| General
Illness Information |
Medical
Term: |
IMPOTENCE, MALE SEXUAL
|
|
Common
Name: |
None Specified |
| Description: |
| A consistent inability to achieve or maintain
an erection. |
| Impotence is not inevitable with aging. The
capacity for erection is retained, though a man may need more
stimulation to achieve erection and more time between
erections than in the past.
| |
| Causes: |
| Psychological causes
include: |
| Guilt feelings. |
| A poor relationship with the sexual
partner. |
| Psychological disorders, including
depression, anxiety and stress. |
| Physical causes include: |
| Diabetes mellitus. |
| Atherosclerosis (hardening of the
arteries). |
| Use of some anti-hypertensive medications and
antidepressants. |
| Disorders of the central nervous system, such
as spinal-cord injury, multiple sclerosis, stroke or
syphilis. |
| Endocrine disorders that involve the
pituitary, thyroid, adrenal or sexual glands. |
| Alcoholism. |
| Drug abuse, especially of marijuana, cocaine,
narcotics, tranquilizers, sedatives, hypnotics and
hallucinogens. |
| Decreased circulation to the penis from any
cause. |
|
| Prevention: |
| Maintain good communication with your
partner. Don't be hesitant about discussing the problem,
exploring your needs and asking for help. Your partner's
understanding is critical to solving the problem. |
| Don't drink more than 1 or 2 alcoholic
drinks, if any, a day. Don't use other drugs that can be
abused. |
| If you have diabetes, adhere closely to your
treatment program. |
| Maintain overall good health. |
| If any new medication you take changes your
sexual function, discuss this with your doctor. A change in
medication may be all that is needed. |
| Regular exercise. |
|
| Signs
& Symptoms |
 |
Inability to achieve an erection. |
 |
Inability to maintain an erection for the
normal duration of intercourse (erection may be too weak, too
brief). | |
| Risk
Factors |
|
|
| Diagnosis & Treatment |
| Medical tests as needed for diagnosis of any underlying
disorder. Physical causes must be ruled out by appropriate
testing. Diagnostic tests may be done at a special center to
measure nocturnal erections. |
| General
Measures: |
 |
Psychotherapy or counseling (alone
or with your partner) from a qualified, professional sex
therapist. |
|
If medication is the cause, a change in
medication or changes in dosage amounts may be
helpful. |
|
Self-administered penile injection therapy
may be prescribed. |
|
Use of vacuum erectile device may be
recommended for some patients. |
|
Surgery to implant an inflatable or
non-inflatable penile
prosthesis. | |
| Medications: |
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Medication may be prescribed to
treat the underlying medical condition.
If hypogonadism present, testosterone cypionate 200 mg IM
every two weeks
If hyperprolactinemia present, bromocriptine
2.5 mg bid up to 40 mg/day
To induce erection:
Intracavernous injection of a solution containing
phentolamine 0.5-1.0 mg and papaverine 30 mg per mL, starting
with 0.1 mL
or
Alprostadil (Caverject) 10-20 mg/mL;
inject into the dorsolateral aspect of proximal third of the
penis. Do not exceed 60 mg dose. Do not use more than 3 times
a week or more than once in 24 hours. Patient to notify
physician if erection lasts > 6 hours for immediate
attention.
Alprostadil (Muse) urethral suppository 125 mg, 250 mg, 500
mg, and 1000 mg pellets. Maximum of 2 uses in 24 hours.
Sildenafil (Viagra)
50 mg 1 hr before desired erection. May be effective in 30
minutes and up to 4 hours after dosage. Older patients or
those with renal or hepatic disease need half the dose of
others to achieve similar blood levels. Side effects:
headache, flushing, indigestion, visual changes. |
|
Recently there has been renewed
interest in herbal therapy for impotence. Ginkgo biloba
in particular, has been considered to be helpful, especially
in impotence and low libido caused by anti-hypertensives and
anti-depressants. It has also been shown to be helpful in
cases of lack of libido in
women. | |
| Activity: |
|
No
restrictions. | |
| Diet: |
|
Eat a well-balanced
diet. | |
| Possible
Complications : |
|
Depression and loss of
self-esteem. |
|
Marital problems or breakdown of
close personal relationships. | |
| Prognosis |
| For cases with physical origins,
treatment of the underlying disorder or changes in a
medication therapy may improve sexual
performance. |
| Spontaneous recovery or recovery after
brief counseling in many cases with psychological
origins. |
| Other medical methods to improve
erectile function have greatly improved the
outlook. | | |
| Other |
|
|