Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Impotence

(ED; Erectile Dysfunction; Male Erectile Disorder)
by Heather Smith
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 cause the blood to flow there. The blood vessels expand so blood can fill it. Meanwhile, other blood vessels constrict, trapping blood inside.

The following factors can cause erectile dysfunction:

Venous Leak

A leak in the blood vessels in the penis can allow blood to escape. This means that an erection cannot be made or may not last long. Injury or disease can cause a venous leak.

Neurovascular Function
  • Complete loss of nighttime erections
  • Diabetes —interferes with nerve signals
  • Hardening of the arteries —can cause reduced blood flow
  • Nerve dysfunction—can reduce feeling in the penis, resulting in impotence
  • Peripheral neuropathy , spinal cord injury, and surgery—can damage nerves
  • Problems with nerve signals and blood flow
  • Side-effects from medications

Psychological Factors

The brain causes many of the nerve signals needed for an erection. Emotional problems may play a role in men who suddenly develop impotence.

Risk Factors

These factors increase your chance of developing impotence. Tell your doctor if you have any of these risk factors:

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 the diagnosis.

The doctor will examine your penis, testes, and rectum. If a physical cause is suspected, you will need lab tests, including:

  • Hormone levels such as thyroid function tests
  • Prolactin levels
  • Testosterone levels
Nocturnal Penile Tumescence Testing

This test can help your doctor determine if the cause is due to emotional problems or physical problems.

Imaging

Sometimes Doppler imaging may be done to look at the blood flow. The test is also done to check for blockage in the arteries or veins that supply the penis.

Treatment

Treatment options include:

Medications

Your doctor may prescribe:

  • Oral testosterone , if you have low testosterone levels
  • Phosphodiesterase inhibitors, such as:
    • Sildenafil (Viagra)
    • Tadalafil (Cialis)
    • Vardenafil (Levitra)
  • Alprostadil , either injected into the penis or inserted into the urethra as a suppository

Use caution and talk to your doctor before taking any over-the-counter medicines for impotence. Some of them may be unsafe.

Vacuum Devices

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

Vascular surgery repairs venous leaks. This has been shown to be effective in some cases.

Penile Implants

There are semi-rigid, malleable, and inflatable implants. They are surgically inserted into the penis.

Sex Therapy

Sex therapy may help impotence resulting from:

  • Anxiety
  • Depression
  • Ineffective sexual techniques
  • Relationship problems
Prevention

To reduce your chance of becoming impotent:

  • Eat a healthful diet .
  • If you smoke, quit . Smoking is significantly associated with impotence in middle-aged and older men.
  • Maintain a healthy weight .
  • Take medications to manage blood pressure , diabetes, or depression.
  • Talk to a therapist or counselor.
  • Ask your doctor about changing medications.

Last reviewed: September 2011 by Adrienne Carmack, MD.

RESOURCES:
CANADIAN RESOURCES
References: