Impotence

Erectile Dysfunction / Impotence

What is erectile dysfunction (ED)?
Impotence, or erectile dysfunction, is the inability to achieve or maintain an erection more than 20 percent of the time. Erectile dysfunction affects millions of men.

Although in the past it was commonly believed to be due to psychological problems, it is now known that 80 to 90 percent of impotence is caused by physical problems, usually related to the blood supply of the penis. Many advances have occurred in both diagnosis and treatment of erectile dysfunction.

What are the risk factors for erectile dysfunction?
According to the National Institutes of Health, erectile dysfunction is also a symptom in many disorders and diseases.

Direct risk factors for erectile dysfunction may include:

prostate problems

type 2 diabetes (diabetes mellitus)

hypogonadism in association with a number of endocrinologic conditions

hypertension (high blood pressure)

vascular disease and vascular surgery

high levels of blood cholesterol

low levels of HDL (high density lipoprotein)

drugs

neurogenic disorders

Peyronie's disease (distortion or curvature of the penis)

priapism (inflammation of the penis)

depression

alcohol ingestion

lack of sexual knowledge

poor sexual techniques

inadequate interpersonal relationships

many chronic diseases, especially renal failure and dialysis

smoking, which accentuates the effects of other risk factors such as vascular disease or hypertension

Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

It is estimated that nearly 5 percent of men become impotent by the age of 40, and 15 to 25 percent by the age of 65. Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.

What are types (and causes) of ED?

premature ejaculation (PE) - the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms.
- primary premature ejaculation is learned behavior that begins when a male first become sexually active. Like any learned behaviors, it can be unlearned. This form of primary PE is psychogenic (as opposed to organic or physical) impotence. (Congenital venous leak is a subset of primary PE and is caused by a congenital venous leak in which venous drainage system in the penis does not shut down properly.)

secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. Secondary PE is due to physical causes, usually involving the penile arteries or veins or both.

performance anxiety is a form of psychogenic impotence usually caused by stress or anxiety.

depression is another cause of psychogenic impotence, and some antidepressant medications cause erectile failure.
organic impotenceinvolves the penile arteries, veins or both, and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis -- being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking -- can cause erectile failure often before progressing to affect the heart. Many experts believe that when veins are the cause, a venous leak or "cavernosal failure" is the most common vascular problem.

diabetes - impotence is common in diabetics. There are 5 million diabetic adult men in the US, and it is estimated that half are impotent and the other half will become impotent in time. The process involves premature and unusually severe hardening of the arteries. Peripheral neuropathy, with involvement of the nerves controlling erections, is commonly seen in diabetics.
neurologic causes - There are many neurological (nerve problems) causes of impotence. Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve injuries, and nerve damage from pelvic operations can cause erectile dysfunction.
drug induced impotence - A great variety of prescription drugs, such as blood pressure medications, anti-anxiety and anti-depressant drugs, glaucoma eye drops, and cancer chemotherapy agents are just some of the many drugs associated with impotence.
hormone induced impotence - Hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence. Rarely is low testosterone responsible.

How is ED often diagnosed?

patient medical/sexual history - may reveal conditions or diseases that lead to impotence and helps distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

physical examination - to look for evidence of systemic problems, such as:
- a problem in the nervous system may be involved if the penis does not respond as expected to certain touching
- secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involves the endocrine system
- circulatory problems could be indicated by an aneurysm
- unusual characteristics of the penis itself could suggest the basis of the impotence

laboratory tests - to help diagnose impotence include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. When low sexual desire is a symptom, measurement of testosterone in the blood can yield information about problems with the endocrine system.

other tests - to help rule out certain psychological causes of impotence.

psychosocial examination - to help reveal psychological factors. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

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