 25% of participants. Other male problems, such as premature ejaculation and loss of libido (decreased sexual desire), are also very common. The NHSLS found that 28.5% of men aged 18-59 years reported premature ejaculation, and 15.8% lacked interest during the past year. An additional 17% reported anxiety about sexual performance, and 8.1% indicated a lack of pleasure from sexual activity. Impotence/Erectile Dysfunction Causes Erectile dysfunction can be caused by any number of physical and psychological factors. In general, ED is divided into organic (having to do with a bodily organ or organ system) and psychogenic (mental) impotence, but most men with organic causes have a mental or psychological component as well. Erection problems will usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern of anxiety and stress that can further interfere with normal sexual function. This "performance anxiety" needs to be recognized and addressed by your doctor. Almost any disease can affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the penis or influence mood and behavior. Vascular diseases account for nearly half of all cases of ED in men older than 50 years. Vascular disease includes atherosclerosis (fatty deposits on the walls of arteries, also called hardening of the arteries), a history of heart attacks, peripheral vascular disease (problems with blood circulation), and high blood pressure. Prolonged tobacco use (smoking) is considered an important risk factor for ED because it is associated with poor circulation and reduced blood flow in the penis. Trauma to the pelvic blood vessels and nerves is another potential factor in the development of ED. Bicycle riding for long periods has been implicated, so some of the newer bicycle seats have been designed to soften pressure on the perineum (the soft area between the anus and the scrotum). Medications used to treat other medical disorders may cause ED. Systemic diseases associated with ED Diabetes Scleroderma Renal (kidney) failure Liver cirrhosis Hemochromatosis (too much iron in the blood) Cancer and cancer treatment Diseases of the nervous system associated with ED Epilepsy Stroke Multiple sclerosis Guillain-Barré syndrome Alzheimer disease Trauma Parkinson disease Respiratory disease associated with ED: Chronic obstructive pulmonary disease Endocrine conditions associated with ED Hyperthyroidism Hypothyroidism Hypogonadism Penile conditions associated with ED Peyronie disease Priapism (painful, abnormally prolonged erections) Mental conditions associated with ED Widower syndrome Performance anxiety Nutritional states associated with ED Malnutrition Zinc deficiency Blood diseases associated with ED Sickle cell anemia Leukemias Surgical procedures associated with ED Procedures on the brain and spinal cord Retroperitoneal or pelvic lymph node dissection Aortoiliac or aortofemoral bypass Abdominal perineal resection Proctocolectomy Radical prostatectomy Transurethral resection of the prostate Cryosurgery of the prostate Cystectomy Common medications associated with ED Antidepressants Antipsychotics Antihypertensives (for high blood pressure) Antiulcer drugs such as cimetidine (Tagamet) Hormonal medication such as Zoladex, Lupron, finasteride (Proscar), or dutasteride (Avodart) Drugs that lower cholesterol Alcohol abuse Mind-altering agents such as marijuana and cocaine Diagnosis Schedule enough time with your doctor to conduct a full interview and physical examination. The first step in the medical management of erectile dysfunction is taking a thorough sexual, medical, and psychosocial history. Erectile dysfunction is a delicate topic, and your doctor should be sensitive and caring to make you comfortable about sharing these intimate details of your private life. Your doctor will ask if you have difficulty obtaining an erection, if the erection is suitable for penetration, if the erection can be maintained until the partner has achieved orgasm, if ejaculation occurs, and if both partners have satisfaction. You will be asked about current medications you are taking, about any surgery you may have had, and about other disorders (history of trauma, prior prostate surgery, or radiation therapy, for example). The doctor will want to know all medications you have taken during the past year, including all vitamins and other dietary supplements. Tell the doctor about your tobacco use, alcohol intake, and caffeine intake, as well as any illicit drug use. Your doctor will be looking for indications of depression. You will be asked about libido (sexual desire), problems and tension in your sexual relationship, insomnia, lethargy, moodiness, nervousness, anxiety, and unusual stress from work or at home. You will be asked about your relationship with your partner. Does your partner know you are seeking help for this problem? If so, does your partner approve? Is this a major issue between you? Is your partner willing to participate with you in the treatment process? Your doctor will want your candid answers to questions like these: How long has a problem existed? Did a specific event such as a major surgery or a divorce occur at the same time? Do you have diminished sexual desire? If so, do you think it is just a reaction to poor performance? How hard or rigid are your erections now? Are you ever able to