Impotence

Erectile Dysfunction (Impotence) What is it? Symptoms What your doctor looks for Diagnosis Prevention Treatment When to call your doctor Prognosis What is it? Erectile dysfunction, commonly called "impotence," is a common medical problem which affects approximately 30 million American men. In erectile dysfunction, a man either cannot achieve or cannot maintain satisfactory penile rigidity to engage in sexual relations. Erectile dysfunction is not the same as premature ejaculation, retarded ejaculation, or infertility. Symptoms A man with erectile dysfunction either has as a problem obtaining erections or difficulty maintaining them. In men with erectile dysfunction, premature ejaculation may also occur because of a need for constant and full penile stimulation. In some men with Peyronie's disease, a connective tissue disorder that can cause erectile dysfunction, painful erections may be an additional symptom, along with new onset of curvature of the penis during erections. Erectile dysfunction usually has a progressive effect, starting as a partial problem initially, but becoming a complete problem over time. It can occur suddenly or gradually, and in some men the problem is intermittent. In men with erectile dysfunction, orgasm and ejaculation usually work normally, since these processes are physically separate from the erectile process. What your doctor looks for The initial evaluation of a man with erectile dysfunction includes a medical and psychosexual history, physical examination, and blood tests. The psychosexual history is used to determine the exact nature of the sexual problem and to identify possible psychological factors which may be contributing to the problem. The medical history searches for physical causes of erectile dysfunction, including: vascular disorders (the most common physical cause of erectile dysfunction); neurological disorders; hormonal disorders; and side effects of medications. Since vascular disorders affect the entire body, many men who have erectile dysfunction because of vascular disease also have a history of heart disease, stroke, or other vascular disorders. Neurological problems may contribute to erectile dysfunction in men with a history of diabetes, spinal cord injury, or multiple sclerosis. In men with low testosterone levels caused by a hormonal disorder, a history of reduced sex drive or libido often accompanies erectile dysfunction. To determine whether medications are causing erectile dysfunction, the doctor will ask about current and past medications, as well as about history of prior surgery. A general physical examination, including measurement of blood pressure and pulse, will be performed to rule out any medical problem. The doctor will then examine your genitalia to identify disorders of the penis and testes. Standard laboratory studies include blood tests for blood sugar (to rule out diabetes), cholesterol, and testosterone level. In some case, further endocrine (hormone) testing may be needed, depending on the results of history, physical exam, and standard laboratory testing. This initial evaluation provides an accurate diagnosis for the majority of patients, and further testing is not usually necessary. Assessment of the erections that occur during sleep and evaluation of the penile blood vessels may helpful in the following groups: men who have a history of trauma; young men who have never had an erection; and men who have a need to know the exact cause of their problem. However, this represents an extremely small minority of patients. Diagnosis The diagnosis of erectile dysfunction can usually be made with minimal evaluation. Although technically the causes of erectile dysfunction can be neatly divided into either mental or physical factors, in real life the problem is frequently a combination of both. This is because most men who have a physical reason for erectile dysfunction will also develop an emotional reaction to the problem. Even when the physical cause of erectile dysfunction can be linked to a neurological disorder, hormonal imbalance, or blood flow problem, the exact diagnosis often has little impact upon the choice of therapy. Prevention Little is known about how to prevent erectile dysfunction. However, since erectile dysfunction is primarily a vascular disorder (related to blood vessels), the best way to prevent erectile dysfunction is to reduce vascular risk factors by avoiding cigarette smoking and maintaining low blood cholesterol levels. Also, men with hypertension should strive to lower blood pressure, while diabetics should keep blood sugar levels under control. Because certain medications have been associated with erectile dysfunction, ask your doctor about possible side effects before you start using any new prescription. Treatment There are many effective treatment options for erectile dysfunction. Currently, the most popular option is Viagra, a new on-demand oral medication which is taken on an empty stomach about one hour before sexual activity. Viagra is effective in approximately 70% of men with erectile dysfunction. It is less effective in men with neurological causes of erectile dysfunction such as prostate surgery, diabetes, and spinal cord injury. Viagra should not be taken in conjunction with nitrate medications commonly used in the treatment of heart disease. Counseling or sex therapy is an appropriate treatment for men with predominantly psychogenic erectile dysfunction (erectile dysfunction caused by psychological factors). If neither of these treatments is effective or appropriate, other medical therapies may be considered. Medications that have the ability to cause dilation (widening) of blood vessels can be administered directly to the penis using intraurethral therapy or self-injection. In intraurethral therapy, which is effective in approximately 30% of men, the medication is inserted into the urethra (opening where the urine comes out). In the self-injection method, effective in 75% of men, the medication is injected directly into the penis. Unfortunately, both self-injection therapy and intraurethral therapy have side effects that may lead men to discontinue therapy over time. Prosthetic devices can also be used to treat erectile dysfunction. External devices, known as vacuum erection devices, are currently available over the counter. Although these devices are safe, inexpensive, and highly effective, many men and their partners find them unappealing. Higher patient and partner satisfaction is seen with surgically placed penile prostheses known as penile implants. However, since these implants require a surgical procedure with the risk of surgical complications, only 10% of men with erectile dysfunction choose this option. Vascular surgery is indicated in young healthy men with traumatic injury to the penile arteries. Unfortunately, the long-term success rates of this surgery are not known at this time. Finally, hormonal therapy is indicated in men whose blood test results are abnormal. Testosterone therapy for men with normal testosterone levels is not effective. When to call your doctor A man should speak to his doctor about erectile dysfunction if he has significant and consistent erectile problems over a period of three months or more. Because of unnecessary embarrassment or shame, many men with erectile dysfunction delay talking about this common problem with their physician. They hope that the problem is only temporary and will go away on its own. Unfortunately, this is often not the case. Although some cases of erectile dysfunction are psychogenic and may resolve on their own, organic erectile dysfunction is usually permanent. Prognosis In general, the prognosis for men with erectile dysfunction is excellent. There are several permanently curable forms of the disorder, including: psychogenic erectile dysfunction, hormonal disorders, and traumatic injury to the penile arteries. Although the remainder of men with erectile dysfunction cannot be cured and are likely to require continued therapy, most can enjoy satisfactory sexual function for the rest of their lives.

Visit our Impotence Overview Browse Ask the Doc archives on impotence and other conditions affecting men Medical Journals Find medical abstracts from MEDLINE, MDX, AIDSLINE, CANCERLIT and more. Merriam-Webster's Medical Dictionary Easy access to 40,000 medical words and definitions. Ask the Doc Answers from the experts at Johns Hopkins. The Hopkins Insider Get the inside story on important health issues from Johns Hopkins experts. American Medical Association Johns Hopkins National Cancer Institute National Health Council National Institutes of Health

Last updated September 02, 1998

©1996-1999 InteliHealth Inc. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen. Use of this online service is subject to the disclaimer and the terms and conditions .
"InteliHealth" and "The Trusted Source" are trademarks of InteliHealth Inc.