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Erectile Dysfunction (Impotence) - Treatment*

Impotence, or erectile dysfunction (ED, E.D.), is an extremely common disorder among as much as 10 percent of the male population, and above the age of 40, nearly 52% of men are affected. Despite this staggering incidence, few men choose to deal with the problem beyond attempting such drugs as Viagra® or Cialis®, both of which may cause substantial side effects, such as colored vision, palpitations, sweating, nausea, etc.

Contrary to popular belief, ED rarely has an instant onset. Most men who begin to experience ED have normal desire and can obtain an erection, only the erection is not hard enough or doesn’t last long enough, hence the term erectile dysfunction (which suggests partial loss) is preferred to impotence (which suggests a total loss). This trend is slowly but definitely changing. This is largely due to tremendous advances in research over past years which have conclusively established that in as many as 80-90% of cases, the cause is not in the mind but in the body. However, many men remain in denial about themselves rather than facing the issue head on.

The main reason for this “denial” is ego or male chauvinism. Throughout human history, most of our societies have been patriarchal and male-dominated. Men’s egos would not let them admit that there could be something wrong with their ‘jewels of manhood’.

What, then, causes ED? Impotence can be of several types:

* The arteries supplying blood to the penis do not bring in enough blood to cause an erection. This can occur because of a narrowing of the arteries such as occurs in the elderly, diabetics and those with high blood pressure or because of injury to the genital region which causes a block in the artery to the penis.

* The last is very common in the young. The injury can be major and sudden as after a vehicular accident causing a fracture of the pelvis or pubic bones, or low grade and gradual, as in bicycle and other riders, and occurs because sustained friction in that region causes a clot-like substance (thrombus) to develop in the artery to the penis. This clot gradually grows and ultimately blocks the blood supply to the penis completely.

* Impotence resulting from injuries is very common but often unsuspected because of ignorance of the causative conditions. The impotence is often discovered much later, after the more obvious wounds and fractures have healed. Ironically, it is most often discovered by the patient himself and not by the doctor.

* The veins of the penis may leak blood and prevent the development of a rigid erection (Venogenic impotence). In a normal man during full erection the veins close down almost completely and practically no blood flows out from the penis. This allows blood to accumulate in the sinusoids of the penis, thus raising pressure and allowing for the development of rigidity or hardness. This type of ED is extremely common. It is said to account for as much as 30-70 percent of all impotence. Some men have venogenic impotence from birth (primary). Such men have never had a rigid erection all their lives. Others develop venogenic impotence suddenly after years of normal sexuality (secondary).

* The nerve supply to the penis is very complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. It is these nerves that activate the arteries and the veins and alter the dynamics of blood flow within them. Many things can go wrong with the nerve supply to the penis. Injuries to the back, especially if they involve the vertebral column and the spinal cord can cause impotence. So also can injury to other nerves supplying the penis such as occurs after pelvic or perineal trauma. A wide variety of operations performed for other conditions can cause incidental injury to the nerves of the penis and cause impotence. These include operations on the rectum, prostate, urethra, spine, retroperitoneum, urinary bladder etc.

* Another disease affecting the nerves to the penis is diabetes mellitus. Impotence is extremely common among diabetics, in fact, as many as 50 per cent of all diabetics are impotent. Impotence in diabetics is almost always organic in origin. Appropriate therapy for diabetes can never restore erectile function because the basic diabetic process can never be reversed. Only the blood sugar levels and the complications of diabetes are controlled. Modern andrology, however, can offer a cure to nearly all patients with diabetes-related impotence. This is another fact that is, unfortunately, not known to most people. Few diabetologists address erectile dysfunction (ED, impotence) in their patients.

* Many drugs also cause neurogenic impotence by affecting the neurotransmitters at the nerve endings. Notable among these are anti-hypertensives (BP lowering) and psychotropics. The list is very large. Often, it is not known that the medicine (which is prescribed for some unrelated disease, such as duodenal ulcer) is the culprit.

* Sometimes, more than one factor can be operative in the same patient. Such patients generally have systemic disease. Notable examples are diabetes, kidney failure, and liver failure.

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Our Values

  • Immediate Appointments Available
  • Walk-Ins are always welcome
  • Only use FDA-approved medications
  • Initial Consultation
  • Orlando Terneny, MD - Board Certified Internal Medicine Specialist in Andrology

*Individual results may vary and are not guaranteed