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Impotence, what is it?

Male Impotence, also known as Erectile Dysfunction, is defined as a partial or total inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This disorder is quite common in men, especially from the age of 40 years. This diminished sexual function greatly impinges on the quality of life of the affected subject and his partner.

This condition can lead to a loss of self-esteem in men, tarnish their self-image, and even lead to anxiety or depression. Impotence can greatly damage the intimacy of the couple, and even lead to avoidance of any physical contact of a man with his partner. It can also increase emotional stress. This stress can, by itself, reinforce the psychogenic components of erectile dysfunction.

causes

The erections are ensured thanks to the balance of the blood flow between the inside and the outside of the penis. Thus, penile erection is a neurovascular phenomenon: it requires the dilation of the penile vessels, the relaxation of smooth muscles, the increase of blood flow in the cavernous bodies, and the occlusion of the veins.

The two cavernous bodies located at the level of the penis constitute indeed a spongy and extensible tissue. Composed of gaps spaces, these cavernous bodies are gorged with blood during the erection. Because of this, vascular diseases of the penis are the most common causes, and account for about 80% of cases of organic erectile dysfunction.

    Other diseases can cause this erectile dysfunction, such as:

  • Diabetes
  • Neurological diseases, such as the consequences of a pelvic cancer operation, with removal of the prostate, which affects the erectile nerves
  • Endocrine disorders: hypogonadism (defective reproductive system leading to loss of testicular function), hyperprolactinemia (overproduction of a hormone called prolactin) or thyroid disease;
  • Blepine hyperplasias of the prostate, whose causes are poorly defined. Here, even if a factor such as endothelial dysfunction, or a malfunction of the blood vessels, can be found, a psychogenic component, linked to performance anxiety, also plays strongly. Sometimes the simple treatment of this psychological element is enough to restore a normal erection.
  • When psychogenic, impotence is more common in younger men, who describe a sudden onset of erectile dysfunction, and early and late morning or night erections. This psychological impotence can be caused by various problems, mainly performance anxiety, but also guilt, depression, relationship problems, or fear, as well as personal anxiety.

The symptoms of impotence

The most common symptoms associated with erectile dysfunction are the inability to achieve and maintain an erection during intercourse, low libido, as well as strong anxiety about sexual performance.

    Other types of male sexual dysfunction may include

  • problems of libido, of sexual interest
  • orgasm
  • ejaculation

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Treatment of impotence

Psycho-social therapy can be effective when emotional or psychological factors contribute to erectile dysfunction. Psycho-sexual treatments can range from simple sex education, through improved communication between the two partners, to cognitive behavioral therapies. They are often combined with pharmacotherapy.

Medications are commonly used to treat erectile dysfunction. All of the molecules work by increasing blood flow to the penis. These pills have proven their safety as well as their effectiveness, when their prescription is supervised by a doctor: it is mainly sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). 65 to 70% of men thus find an erectile function of quality.

If these pills do not work, there is a medication that can be delivered directly into the penis, intracavernous: thus, after learning from the doctor or the nurse, patients can do their own injection of alprostadil, used alone or in combination with papaverine and phentolamine. These injections are effective in more than 70% of cases, however up to 30% of patients experience pain at the site of the injection.

Finally, when drugs do not work, there are other options: devices using a vacuum pump, also called penis pumps, allow erection through a purely mechanical action. By creating a vacuum, the blood is sucked into the penis. The erection is then maintained by means of a tourniquet.

Penile implants, placed inside the penis, make it powerful enough for sexual activity. These implants are effective, however they must be placed by means of a surgical operation. This type of treatment, whose complications are significantly higher than with drug molecules, will only be offered to certain patients, in whom more conventional therapies have failed.

Risk factors

  • tobacco
  • Diabetes
  • hypertension
  • lipid abnormalities
  • obesity
  • lack of physical exercise

Preventing impotence

The prevention factors to avoid erectile dysfunction are to adopt a healthy lifestyle. Regular physical activity is paramount. Other protective factors are related to diet, in order to prevent diabetes, obesity and hypertension. Finally, tobacco and the use of illicit drugs are to be banned... Similarly, alcohol consumption should remain moderate.