obtain an erection suitable for penetration even momentarily? Is maintaining the erection a problem? Can you achieve orgasm, climax, and ejaculation? If so, does it feel normal to you? Does the penis become somewhat rigid at climax? Do you still have morning erections? Is penile curvature (Peyronie disease) a problem? What would be your preferred frequency of intercourse, assuming the erections were working normally? How would your partner answer this same question? What was your frequency before the erections became a problem? Have you already tried any treatments for ED yet? If so, what were they and how did they work for you? Were there any problems or side effects to their use? Are you interested in trying a particular treatment first? Are you against trying a particular type of therapy? If so, what caused you to make this judgment? To what degree do you wish to proceed in determining the cause of your ED? How important is this information to you? A physical examination is necessary. The doctor will pay particular attention to the genitals and nervous, vascular, and urinary systems. Your blood pressure will be checked because several studies have demonstrated a connection between high blood pressure and erectile dysfunction. The physical examination will confirm information you gave the doctor in your medical history and may help reveal unsuspected disorders such as diabetes, vascular disease, penile plaques (scar tissue or firm lumps under the skin of the penis), testicular problems, low male hormone production, injury, or disease to the nerves of the penis and various prostate disorders. Impotence/Erectile Dysfunction Treatment Currently, virtually any man who wishes to have erectile function can obtain it, regardless of the underlying cause of his problem. Many reasonable treatment options exist. Your first step is to find a well-trained, experienced, and compassionate doctor who is willing to take the time to understand you and fully discuss the treatments available to you. Sex counselling is an important part of erectile dysfunction management. Many professional sex counsellors are skilled in working with patients with ED, but your primary care doctor and urologist may also serve in this capacity to some degree. These are usually the first professionals to learn about the problem. Men are frequently reluctant to discuss their sexual problems and need to be specifically asked. Opening a dialogue allows your doctor to begin the investigation or refer you to a consultant. After testing is completed, your doctor can then discuss your particular situation, the most likely cause, and reasonable treatment options. Options include sex counselling, medications, external vacuum devices, hormonal therapy, penile injections or intraurethral suppositories. In highly selected cases under the supervision of a urology specialist in ED, combination therapy using several of these methods together can be used. If none of these therapies is satisfactory, penile prosthesis implants can be considered. Anxiety and stress can often be related to impotence and in many instances the causes are mental and emotional. External stresses and anxieties such as finance, health, work or redundancy can have a depressing effect which can affect the sexual area and also previous bad experiences such as a failed marriage or a bad sexual encounter may cause the man to struggle in this area. Some suggestions to try may be Reserve time for non-sexual intimacy with one's partner. Couples who reserve weekly talk time and time for a weekly date alone without the kids will maintain a closer relationship and are more likely to feel sexual interest. Detach sex and affection, so that neither person is afraid to be affectionate on a daily basis, fearing that it will be interpreted as an invitation to proceed to intercourse. Reading books or taking courses in couple communication, or reading books about massage may also encourage feelings of closeness. For some individuals, reading novels or viewing movies with romantic or sexual content may also serve to encourage sexual desire. Regularly reserving "prime time," before exhaustion sets in, for both talking and sexual intimacy may encourage closeness and sexual desire. Far too often, couples do not make time for each other earlier in the evening when they have the energy for physical intimacy. Alternative therapies can sometimes aid in a variety of ways. Counselling can help to get to the root of past traumas or fears and confront them; alternative therapies such as massage and spa treatments can help the man to grow in confidence and sometimes a therapist can be a listening ear. Aromatic baths before bed offer a means of using essential oils in a natural way. Sandalwood is the best oil to try for this. Another good idea is if the partner of the man can give a massage diluting Sandalwood in carrier oil. Try to just enjoy the massage and not be pressured by feeling it must lead to sexual intercourse so that each person can truly relax. Jasmine is another essential oil which can help to restore confidence and Neroli can complement this very well if the cause of the impotence is anxiety. Clary Sage is very relaxing and all of these oils are reputed to have “aphrodisiac” qualities. |
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