Male impotence or sexual dysfunction in men is a term that includes all conditions that interfere with sexual performance. About 100 million men worldwide are affected by impotence, on and off. One of the main causes of impotence is erectile dysfunction (ED), which is the recurrent lack of ability to achieve or maintain penile erection sufficient for satisfactory sexual intercourse. Erectile dysfunction is seen more frequently in older men and may affect about 4 in 10 men above 40 years.
Principles of Treatment of Impotence or Erectile Dysfunction
The medical treatment of impotence is based on three important principles:
- Assessment of the nature and causes of impotence
- Diagnosis and treatment of background causes of impotence
- Specific Treatment of Impotence, especially erectile dysfunction
1. Assessment of the Nature and Causes of Impotence
As a preliminary step, both partners should be interviewed to ascertain the nature and cause of impotence. It is important to probe the role of addictions and psychiatric illnesses such as depression and psychosis. This is followed by physical examination and laboratory investigations to detect underlying diseases, infection, injury, hormonal imbalance, etc.
2. Diagnosis and Treatment of Background Causes of Impotence
Impotence may be caused by multiple factors, and therefore, it is necessary to develop a holistic approach to its treatment.
- Treatment of serious illnesses such as heart disease, diabetes, atherosclerosis and high blood pressure is crucial and should be undertaken first.
- Psychotherapy or psychiatric treatment may be required in more complex cases involving depression, anxiety and addictions.
- Sex counseling or therapy based on the methods developed by Masters and Johnson may be required if there is sexual incompatibility between the partners.
3. Specific Treatment of Impotence or Erectile Dysfunction
Specific treatment includes oral pills, injections into the penis, medicated patches or pellets, mechanical aids and surgery.
a. Oral pills for the treatment of impotence:
These include sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) pills, which act by inhibiting phosphodiesterase-5, which prevents the breakdown of cGMP and prolongs its action of causing erectile response to sexual stimulation.
Sildenafil is effective in 8 out of 10 men with erectile dysfunction. It is taken orally about 60 to 90 minutes before intercourse. Dosage is 25 to 100 mg in 24 hours. Elderly men should start with 25 mg.
Adverse effects of sildenafil are short-lived include headache, flushing and indigestion. Sildenafil is contraindicated in men who have low blood pressure (less than 90/50 mmHg), have suffered recent stroke or heart attack or have been prescribed nitrates (anti-anginal tablets).
Tadalafil and vardenafil are similar to sildenafil and can be taken in the dose of 5 to 20 mg. However, tadalafil has much longer duration of action. Therefore, it is also called the weekend pill.
b. Intrapenile injections for the treatment of impotence:
These medications include alprostadil (Caverject) and papaverine, which are injected into the penis. They have rarely used now because of the development of sildenafil. However, they are effective and safe. The commonest side effects are scarring after repeated injections and painful and persistent erection (priapism), which requires immediate medical attention.
c. Patches and pellets applied locally:
Alprostadil patches may be applied topically on the penis or through the urethra as pellets with the help of an applicator. However, it is less successful than intrapenile injection.
d. Mechanical contraptions for treatment of impotence:
These consist of a vacuum cylinder and pump can be used by men who cannot take sildenafil because of heart disease or other conditions. These mechanical aids cause erection by creating a vacuum and drawing blood into the penile tissues, which is then maintained by use of an elastic band at the base of the penis.
e. Surgery for the treatment of impotence:
The most common surgical procedure in the treatment of impotence is the insertion of inflatable cylinders into the penis. These cylinders are expanded with fluid with the help of a small pump inserted into the scrotum. Side effects include mechanical breakdown of the device and infection. Other surgical techniques involving reconstruction of penile arteries and blockage of penile veins have not been very effective in treatment of erectile dysfunction.
In summary, once the underlying causes have been detected and treated, specific measures can be used to treat impotence or erectile dysfunction. The most popular among these is sildenafil (Viagra). However, though it is effective and relatively safe, it is quite expensive, which explains the plethora of spam messages offering cheap Viagra!
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
Sources:
Bennett P.N, Brown M.J. Clinical Pharmacology. Churchill Livingstone, 10th ed. 2008
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Medical Causes of Impotence - Erectile Dysfunction (ED)
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