Last week I opened a Pandora box, when I discussed impotence. Or should I say I struck a raw nerve, by bringing to the fore man’s major infirmity – erectile dysfunction, ie metaphorically speaking. Some Professors in Gregory University Uturu, and some of my colleagues retired Permanent Secretaries were all interested in the Management of impotence and low libido. One Professor told me he has booked next week’s Sunday Sun Newspaper that I should not disappoint him by not writing the follow up as I promised.
As I stated last week, impotence (erectile dysfunction) is the inability to initiate and maintain an erection in at least 50% of the attempts at intercourse or the cessation of attempts at intercourse due to wobbling penis.
I said also, that impotence usually results from vascular impairment, neurological disorders, drugs, abnormalities of the penis, or psychological problems, that interfere with sexual arousal. I told us also, that physical causes are more common in older men: while psychological problems are more common in younger men.
Impotence becomes more common with age, though it is not considered a normal part of aging. Instead, it results from underlying problems that commonly occur in older people. I said also that about 50% of 65-year-old – men, and 75% of 80-year-old-men are impotent.
Usually the diagnosis of impotence which I have practiced for the past 40 years and still counting, is typically to allow my patients to tell me about their erection problems. I would then ask about the symptoms to be sure that impotence, and not another sexual dysfunction, such as a problem with ejaculation is the problem. I would ask if sexual desire is accompanied by the inability to achieve an erection sufficient for sexual intercourse, and if the man has erections during sleep or in the morning on awakening. These are physiological signs suggestive of psychological impotence.
Answers to these questions can help me determine whether the impotence stems from physical or psychological problems. I also review the patients history of vascular, pelvic, rectal or prostate surgery. Any changes in male sex characteristics – such as breast, testicular, and penile size – and changes in hair, voice, or skin are considered. I would also explore the possibility of psychological problems such as depression or anxiety.
Any new stressful situation, such as a change of sex partners or problems with relationship or work, can also be an important factor. I would also ask my patients about the use of prescription, non prescription and illicit drugs and alcohol.
Blood samples are usually taken to measure total testosterone levels and the amount of bioavailable (usable) testosterone.
Testosterone deficiencies can cause impotence as well as lead to breast enlargement (gynecomastia), loss of pubic hair and smaller softer testes. Measurement of blood pressure in the legs may indicate a problem with arteries in the pelvis and groin that supply blood to the penis. I, usually determine also whether the nerve supply to the penis is normal.
Other blood tests can help identify common diseases that can lead to impotence. For example a complete blood cell count can identify anemia and infection, a blood sugar (glucose) and glycostatic Hemoglobin (HbA1c) can reveal diabetes and a thyroid – Stimulating hormone test can detect an overactive or under active thyroid gland.
The blood vessels of the penis can be evaluated by an ultra sound examination. Another test involves injecting the penis with drugs that dilate the arteries. If the injection does not cause an erection or if the man cannot maintain an erection, the penile veins may be leaky and unable to hold blood in the penis.
Impotence can usually be treated without surgery. The type of treatment depends on the cause of the impotence and the person’s lifestyle. A specific exercise for those with impotence from psychological causes is the three – stage – sensate – focus – technique. This technique encourages ultimate contact and emotional warmth, putting less emphasis on intercourse than on building a relationship.
The First Stage – consists of caressing: the partners concentrate on giving each other pleasure, without touching each others genital areas.
The Second Stage – allows partners to touch the genital areas and other erogenous zones, but intercourse is prohibited.
The Third Stage – intercourse occurs. Both partners achieve comfort at each level of intimacy before proceeding to the next stage. If this technique is not successful
Psychotherapy or behavioral sex therapy, may be appropriate. If the person has depression, drug treatment or counseling may help.
Sildenafil (viagra) is an oral drug that can relieve some cases of impotence by increasing blood flow to the penis. Taken 30 to 60 minutes before sex. It is effective only when sexual arousal occurs. It must not be taken in combination with nitrates, because of serous and sometimes fatal side effects. Note please, and very seriously too viagra must never, repeat must never be taken by someone with heart disease
Yohimbine is not better than a placebo (an inactive substance). Testosterone replacement therapy benefits men whose impotence or loss of sex drive stems from abnormality low testosterone levels. The testosterone can be injected usually weekly or applied as a skin patch. The drug may cause side effects, such as prostate growth, and an excess of red blood cells that can lead to a stroke.
Binding and vacuum devices often are used to achieve and maintain an erection, although they are not appropriate for men with bleeding disorders or those taking anticoagulant drugs.
Binding devices – such as bands and rings made of metal, rubber, or leather, are placed at the base of the penis to slow the outflow of blood. These medically engineered devices can be purchased with a doctor’s prescription in the pharmacy, but inexpensive versions, called cock rings. These can be purchased in stores that sell sexual paraphernalia. For mild impotence, a binding device alone can be effective.
Vacuum devices – consisting of a hollow chamber and a syringe, pump or tubing, fit over the limp penis. A gentle vacuum is created by using the syringe or pump or by sucking on the tubing. Vacuum pressure helps draw blood into the arteries of the penis. When the penis is erect, a binding device is applied to prevent the blood from flowing out through the veins.
This combination of devices may help an other wise an impotent man maintain an erection for as long as 30 minutes. Occasionally a binding device causes problem with ejaculation, especially if it is too tight. For safety the person must remove the device after 30 minutes. Binding devices can cause bruises if used too often. However both devices are considered safe.
Impotence also may be treated with injections of specific drugs self administered directly into the erectile tissue (corpus cavernosum) of the penis. An erection occurs 5 to 10 minutes after an injection and may last as long as 60 minutes. Side effects may include, bruising and aching. Also injections may cause painful, persistent erection (priapism).
When impotence does not respond to other treatments, a permanent penile implant or prosthesis may help. Permanent devices are especially successful for chronic impotence caused by diabetes.
A variety of implants and prostheses all requiring surgical insertion are available. One device consists of firm rods that are inserted into the penis to create a permanent erection whenever needed.
Another is an inflatable balloon that is inserted into the penis, before having intercourse, the man inflates the balloon. Generally such surgery requires at least a 3-day hospitalizations, and a 6-week – recovery.
Surgical technique to restore blood flow to penis are still experimental. Always be medically guided.
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