Impotence is defined as the inability to either get or sustain erections well enough to perform intercourse. It occurs more commonly than many think. Impotence is found in one out of ten men; and if you are over 60 years old, it occurs in one out of three men. Although it is common, it is not normal, nor is it an inevitable part of aging. However, the good news is that impotence is treatable.

Not too very long ago it was thought that impotency was caused, for the most part, by psychological or emotional problems. That is no longer the case. Although there is often an emotional side to impotence, it usually begins due to physical problems. In discussing the causes, let's first look at how an erection takes place.

In the flaccid state, blood moves into the penis through the small arteries at the same rate it exits the penis through a series of veins. During an erection, a series of chemicals are released in the penis that causes the arteries to enlarge, bringing more blood into the penis. At the same time, the outflow veins are constricted, limiting the exit of blood. The penis expands and becomes erect. If either of these functions does not work properly, the erection may not be firm or does not stay firm for long. Therefore, conditions that restrict the inflow of blood or that cause venous leakage can result in impotence. Let's look at some of the causes.

Any disease process that damages blood vessels can cause impotence. These include arteriosclerosis, high blood pressure, high cholesterol, and smoking. Injury to nerves is another important cause. This can be the result of diabetes, surgery, or neurological conditions such as multiple sclerosis, stroke, or Parkinson's disease. Diabetics are in a high-risk category for impotence in that nearly half of the men with diabetes are impotent. Diabetes is not only a sugar disease but effects the blood vessels and small blood vessels and nerve endings responsible for erections.

Along with these physical causes, stress or performance anxiety can be a factor. It is usual that emotional factors play a primary role in impotence; however, they are present to some degree in most situations.

Your doctor can test for impotence in a variety of ways; but the tests are directed to checking the blood vessels, nerves, hormones, and tissues of the penis to detect any abnormalities. In addition to examining the penis and prostate for physical abnormalities such as PeyronieÌs disease or prostatitis, the nerves can be checked by testing certain reflexes and for loss of sensation. Blood vessels can be examined in several ways. Sleep monitoring evaluates nighttime erections that normally occur several times during sleep. This can be done by either a stamp test or snap gauge which are applied to the penis at bedtime and check in the morning to see if there has been a rigid enough erection to separate the stamps or break the test strips on the snap gauge. The Rigiscan is a computer-monitored strain gauge. It more precisely monitors erectile function at night by quantifying the rigidity of the erections that occur.

Evaluation of blood flow can also be done in several ways. Certain drugs, when injected into the penis, cause a dilation of inflow arteries and constriction of the outflow veins producing an erection. Evaluating the response to this injection can give valuable information about the status of the vascular supply of the penis. More extensive tests would be a color flow Doppler or a DICC study which stands for dynamic infusion cavernosometry and cavernosography. These tests more precisely check the blood flow both into and out of the penis. In summary, testing can be very helpful to determine if there is a physical cause for impotence.

The treatment of impotence can be divided into surgical and nonsurgical choices. Options under the nonsurgical category include medications, vacuum devices, or penile self-injections. Let's look at these separately.

If there is a deficiency in the male hormone, testosterone, it can be treated by giving replacement. This can be done by either slow-release, intramuscular injections or by skin patches applied daily. Oral medications, such as Yohimbine, that improve penile blood flow can also be tried. Unfortunately, they are only effective some of the time.

More commonly, penile self-injections or vacuum therapy is used. With self-injection, medication is injected with a small syringe and needle, like used by diabetics to inject insulin. An area on the side of the penis is chosen that is less sensitive then most places on other parts of the body. The medication draws blood into the penis and holds it there by reducing the venous outflow. The erection usually will last 30 to 45 minutes and is not influenced by ejaculation. Side effects can be bruising, scar tissue formation, and prolonged erections; but these are minimized by proper technique. Most patients can easily be taught the technique. This has become one of the most common nonsurgical treatments for impotence.

The vacuum device works by placing a plastic cylinder over the penis and pressing the cylinder over the abdomen to create a seal. A hand or battery-powered pump develops a vacuum that draws blood into the penis. A constricting ring is slipped from the cylinder on to the penis holding blood in the penis to maintain the erection. The ring should be removed within 30 minutes. These devices are purchased with a prescription and are usually covered in part by Medicare and some insurance companies. The drawbacks are that it produces a somewhat cold-feeling erection and it can be awkward to use for some.

The surgical treatment of impotence includes implant surgery and penile revascularization. Implant surgery involves placing a prosthetic device into the erection chambers of the penis. These can be either malleable or inflatable implants. The malleable implants maintain permanent rigidity but can be bent to allow for concealment. They are less expensive than their inflatable counterparts and also less prone to mechanical failure. On the other hand, the inflatable implants look and feel more natural but are fluid filled and could malfunction with time.

Revascularization surgery can be done in a very select group of patients. The procedure involves transferring a blood vessel from beneath the abdominal muscle and connecting it to vessels in the penis, bypassing a blockage. This procedure is usually reserved for younger men who do not show signs of arteriosclerosis.

As has been seen, impotence is a common problem that can be caused by many factors. Most importantly, it can be treated.

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