Impotence
What is Impotence ?
Impotence is the inability to achieve or sustain an erection of sufficient hardness to achieve satisfactory penetration for sexual intercourse.
How do erections work ?
The penis is a spongy organ. It contains a network of arteries that bring blood in and veins that take it away. An erection occurs when blood flows into the penis and is trapped there causing the organ to swell and become hard. The mechanism that causes the blood to be trapped is in response to electrical impulses passed down by nerves and a release of chemicals. When the man receives sexual stimulation, which may be through any one of his senses, the brain sends a message via the spinal cord to the penis. In response chemicals are released by the penis which cause the tiny muscles in the walls of the arteries to relax and the diameter of the arteries to enlarge allowing stronger blood flow. As they fill with blood the squash the thin walled veins. Blood is no longer able to escape and the penis becomes firm. At the same time another chemical is released which destroys the one that relaxes the artery walls. However the rate of production of these two opposing chemicals is such that they balance out allowing the erection to stay at the correct firmness. But, once the stimulation has ended the second chemical takes over and the arteries return to their former size and the veins bounce back allowing the blood to flow out of the penis and go back to its resting state.
What causes Impotence ?
Impotence can be due to many causes. One study showed that up to 40% of men over 50 will suffer impotence. But don’t be alarmed by statistics it doesn’t mean it will happen to you and even if it does there is help available! Impotence may affect a man once or twice in his life or it may be an ongoing problem. It used to be thought that mostly it was due to psychological causes but these days we know that this is only part of the problem. All men who suffer repeated episodes of impotence should get it checked out. Looking at the mechanism of erections it can be seen that problems may occur at several levels.
An erection can occur as a spinal reflex – that is independent of the brain’s control – which is why people with certain spinal injuries can still achieve erections. However the local delicate circuitry in the pelvis may be damaged by trauma from accidents or some types of surgery such as radical prostatectomy. The same conditions that cause blood vessel disease leading to heart attack and stroke may cause the same problems in the blood vessels of the penis . Watch out – smoking may cause impotence! Diabetes, uncontrolled high blood pressure and cholesterol problems are among the potential causes.
Psychological factors will play a part and in some cases may well be the only cause. A proper medical examination should occur before treatment instituted. Relaxation techniques and a caring understanding partner will help.
How can I assess myself ?
Firstly talk stock of your lifestyle and health status. Now think about when the problems are occurring and rate the following statements for yourself:
I am able achieve and maintain an erection when I want to have sex
I wake up from sleep with an always mostly sometimes never
If you answered never or sometimes to any of these you should discuss it with your GP. If you answered always to number 2 but feel you have problems with 1 or 3 some then relaxation techniques may well be the answer. Try this first but if the problem persists see your doctor.
Where can I go for help?
Your GP is a good place to start. He or she will take a medical history from you about the problem including a discussion about stress factors. Your general health will be explored including questions about any medication that may be affecting you. You will then have a physical examination including blood pressure and genital examination and probably a prostate check which involves the doctor inserting a finger into your rectum to check prostate size (it’s not as bad as you think!). The Sexual Health Centre in your capital city or public hospital outpatient services can help too if you don’t have a GP. There are also men’s clinics that advertise that they deal with this type of problem. Always check the people you see are properly qualified and experienced.
What sort of tests will I have?
Depending on the results of the clinical history and examination the doctor may or may not order tests. You may have a series of blood tests looking at checking for diabetes or high cholesterol. You may have also urine test to check for sugar. Your doctor may refer you to a specialist urologist for further specific testing which can look at penile "tumescence" which sort of blood pressure testing of the penis. In its simplest form this involves you wearing a sleeve round your penis over night, which detects changes in pressure and can confirm whether there is activity occurring. However once major medical causes have been excluded it may be suggested that you go straight to trying an injection, as described below, with out any further investigations
What treatment is available?
Obviously this depends largely on the cause of the impotence. Counseling always helps. If you are in a relationship your partner should be encouraged to attend too.
Medications are now available. CAVERJECT is a medication that a man gives by injection directly into his penis. This drug causes an erection to occur that lasts for about 30 minutes and enables the man to have sex. This medication has been available on prescription for about 2 years now.
VIAGRA was released in Australia last year. It acts to block the effects of that second chemical mentioned above which means that the arteries stay dilated longer, and so does the erection. It needs the sexual stimulation to have been applied first so it won’t help a flagging libido. It has an interaction with certain anti angina drugs and should only be taken after proper medical assessment.
For severe irreversible cases of impotence there are implants available. These are either firm silicone rods inserted at operation into the penis or inflatable tubes which can be pumped up when the man wants to have sex.
What can I do myself while I wait to get answers?
Take the pressure off yourself and remember there is more to sex than just an erect penis. Find other ways to feel good about your body. Talk to your partner and learn to touch and explore other parts of yours and your partner’s body that feel good to stroke and fondle. Remember you can actually orgasm without an erection!
The information in this sheet is meant as a general guide . For specific treatment and advice for personal problems everyone should consult their doctor.