Sometimes impotence is a sign of serious disease, and sometimes it is emotional.
What is it?
Simply stated, when your penis doesn’t become erect properly, you have erectile dysfunction, which is sometimes called impotence. Erectile dysfunction is described as the total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. In other words, erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse. Erection is a very complex function that requires coordination of your emotions, blood circulation and three separate parts of your nervous system.
How bad is it?
ED is usually organic and may represent a sign of serious disease.
What causes it?
The causes are numerous, but this list breaks them down into six major categories:
- Psychological. Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases.
- Drugs. The extensive list of drugs that affect sexual function includes alcohol, tobacco and most illegal drugs. Commonly prescribed medications that may affect sexual function include blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). Review your entire list of medications with your physician.
- Vascular (circulatory) disease. Atherosclerosis, the common disease called hardening of the arteries that causes heart attacks and strokes, can affect the blood supply to the penis.
- Nerve diseases. Diabetes can damage nerves, as can surgery on the prostate or lower bowel. Spinal cord damage or disease and even some brain diseases can also interfere.
- Hormones. Male hormones (testosterone) can be decreased as a result of an endocrine disorder or due to other conditions such as alcoholic liver disease.
- Diseases or injury affecting the penis. Peyronie’s disease and priapism are the diseases most often associated with ED. Peyronie’s disease is a condition of unknown cause that scars the penis and bends it. Priapism is the name for a persistent erection. It can damage your penis permanently and is sometimes the result of injection treatments for impotence. If you have an erection that persists and hurts, consider it a medical emergency and get help quickly.
How do I know I have it?
If you are not satisfied with the quality of your erections, particularly if they used to be better, get a medical checkup to look for significant causes. One of the easiest ways to find out if the cause is emotional is to find out if you have good nighttime erections. Many men have erections at night as part of their sleep cycle.
What can I do about it?
Sometimes men sleep through their nocturnal erections. Your doctor may first want you to use a device that records erections while you sleep. If you have none, something is wrong and needs to be treated. Your doctor will search for all possible causes, starting with the list of medicines and drugs you use.
Viagra (sildenafil) was developed to treat heart disease. During Viagra’s pre-marketing trials, the patients noticed they were having erections. Since Viagra came to the market two other oral prescription medications were approved by the Food and Drug Administration for ED: Levitra (vardenafil HCl) and Cialis (tadalafil). All three drugs help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sex. Viagra and Levitra work best between one and two hours after taking it. Cialis remains active for as long as 36 hours. Each medication needs sexual stimulation. Sexual function with Viagra improves by a factor of three to four, meaning four out of five patients taking the drug see improvement. All these medicines may have side effects with the most common including headache, flushing, runny nose and indigestion.
After intercourse, blood flow to the penis should decrease, causing the penis to return to its flaccid state. At least 85 percent of men improved their erections with Levitra. These drugs can improve erections in men who had other health problems, such as diabetes or prostate surgery. Men who have significant heart disease or who are taking any form of medication known as nitrates should not take these drugs. (Nitrates help relieve chest pain that can occur because of heart disease.) Also, men who take alpha-blockers, sometimes used for prostate problems or high blood pressure, shouldn’t take these drugs for ED because they may drop blood pressure to an unsafe level. These drugs may also be dangerous for people who have coronary artery disease, heart failure and low blood pressure, and those who are taking many different drugs for high blood pressure.
Before these medications were available, many men with ED were able to get satisfactory erections by using injections directly into the penis. These injections are still available and are very effective when used properly. Occasionally, these injections and the other drugs for ED may cause priapism, or abnormal persistent erections. Therefore, they must be used with caution.
You can also try a tiny pellet of medicine that you can insert into your penis before intercourse. It works the same way as medications and injections.
Also, some mechanical devices can create erections using a vacuum pump to draw blood into the penis and a rubber band around the base of the penis to hold the blood there. The ones available by prescription work. The others don’t, according to the American Urological Association.
And finally, devices can be implanted surgically into your penis. Some are semi-rigid – stiff enough to permit intercourse but flexible enough to bend so they fit into your pants. A more complicated device actually inflates and deflates from a pump placed into your scrotum.
Points to remember
- Impotence may be a sign of serious disease.
- Nighttime erections may distinguish between emotional impotence and organic impotence.
- Drugs are a common cause of impotence.
- Nearly all types of impotence can be treated in one way or another, often with a return to normal orgasmic function.