Generality
Impotence is the inability to have and maintain an erection, even when a good sexual desire is present.
Quite widespread problem among men over the age of 40, impotence recognizes traumatic causes (eg: violent bumps in the penis), vascular (eg: diabetes), neurological (eg, multiple sclerosis), hormonal (ex: hypogonadism ) and anatomical (eg: Peyronie's disease); furthermore, it may depend on the use of certain drugs (eg: diuretics), psychological conditions (eg: depression) and certain behaviors or habits of life (eg: alcohol abuse).
Impotence is a medical condition whose diagnosis is based on physical examination, medical history and, possibly, more detailed investigations (eg blood tests, penile ecodoppler, etc.)
The presence of impotence imposes the implementation of a causal therapy (ie a therapy against the triggering cause) and, sometimes, of a symptomatic therapy (ie aimed at alleviating the symptomatology).
A brief review of what is the Erection of the Penis
The phenomenon of the erection of the penis (or penile erection ) is the result of a spinal reflex, which involves a greater inflow of blood to the arteries of the cavernous bodies and, consequently, the swelling, the increase in size and the elevation of the penis.
Penile erection is a complex physiological response, which reflects the state of male sexual excitement and depends on the perfect fit of vascular, endocrine (ie hormonal), neurological, muscular and emotional factors.
The erection of the penis is, in fact, the event that precedes ejaculation, ie the act by which man emits from the penis the seminal fluid necessary for reproduction.
What is Impotence?
Impotence is the inability to have or maintain a penile erection, even in spite of good sexual desire.
Impotence is a very sensitive issue for the male population, because, in those who suffer from it, it is a source of embarrassment and can have a strongly negative impact on mood, on the relationship with the partner and on the quality of life in general.
In the medical field, impotence is also known as erectile dysfunction .
Forms of Impotence
There are various forms of impotence : there is impotence characterized by the total inability to achieve an erection of the penis; there is impotence characterized by a reduced ability to have a penile erection (in this case, the patient does not always succeed in having a penile erection); finally, there is impotence marked by an inability to maintain a penile erection long enough to have an ejaculation.
Epidemiology
Impotence is a common condition, especially among older men .
On the spread of impotence in the male population, the most reliable statistical surveys report that:
- About half of men between 40 and 70 years complain of a form of impotence;
- About 10% of men between 40 and 70 suffer from a severe form of impotence;
- 5-10% of men under 40 suffer impotence;
- In Italy, men with impotence problems are around 3 million, or 10-15% of the entire male population.
Causes
Impotence recognizes traumatic, vascular, neurological, hormonal and anatomical causes ; furthermore, it may depend on the use of certain drugs, psychological conditions and certain behaviors or habits of life .
Penile erection depends on neurological, vascular, hormonal, muscular and emotional factors; a problem with one or more of these factors triggers impotence.
Traumatic causes
Impotence is due to traumatic causes, when it arises from:
- A violent impact on the penis,
- An unnatural movement of the penis during the erection phase or
- Surgery in the penis or prostate.
Traumatic causes of impotence are the damages that the penis can suffer after violent knocks against it, unnatural movements during erection or surgical interventions in the penis itself.
Impotence due to traumatic causes is also called post-traumatic impotence or post-traumatic erectile dysfunction .
Did you know that ...
According to statistics, 15-25% of men suffering from trauma to the head of the penis would develop erection problems some time after the event.
Vascular causes
Impotence is due to vascular causes, when it follows one of those medical conditions that affect the blood supply to the various organs of the human body, including the penis.
Among the medical conditions with the aforementioned consequences, they deserve a report:
- Cardiovascular diseases, such as atherosclerosis, heart diseases etc.,
- Hypertension e
- Diabetes with its complications.
Impotence due to vascular causes is also called vasculogenic impotence or vasculogenic erectile dysfunction .
Neurological causes
Impotence is due to neurological causes, when it derives from those medical conditions that affect the health of the central nervous system and the nerves responsible for penile control.
Among the medical conditions in question, they deserve a special mention:
- Multiple sclerosis,
- Parkinson's disease,
- Spinal cord injuries e
- Stroke with its complications.
Impotence from neurological causes is more properly called neurogenic erectile impotence or neurogenic erectile dysfunction .
