Impotence

(Erectile Dysfunction)

---

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention | Organizations

---

Definition

Impotence is the inability to attain or maintain an erection of the penis that is firm enough for sexual intercourse.

Causes

To initiate and maintain an erection, the penis must fill with blood. Nerve signals stimulate this engorgement. They prompt the blood vessels in the penis to expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

The following factors can cause erectile dysfunction:

Venous Leak

If a leak in the blood vessels in the penis allows blood to escape, an erection may not be attainable, or may not last long. This can be caused by injury or disease.

Neurovascular Function

• Erection cannot be attained if nerve signals do not prompt blood vessels to expand or if blood flow to the penis is reduced.
• Nerve dysfunction can also diminish feeling in the penis resulting in impotence.
• Diabetes can interfere with nerve signals.
• Arteriosclerosis (hardening of the arteries) can cause reduced blood flow.
• Peripheral neuropathy, spinal cord injury, and surgery can also damage nerves.
• Many medications also cause erectile dysfunction through this mechanism.

Psychological Factors

The brain initiates many of the nerve signals required for a successful erection.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Age: 65 and older
• Medical conditions:
  • Diabetes
  • Arteriosclerosis (hardening of arteries)
  • Chronic kidney disease
  • Liver failure
  • Peyronie's disease (bending of the penis caused by scar tissue)
  • Endocrine disorders
  • Neurological disorders (i.e., multiple sclerosis, peripheral neuropathy, stroke)
  • Hypertension
  • Psychiatric disorders (i.e., anxiety, depression)
• Traumatic conditions:
  • Vascular surgery
  • Pelvic surgeries (particularly for prostate cancer)
  • Spinal cord injury
• Behaviors:
  • Alcohol use
  • Illegal drug use
  • Anabolic steroid use
  • Heavy smoking
  • Ineffective sexual techniques
  • Interpersonal conflicts with a sexual partner
• Medications:
  • Antihypertensives
  • Antihistamines
  • Antidepressants
  • Tranquilizers
  • Antipsychotics

Symptoms

Symptoms include:

• A less firm penis
• Fewer erections

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Expect questions about the frequency, quality, and duration of your erections. Your answers may help determine if primarily psychological or physical factors are causing your impotence.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, the doctor may order laboratory tests.

Treatment

Treatment options include:

Sildenafil (Viagra) - taken orally once a day, 30 to 60 minutes before sexual activity

Alprostadil - either injected into the penis or inserted into the urethra as a suppository

Oral Testosterone - only for men whose impotence is caused by low testosterone levels

Vacuum Devices -

• Plastic cylinder for the penis
• Hand pump for pumping air out of the cylinder
• Elastic band for holding the erection after removal of the cylinder

Vascular Surgery - repairs venous leaks, and has been shown to be effective in some cases

Penile Implants - semirigid, malleable and inflatable implants that are surgically inserted into the penis

Sex Therapy - may help impotence resulting from:

• Ineffective sexual techniques
• Relationship problems
• Anxiety
• Depression

Prevention

To reduce your chance of becoming impotent:

• Take medications to manage blood pressure, diabetes or depression.
• If medications may be the problem, ask your doctor about changing the medication or adjusting the regimen.
• Maintain a healthful lifestyle and diet.
• Try ongoing communication and relationship counseling to prevent or manage interpersonal conflict.

Organizations

American Urological Association
http://www.auanet.org/index_hi.cfm

American Foundation for Urologic Disease
http://www.impotence.org/

SOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases

American Urological Association

American Academy of Family Physicians

American Foundation for Urologic Disease

---

Last reviewed June 2001 by Medical Review Board