Sunday, November 18, 2007

What is impotence? How is it diagnosed? How is it treated?

What is impotence?

Impotence is the inability to achieve and keep enough stiffness of the penis to enter the vagina and have intercourse.

It is normal for most men to have an occasional instance of impotence when tired or nervous. When impotence becomes a pattern or a long-lasting problem, however, it can profoundly affect the emotional lives of men and their sexual partners.

Impotence affects older men more than younger men. Midlife and the later years bring changes in circulation that may affect the sexual organs. Couples need to be more open and understanding with each other about sexual problems such as impotence.

Fortunately, impotence can often be cured.

How does it occur?

An erection is caused when there is increased blood flow into the penis and the penile veins clamp down to make sure the blood is trapped there, causing stiffness. Nerves in the penis provide the sensations of pleasure and help maintain the erection until ejaculation.

There are many possible physical and nonphysical causes of impotence, including:

  • disturbance of blood circulation to the penis
  • overeating and drinking, which diverts blood to the gastrointestinal organs
  • extreme fatigue and jet lag
  • fear of failure at intercourse and loss of interest in sex
  • depression, stress, or anxiety
  • diabetes
  • neurological diseases or injuries, such as paraplegia and multiple sclerosis
  • alcohol and drug abuse
  • low levels of male hormone (testosterone)
  • side effects of medications for heart disease, high blood pressure, and nervous disorders (tranquilizers)
  • complications after radical surgery for cancer of the prostate.

How is it diagnosed?

If impotence lasts longer than 2 months or is a recurring problem, you will want to have a physical exam by your doctor or ask him or her to refer you to a doctor who specializes in erectile problems.

The exam will include urine and blood sugar studies so that the doctor can rule out diabetes. In addition, the doctor may want to measure the male hormone level in your blood.

The doctor may want to test penile blood flow and pressure and may also want to measure the nighttime stiffness of the penis by the stamp test or snap gauge test. In the snap gauge test, a band is placed around the penis before you go to sleep. If there is an erection, the snap gauge will break.

For the stamp test, you take a strip of stamps (such as Easter Seals) and make a ring around the nonerect shaft of the penis, moistening and sealing the stamp overlap before going to sleep. (Do not use postage stamps because the glue is too strong.) If an erection occurs during sleep, the stamp ring will break, waking you, and allowing you to feel the degree of erection. Awakening the next morning with the ring intact means you did not have an erection while you were sleeping. Repeat the test the next two nights. If you have the same negative result three times, you probably have impaired circulation in your penis.

If the doctor has ruled out physical problems as a cause of your impotence, he or she will probably refer you and your partner to a psychotherapist or family counselor.

Psychological problems causing impotence are varied, but most can be helped. Therapy often leads to improved function in other areas of life as well as in sexual function. Psychotherapists often like to work with both partners. Therapy, like other treatments, can be uncomfortable although worthwhile. If you have concerns about your referral, ask to discuss them with your primary doctor.

How is it treated?

If you have low blood pressure to your penis or have a problem with blood flow to it, you may have several options.

Drug Treatment

If a man's level of male hormone (testosterone) is low, he can take monthly injections (in the arm) of testosterone.

Drugs may also be used to get more blood to enter the penis through the arteries, producing or enhancing an erection. Drugs can be injected directly into the penis to produce an erection. The new drug Viagra (sildenafil) can be taken as a pill rather than injected into the penis.

Viagra can help men have and keep an erection. It should be taken about an hour before sexual activity. Viagra should not be used by men who are taking nitrates because the combination could make the blood pressure too low. Erythromycin and some antifungal medicines can interact with Viagra, too, so a lower dose of Viagra is prescribed for men taking these medicines. Viagra can cause some mild side effects, including flushing, headache, and less commonly, indigestion.

Individualized combinations and dosages of other drugs can be self-injected into the penis when an erection is desired.

An occasional problem with injections has been priapism (painful and prolonged erections), requiring emergency treatment. Therefore, the injections must be done only with a doctor's prescription. A man will usually become erect in 3 minutes or less. Men with hormonal or nerve problems will usually respond in 5 minutes. Erections occurring from injections usually last as long as an hour.

External Mechanical Devices

There are mechanical devices that trap blood in the penis to cause an erection. They come with a vacuum chamber, a pump, connecting tubing, and elastic bands. The system requires time and dedication on the part of the couple to become comfortable with it. There are a number of such devices on the market. They may be covered by Medicare when the problem is vascular and the device is prescribed by a physician.

You insert the soft penis into the vacuum chamber tube connected to a pump by a piece of tubing. You then apply suction by using the small hand pump. Negative pressure or suction pulls blood into the penis producing an erection. The blood is held in the penis by placing a tight band, similar to a rubber band, around the base of the erect penis. You should not keep the band in place longer than 30 minutes or fall asleep with it on.

Advantages of these devices include:

  • Initial positive results increase the desire to remain sexually active.
  • They may help to reestablish penile blood flow by creating stiffness.


Men who have defects of penile arteries or veins may choose surgery to correct the defects.

Invasive Mechanical Devices or Implants

These are mechanical devices actually placed inside the body.

Invasive devices are used only when:

  • There is nerve and vascular damage.
  • There has been no improvement with mechanical devices used outside the body, hormonal replacement therapy, or medical treatment of the cause.

Treatment involves inserting a mechanical device or prosthesis into the spaces where the blood normally collects to stiffen the penis.

Although the overall success rate of the penile prosthesis is greater than 95%, many urologists urge couples to consider simpler, less expensive alternatives before surgery.

The urologist or doctor will discuss the advantages and disadvantages of each type of device and help the couple select the appropriate one. The implant has rods or cylinders that can be inflated or deflated at will. Most prostheses can be inserted during a one-day surgery requiring no overnight hospital stay.

Semi-rigid or rigid implants:

Advantages of a semi-rigid or rigid implant are:

  • It is inexpensive.
  • It is simple to insert.
  • It can be inserted under local anesthesia.
  • It is always ready for use once it is in place.
  • It has a 20-year successful history.

Disadvantages of a semi-rigid or rigid implant are:

  • It is always at its full size.
  • It may be hard to conceal. A malleable semi-rigid implant can be bent to hide it and brought into position when desired.

Inflatable Implants:

Advantages of an inflatable implant are:

  • It can be easily hidden. It uses a pump tucked in the scrotum above the left testicle and a fluid reservoir behind the pubic bone. The hollow cylinders that replace the erectile tissues are connected to the reservoir and can be inflated or deflated at will. The penis returns to a resting state when the fluid is returned to the reservoir from the cylinders by reversing the flow with the pump.

Disadvantages of an inflatable implant are:

  • It is more expensive.
  • Its insertion requires a hospital stay of 24 to 48 hours.
  • Since it is more complex, there are more ways in which the device could stop working.

For More Information

Information and support are available through Impotence Anonymous (IA) and Impotence Institute of America (IIA). The hotline for both is: 1-800-669-1603.

You may want to write the IIA at:

The Impotence Institute of America
119 South Ruth
St. Maryville, TN 37801-5746

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