Impotence is a sexual dysfunction, also known as erectile dysfunction. It is defined as the inability to develop or maintain an erection during sexual intercourse but can also be the inability to achieve ejaculation. Impotence can affect men of all ages, but the risk of experiencing it increases with age. According to The Merck Manual, impotence, or erectile dysfunction (also known as ED), affects up to 20 million men in the US. The prevalence of partial or complete ED is > 50% in men aged 40 to 70 years old, with the prevalence increasing with aging. The Journal of Urology reports that men in their 60’s are more likely to suffer from impotence than men in their 40's. Impotence is also more common in men with less education, mainly because that demographic typically leads less healthy lifestyles (unhealthy diets, more drinking and less exercise).
In a major study performed by Johns Hopkins University from 2001-2002, researchers took a sample of more than 2,100 men, aged 20 and older, and examined the prevalence of erectile dysfunction and its association with other health problems. The results showed that 18.4% of men over 20 had suffered erectile dysfunction, with ED being defined as being "sometimes able" or "never able" to get and keep an erection. Impotence was even more commonly seen in older men with 70% of men over 70 years of age or over reporting erectile problems (while only an average of 5% of men 20-40 years old reported problems).
What Are the Causes of Impotence?
Causes of impotence can be either organic and physical or psychological. They include:
- Medications: Certain medications can affect blood flow, leading to impotence. Medications such as alpha-adrenergic blockers, beta-blockers, chemotherapy medication, anti-depressants, diuretics and SSRIs are all known to cause impotence.
- Neurogenic Disorders: Nerve conditions affect the brain's ability to communicate with the reproductive system. Neurological disorders associated with impotence are multiple sclerosis, stroke, spinal or brain tumors, Alzheimer's disease and Parkinson's disease.
- Cavernosal Disorders: Also known as Peyronie's disease, is a disorder where a man's penis is abnormally bent or curved to the point where significant pain is seen during an erection and interferes with sexual activity.
- Endocrine Disorders: The endocrine system releases specific hormones into the blood system. Chronic diabetes is an example of an endocrine disorder whose side effects can contribute to impotence. These include nerve damage, affecting sensations to the penis, impaired blood flow and hormonal imbalances.
- Psychological Causes: Performance anxiety, stress, negative thoughts and feelings, and mental disorders (e.g. panic disorders and clinical depression) are known to cause causes of erectile dysfunction.
- Surgery: Any surgery involving pelvic area structures have the chance to cause damage to the nerves and/or blood vessels in the penis, affecting the ability to get or maintain an erection.
- Age: As stated above, impotence can affect men of all ages, with the risk of experiencing erectile dysfunction increasing with age.
- Lifestyle Choices: Overtime, recreational and illegal drug use can cause damage to the nervous system. Smoking cigarettes is one of the key causes of erectile dysfunction. Recreational drugs that stimulate the central nervous system, such as amphetamines and cocaine, are also culprits for ED.
How Is Impotence Diagnosed & What Are Its Symptoms?
The symptoms of impotence include the inability to sustain an erection long enough for sexual intercourse, the inability to achieve ejaculation during intercourse, or both. It is also characterized not being able to achieve an erection or ejaculation at all, an inconsistent inability to do so, or being able to only briefly sustain erections.
There are a variety of tests that can be completed to diagnose impotence. These include:
- Duplex Ultrasound: This test combines a Traditional ultrasound with a Doppler ultrasound and is used to evaluate blood flow, scarring or calcification of erectile tissue, and signs of venous leak or atherosclerosis.
- Hormonal Evaluation: This test is completed by taking a blood sample from the patient to measure the levels of testosterone, the male sex hormone, in the blood. If the results come back with too low levels of testosterone, further tests may be recommended to rule out hormonal conditions that can contribute to impotence.
What Are the Treatment Options for Impotence?
After diagnosing the underlying cause, there are a variety of treatments for impotence.
The most well-known drug for erectile dysfunction is Viagra, which was the first FDA approved prescription drug for the treatment of ED back in 1998. Viagra, along with other ED medications such as Cialis and Levitra, increases blood flow to the penis therefore allowing a man to obtain and keep an erection hard enough for sexual intercourse. There are also vasodilating drugs that are administered via self-injection. This is typically the treatment prescribed for men where the oral PDE5 inhibitors (such as Viagra) didn't work or were contradicted. The last option is a topical cream, Vitaros, that has not been approved yet by the FDA but has had some successes in Canada and Europe for those men it was prescribed to.
Erectile Dysfunction Vacuums
A VCD (Vacuum Constriction Device) or a VED (Vacuum Erection Device), commonly referred to as a "penis pump", is a non-invasive treatment that has shown to work effectively for many men with ED. The pump is a cylinder with an external pump attached to it. The cylinder is attached directly to a man's penis and the pump is used to make the penis erect by creating a vacuum within the cylinder.
The two primary categories for surgical impotence treatments are penile implants and vascular surgery. Penile implants surgically place a medical device, called a penile prosthesis, into a patient's penis. There are two types of devices: non-inflatable (semirigid) devices and inflatable (hydraulic) devices. Vascular surgery is the other surgical option, commonly referred to as penile revascularization. With this procedure, the damaged blood vessel believed to be causing the ED is bypassed by using a healthy blood vessel from the patient, improving the blood flow to the penis.
Shockwave Therapy Treatment
One of the newer methods being used successfully for treating impotence, low-intensity extracorporeal shock wave therapy (LI-ESWT) has shown to result in the formation of new blood vessels from damaged preexisting blood vessels, this process is known as angiogenesis. Commonly known by the name GAINSWave™, this treatment has shown to be rehabilitative or even curative for men experiencing ED, enabling them to regain spontaneous sexual activity with normal intimacy.
Changing in Lifestyle
When exploring all options for treating impotence, it is important for men to consider changing some key aspects in their lifestyle as these adjustments may be a significant way to help ease their problem. Studies have shown that men who were physically active were much less likely to experience impotence when compared to men to didn't exercise and whose lifestyle was more sedentary. Therefore, eating healthier and regularly exercising could result in lowering the incidences and severity of ED men experience.
Questions? Contact Philadelphia Urology Associates for Answers
At Philadelphia Urology Associates, Dr. Bruce Sloane is a nationally renowned specialist in Men's Health issues and Age Management Medicine. Throughout Philadelphia and the surrounding areas, patients seek his expertise to treat impotence and other sexual performance issues. Using state-of-the-art equipment and having extensive specialized education and training, Dr. Sloane will find the treatments and solutions that will work for you.
If you have any questions about the treatments available for Erectile Dysfunction (ED, impotence) or any other urological issues or disorders, we urge you to contact us now online or call us at (215) 563-1199 today to discuss how we can help you!