Hormonal causes
Impotence is due to hormonal causes, when it depends on one of those medical conditions that alter the production of the hormones involved in the penile erection phenomenon.
Among the medical conditions with the aforementioned effects, we note:
- Hypogonadism,
- Hyperthyroidism,
- Hypothyroidism e
- Cushing's syndrome .
Impotence due to hormonal causes is also known as hormonal impotence or hormonal erectile dysfunction .
Anatomical causes
Impotence is due to anatomical causes, when it is the consequence of an anatomical alteration of the penis.
The most famous and important anatomical cause of impotence is Peyronie's disease .
Impotence due to anatomical causes is better known as anatomical impotence or anatomical erectile dysfunction .
drugs
The list of drugs that can induce impotence includes: diuretics, antihypertensives, fibrates, antipsychotics, antidepressants, corticosteroids, anti H2 (or histamine H2 receptor antagonists ), anticonvulsants, antihistamines, anti-androgens and cytotoxic chemotherapy .
Did you know that ...
Anti-androgens are drugs used to induce impotence in prisoners subjected to chemical castration .
Psychological conditions
The phenomenon of penile erection is strongly affected by the emotions and mood of a man. This explains why the presence of impotence can be related to:
- Depression or low mood ;
- Anxiety due to discomfort, worry, fear, etc .;
- An emotional trauma resulting from relationship problems, sexual inexperience, history of one or more sexual abuse, history of sexual disorders or dysfunctions, start of a new relationship, etc.
Curiosity
Until a few years ago, experts believed that around 90% of cases of impotence were purely psychological, but recent studies in the neurophysiological, hemodynamic and pharmacological field have shown that erection difficulties are, in at least 50% of cases, related to an organic cause (eg: a).
Behaviors and habits of life
Among the behaviors and habits of life that can cause impotence, deserve a mention: the abuse of alcohol, the excess of physical activity that leads to a state of chronic fatigue and the use of drugs such as, for example, cannabis, heroin and cocaine.
Is cycling a cause of erectile dysfunction?
According to some scientific studies, men who practice cycling for more than 3 hours a week tend to suffer from impotence more easily than men who do not use bikes specifically.
The cause of the problems of erection in cyclists would be to be sought in the long stay on the bicycle saddle.
Risk factors
The list of impotence risk factors includes:
- Aging;
- Diabetes and cardiovascular diseases;
- Cigarette smoking and smoking in general;
- Overweight and obesity;
- Some medical treatments, including prostatic surgery and radiotherapy;
- Traumatic injuries to the penis;
- The use of those drugs, reported in a previous sub-chapter, capable of causing erectile dysfunction;
- The presence of depression, anxiety and other psycho-emotional problems;
- Alcohol abuse;
- The use of drugs.
Symptoms and Complications
The typical symptoms of impotence are:
- Difficulty getting an erection ;
- Difficulty maintaining an erection ;
- Absence of nocturnal penile tumescence (NB: nocturnal penile tumescence spontaneous penile erection, which takes place during sleep or upon awakening from it).
Sometimes these disorders may be followed by other disorders, such as, specifically, a decrease in sexual desire (or decreased libido), ejaculation problems (eg, premature ejaculation, delayed ejaculation, etc.) and difficulty in reaching orgasm .
Complications
When he is incurable or not subjected to appropriate treatment, impotence can have serious repercussions on the lives of the men who are affected; in fact, it can be at the origin of:
- Unsatisfying sex life;
- Stress, anxiety and / or panic;
- Strong embarrassment and / or low self-esteem;
- Relationship problems;
- Inability to procreate.
When should I go to the doctor?
Impotence is a serious problem, for which it is good to contact a doctor when:
- It is not sporadic (which could suggest a temporary emotional problem), but permanent (ie, erection of the penis is always difficult);
- It is associated with episodes of premature or delayed ejaculation;
- It appears in the presence of medical conditions such as diabetes or some heart disease;
- It is associated with a series of symptoms that lead to thinking about the presence of some disease.
Diagnosis
The process of investigations that leads to the diagnosis of impotence and indirectly to the identification of its causes always begins with an objective examination and a medical history ; in fact, through physical examination and anamnesis, the doctor ascertains the difficulties of erection and, on the basis of the associated symptoms and the characteristics of the patient (eg habits, emotional state, etc.), he understands with which tests to identify the triggers .
