The Evaluation and Treatment of Impotence

I would like to discuss with you assessment and treatment of impotence or erectile dysfunction. This is a common condition that impacts nearly 30 million of American men. That’s the bad news. The good information is that mostly everyone can be treated for this common condition. I would like to: one – begin with the definition of impotence or erectile dysfunction, two – discuss the common causes of erectile dysfunction, and three – to review with you some of the treatment options that you can use to resolve this condition.

Let’s begin with the definition of erectile dysfunction. It is defined as the inability to achieve and maintain an erection adequate for penetration to the mutual satisfaction of both partners. Now how does an erection occur? An erection occurs because of the coordinated reactions between the brain and central nervous system; the blood vessels that go to the penis, the nerves from the spinal cord to the penis, and the hormones or testosterone that is produced in the testicle.

Erectile Dysfunction Causes

 blood vessel obstruction

Now, what are some of the common causes of erectile dysfunction? The most common are due to vascular or blood vessel obstruction, which decreases the blood supply to the penis. Other common causes are nerve conditions or nerve damage such as seen with following a stroke or patients, who have multiple sclerosis or spinal cord damage. Another common cause is diabetes, and nearly 50% of men with diabetes will have erectile dysfunction.

There are scores of medications that cause erectile dysfunction. Drugs used to treat high blood pressure, medications used for depression, medications used for pain relief, or sleep medications are just a few of the numbers of drugs that can be associated with the side effects of erectile dysfunction.

Also, there is the possibility of hormone deficiency with a decrease in the production of testosterone by the testicles. Surgical procedures, particularly surgical procedures that are done in the pelvis, such as procedures to remove the cancers of the colon, the prostate, and bladder can be associated with erectile dysfunction. Other causes of erectile dysfunction include kidney disease and a condition called Peyronie’s disease where the penis is bent and making a penetration difficult or impossible.

Diagnosis of Erectile Dysfunction

Now how is the diagnosis of erectile dysfunction made? The doctor will be asking you some questions such as:

  • Do you get erections in the morning upon awakening?
  • Is the problem with erectile dysfunction intermittent or is it constant?
  • Do you have any other associated conditions such as previously discussed that may affect the nerves, the hormones or the blood vessels?
  • Can you achieve an erection with self-stimulation or masturbation?”

Next, a physical examination will be done, including checking the blood pressure and also an inspection of the penis, the testes, and the prostate exam. Then blood tests will be done to test the glucose level to see if there is diabetes, and the lipid level to test for cholesterol, and possibly even the thyroid hormone. Also, a urinalysis and PSA test is done to all men over the age of 50 to be sure that there is not a problem of prostate cancer.

Erectile Dysfunction Treatment

Viagra, Levitra, and Cialis

Let us now turn to the treatment of erectile dysfunction. I’m sure many of you have heard of the medications such as Viagra, Levitra, and Cialis. All three of these pills work by increasing the blood supply to the penis in order to facilitate an erection. There are also pellets of prostaglandin, and there are injections of prostaglandin that can be injected through a very tiny needle about the size of a hair into the penis that will increase the blood supply to the penis.

Hormone treatment is indicated if there is a confirmation that there is a decrease in the production of testosterone by the testicles. Another treatment option is a vacuum device, which is applied to the penis to increase the blood supply to the penis, which is then trapped in a place with a thick rubber band at the base of the penis.

Finally, if those conservative options do not resolve the problem, there are surgical procedures such as the insertion of a prosthesis that can aid and assist a man to achieve and maintain an erection adequate for sexual intimacy.

In summary, impotence is a common condition that affects nearly millions of American men. Second, the diagnosis is easily achieved with a few questions, a physical examination, and a few laboratory tests. And finally, treatment is available. No one needs to fight with erectile dysfunction alone in his bedroom. Help is available for all men who have this common condition.