Male Erectile Disorder (Impotence)

Male Erectile Disorder (Impotence)

Definition

Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection.

This is also know as erectile dysfunction.

The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience ;while others report being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection,lose it when attempting penetration. Still other report that have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.

Male erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.

Etiology

Aging:with advancing age,
-The orgasm is less intensive,
-The ejaculate is reduced

The interval between the two successive acts is increased.

Psychological factors:
Fatigue
Depression
Stress
Mental disorders
Guilt
Fear of failure
Low self esteem
Religious restrictions
Homosexuality
Long/serious illness
Traumatic initial experience
Negative feelings towards the partner
Vascular causes
Use of tobacco/Alcohol
Atherosclerosis
Peyronie's disease
Diabetes
Hypertension
Venous leak or occlusion
Trauma
Surgery
Radiation

Harmonal causes :

Hypogonadism
Hyperprolactinemia
Diabetes
Thyroid disease
Androgen deficiency
Estrogen excess Adrenal
pituitary of Hypothalamic disease

Neurogenic causes :

Peripheral Neuritis
Autonomic neuropathy (in Diabetes)
Multiple sclerosis
Spinal cord disease

Drug related casuses :

Antiandrogens
H2receptor antagonists
Diuretics
Antihypertensive
Anticholinergics
Antidepressants
Antipsychotics
CNS Depressants
Substance abuse

Miscellaneous

Rental failure
Prostatectomy

Diagnostic tests

Stamp Test :A long strip of postal stamps in wound around the base of the penis at night before going to bed. Next morning if the perforations of the strip are found to be torn off, impotence is supposed to be of psychological in origin.

Peno-brachial index : The ratio of penile systolic blood pressure to that of brachial systolic blood pressure is normally 0.6. If found to be low, impotence is vascular in origin .

Papaverine Injection Test : Papaverine is a vasoactive drug. Using a 26 gauge needle, 30 mg papaverine is injected at the mid-shift of Corpus cavernosum of the penis. He is isolated, asked to stoke the penis and expose to erotic literature. An erection will occur in 10 to 15 minutes. If the erection is short-lived or partial, then impotence is considered as vasculogenic. If the erection is full, then impotence is considered to be neurogenic or psychogenic. In origin.

Caution : This test should be performed in a hospital setting or where the facilities for detumescence are available. The patient should be observed for next few hours till the erection subsides.

Rigiscan Test :

This is a gold standard for evaluation of Nocturnal Penile Tumescence and Rigidity (NPTR). This test is based on the physiological principle that a male gets erection 3 to 5 times during REM sleep. At night before going to sleep one ring of Rigiscan is slid over the base of the penis and the over the tip. Next morning, the tracing obtained are studied. This test can quantify erectile tumescence and rigidity. Rigiscan tracing indicates whether the impotence is organic or psychological in origin.

Arterial insufficiency and venous leaks can also be suspected on the basis of Rigiscan graphs. Patients with purely artery disease have low levels of rigidity but of adequate duration. Patients with venous leak will have varying rigidity levels with shortened duration.

Penile Ultrasound :

This test is for evaluation of the functioning of the penile arteries. A simple acoustic Doppler emits auditory signals or a colour Doppler can help visualization of arteries. Cavernosometry and caver nosography: this haemodynamic test is useful for diagnosing venous-occlusive dysfunction of the corpora. Biothesiometry, electromyography , nerve conduction studies: these are for evaluation of neurogenic impotence.

Treatment

Counseling

Sexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counselling is towards strengthening the marital relationship. Wife is requested to co-operate. The client is requested to quit smoking and alcohol. He is advised relaxation exercise, yoga. The couple is educated about anatomy, physiology of sexual organs sexuality are countered. Their myths and misconceptions about sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.