John J. Bauer, M.D.
Impotency or Erectile Dysfunction
John J. Bauer, MD, Urologist
Impotency or inability to have an adequate erection is a common problem affecting young as well as older men. There is often an embarrassment associated with this problem, and most men think that they are one of the very few persons to be so affected, but, in reality, it is a very common problem.
The causes of impotency are quite varied. It may be due to an infection or congestion of the prostate, side effect of medication or drugs, cigarette smoking, blockage of the blood vessels to the penis, damage to the nerves of the penis, lack of hormones, or associated with some diseases such as Peyronie's disease, diabetes, trauma to the pelvis or post-operative from such surgeries as resection of the prostate or radical surgery on the bladder, prostate, or colon.
Initially, the patient is evaluated with a detailed medical and sexual history to determine the type of problem, and for how long the problem has existed. The problem is manifested in many ways such as a decrease in one's sexual desire, difficulty in getting a satisfactory erection, difficulty in maintaining an erection, decrease in the quality of the erection, difficulty in ejaculating, pain or blood in the ejaculate, or premature ejaculation.
Treatment of the problem is largely dependent on what the cause(s) of the erection problem is. In general, there is a logical and step-wise evaluation to determine the cause of the problem, which in addition to the history usually consists of a physical examination, blood testing and at times, blood pressure measurements of the penis or x-rays of the corpora of the penis. If the initial examination or treatments (medication, hormone replacement, prostatic massages, counseling or combination of these therapies) do not seem to correct the problem, the patient may be candidate for either penile injection of medication (Papaverine/Regitine), the use of a vacuum device or a penile implant. How much is done to correct the impotency is dependent on the patient's desire to achieve potency. At any time, the evaluation or treatment can be stopped.
It used to be thought that almost all cases of impotency were psychological in origin. This is not the case today. However, many patients do have some psychological overlay to the problem. Impotency is intensely intertwined with manliness and loss of erections often provides great anxiety in the patient. This anxiety to perform is often the cause of continued problems even after correction of the initiating cause of the impotency. We call this anxiety performance failure or fear of failure.
The anxiety associated with whether there will be a failed erection induces such failure. This is often unconscious in nature and the patient is unaware of the degree that the mind is playing in the continued failure. One can not will an erection up, but one can prevent such from happening. As our anxiety level rises, we liberate epinephrine from our sympathetic nervous system. This compound in very minute amounts causes the artery going into the penis to constrict, thus reducing the blood flow in and resulting in a lack of or a loss of the erection.
As a society, we are very much performance orientated. That is, we are concerned not about the quality of the love-making, nor whether we or our partner are satisfied, but whether it works. It is because of this that the couple often needs to have a better understanding of what it is that each expects from the other, followed by a change in how we make love, what our attitudes are, and how we interact with our partner in order to help correct the problem.
Impotency is not a life-threatening disease, but one that is usually correctable.