General Illness Information
IMPOTENCE, MALE SEXUAL
Common Name: None Specified
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.
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.
- Drug abuse, especially of marijuana, cocaine, narcotics, tranquilizers, sedatives, hypnotics and hallucinogens.
- Decreased circulation to the penis from any cause.
- 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).
- Same as problems listed in Causes.
- Recent illness that has lowered strength.
- Recent major surgery, especially prostate surgery.
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.
- 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.
- 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
- 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.
Eat a well-balanced diet.
Possible Complications :
- Depression and loss of self-esteem.
- Marital problems or breakdown of close personal relationships.
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.