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What is impotence?

With the advances in medical science, the experts have replaced the word impotence with a less pejorative and less derogatory name. Today, impotence is referred to as Erectile Dysfunction (ED), the inability to attain and maintain an erection for a satisfactory sexual intercourse. While the word impotence used to connote a hopeless and permanent condition, Erectile Dysfunction nowadays is synonymous with a disability that can be treated with great success in most cases.

How common is ED?

Erectile Dysfunction affects an estimated 20 million men older than 18 years of age in the United States alone. The prevalence is 52% among men aged 40 to 70, and the incidence increases with age. Normally, men who are otherwise healthy can enjoy sex throughout life, even after age 70, albeit less frequently, with softer erection, and the amount and force of the ejaculate somewhat diminished. With currently available medication, the quality of erection can be improved more than 95% in majority of cases.

What are the causes of Erectile Dysfunction?

The etiology of ED could be primary (the man has NEVER been able to get and maintain erections at all) and this is almost always due to some psychologic reasons, like fear of intimacy, sexual guilt, severe anxiety, depression. Rarely, the primary factor is biogenic, usually associated with low levels of testosterone and associated with hypothalamic-pituitary-gonadal axis (brain-hormonal disorders). The other cause could be secondary, where the man previously was able to attain and sustain erections but presently could not. More than 90% of these are organic (caused by a medical disease), which can be treated.

What is the major cause of ED?

The major cause is usually vascular, where the arteries supplying the male genitals are blocked with arteriosclerosis (hardening of the arteries) due to cholesterol deposits, like those blockages found in the coronary arteries of the heart that cause heart attacks. Others include hormonal disorders (hypo or hyperthyrodism, etc), drug use (those taking medications for high blood pressure, etc.), and neurologic disorders (stroke, multiple sclerosis, spinal cord injuries, etc).

Can the penile arteries be blocked?

Yes, the tiny arteries to the male organ itself can be obstructed by cholesterol deposits, and as a result, not enough blood enters the male genital to fill it up to cause distension and erection. To attain and maintain erection, the penis must be fully filled with blood to keep it engorged and hard.

What causes cholesterol blockages in the arteries?

There are many factors. Among them are smoking cigarettes (a major culprit!), eating red meats (pork, beef, and any dish made of any of these two), eggs, butter, cheese, and other foods that are high in cholesterol, and lack of daily physical exercises. The healthier diet consists of fish, vegetables, fruits, high fiber oats, bran and wheat, and a daily multivitamin-mineral supplement. We do not have to eat red meats and eggs to stay healthy. As a matter of fact, it would be healthier for all of us if we stayed away from them. Diabetes also aggravates hardening of the arteries.

How does smoking cause harm?

Smoking has many bad effects on our health. It causes thickening of our blood that lead to blood clot formation on the walls of the arteries throughout our body. As a result of this, the clotted blood becomes so hard it blocks the arteries, like junk blocking our kitchen sink or sewer pipes. This blockages (arteriosclerosis) affect the coronary arteries of the heart, the cerebral arteries of the brain, arteries of the genitals, arteries to the legs and feet. The other harmful effect of smoking is from the poisonous smoke (the nicotine/tar/other chemical combination in the cigarettes) that constantly irritates the sensitive mucosal lining of our breathing pipes and the lungs. This causes not only emphysema ("burned" lung tissues) but cancer of the throat, breathing pipes, the lungs, breasts, and other organs in the body in both males and females. Erectile Dysfunction is another side effect of smoking.

Does prostate surgery cause ED?

Yes, surgery of the prostate gland in men causes Erectile Dysfunction in most, if not all, patients. Those with TUR (Trans Urethral Resection for removal of BPH, benign prostatic hypertrophy: super-enlarged prostate gland that blocks urine flow) have 40% incidence of Erectile Dysfunction. But nowadays, this condition is no longer a hopeless situation like it was about five years ago. Today, we have a medication that takes care of this surgical complication.

What is this "wonder" drug?

The "magic" medication is Sildenafil Citrate (Viagra), which we have written about in this column when it was first introduced in the United States about 4 years ago. This oral tablet has revolutionized the management of impotence, which has since then been renamed Erectile Dysfunction, a much less ominous condition. The success rate in the treatment of ED is so high this condition does not pose much of a problem any more in majority of cases.

How is Viagra used?

The manufacturer recommends taking one 50-mg tablet an hour before sex but we are warning the readers that those on any medication with Nitrates MUST NOT take Viagra because Nitrates and Viagra are a dangerous combination. We suggest those interested in this medication to consult with their physician before taking this wonder drug.

Does alcohol cause ED?

One drink does not cause Erectile Dysfunction, but excessive alcohol ingestion (two or more drinks) could cause temporary ED. This condition can also be situational, involving time, place, damaged self-esteem, a particular partner, or some perceived competitive defeat. The psychological component is very strong. Hence, it is very important that a romantic ambiance and a happy rapport between lovers are a prelude to sexual intimacy in order for the partners to experience the fulfillment and true joy of sex.

When is Penile Prosthesis implanted?

Penile prosthesis is a device that is surgically inserted into the penis to keep it erect, but recommended only for impotence which does not respond to medication or other treatments. This prosthesis has been relegated to the background since the introduction of Viagra and vascular bypass surgery that redirects blood to the genitals, especially among diabetic patients.

How does one know which treatment is best?

After an interview, physical examination and some appropriate tests, the physician (usually a Urologist) will determine and prescribe a treatment regimen for the patient. The management is tailored to the individual situation. It is for this reason why it is very important to seek medical help as promptly as possible, because the earlier it is diagnosed, the simpler it is to manage and the greater the success rate is.

©2003Raoul R. Diez, M.A.O.D.