For those who complain of impotence symptoms, the anamnesis focuses mainly on three aspects: the sexual life, the characteristics of the problems of erection in progress and the search for factors favoring the condition.
It is above all thanks to the anamnesis that the doctor decrees which tests are useful to pinpoint the triggers.
Possible diagnostic tests to identify the causes
Among the diagnostic tests useful for recognizing the causes of a state of impotence, include:
- Blood tests . They allow to identify vascular causes (eg: diabetes) and hormonal ones (eg: hypogonadism);
- Urine tests . They allow the identification of some vascular causes (eg: diabetes) and some hormonal causes (eg: Cushing's disease);
- Measurement of sacral evoked potentials (PE) . It is a neurological examination, which allows to study the electrical conduction of sensory and motor stimuli that start and reach the genital area, through the pudendal nerve and the sacral spinal cord.
In the presence of impotence, the measurement of sacral evoked potentials makes it possible to determine whether the condition depends on neurological causes;
- The penile echocolordoppler . Painless examination, is a special ultrasound of the penis that allows to study, sometimes using a vasoactive drug stimulating the erection, the blood flow along the arteries of the corpora cavernosa.
In the presence of impotence, the penile echocolordoppler makes it possible to establish whether the condition is the result of vascular causes;
- A psychological assessment . It is essential in case of impotence due to emotional problems or psychological disorders.
Therapy
To learn more: Drugs for the Treatment of Impotence »The treatment of impotence involves a causal therapy, that is a therapy aimed at counteracting the triggering cause of erection disorders, and, sometimes, a symptomatic therapy, that is a treatment aimed at facilitating erection and improving the quality of the patient's sexual life .
In order to implement a correct causal therapy, it is essential, during diagnosis, to accurately identify the cause of the state of impotence.
Causal Therapy
The causal therapy of impotence varies according to the cause, therefore it differs from patient to patient.
Here are some examples of causal therapy of impotence of particular interest:
- If impotence depends on a deficiency of the hormone testosterone (hypogonadism), the causal treatment consists of a hormone replacement therapy based on synthetic testosterone.
- If impotence arises from the presence of diabetes, causal therapy consists of careful control, with all the appropriate drugs, of blood sugar.
- If impotence is the result of heart disease, causal treatment involves treating this disease (in this case, the therapeutic options are numerous and vary according to the cardiac pathology present).
- If impotence is related to smoking, alcohol abuse and / or drug use, causal therapy consists of correcting these habits in favor of a healthier lifestyle.
- If impotence has psychological causes, causal treatment may consist of a form of sex therapy (eg, so-called sensory focus) and / or so-called cognitive-behavioral psychotherapy.
Symptomatic Therapy
Especially useful when the causal therapy does not resolve the disorders of erection at the root, the symptomatic therapy for impotence can be pharmacological or surgical .
In general, doctors give priority to drugs, as they are effective and fairly safe solutions, and reserve the right to resort to surgery only if the aforementioned drugs do not bring any benefit.
DRUGS
Among the useful drugs for men who complain of impotence, they deserve a special mention:
- Phosphodiesterase type 5 inhibitors (or 5-phosphodiesterase inhibitors ). By enhancing the effects of nitric oxide, these medicines improve the blood supply to the corpora cavernosa, consequently also the ability to have an erection.
The most important phosphodiesterase type 5 inhibitors are: sildenafil (best known by the term Viagra ), tadalafil (commercially known as Cialis ), vardenafil (whose trade name is Levitra ) and avanafil (commercially known as Spedra or Stendra ).
- Papaverine . It is a vasodilatory substance able to relax the smooth muscles and increase the blood supply to the penis.
The administration of papaverine occurs by intracavernous injection (ie an injection at the level of the corpora cavernosa)
- The Alprostadil . It is a vasodilator, which can be administered by intracavernous injection or intraurethral injection (ie through the urethra).
SURGERY
The symptomatic surgical therapy of impotence consists in the implantation of a penile prosthesis (also called penile prosthesis ).
Currently, there are many different types of penile prostheses; among these, we note, in particular, the penile hydraulic prostheses (or penile hydraulic pumps) and the penile semi-rigid prostheses :
- The former are designed to inflate thanks to a liquid, simulating a physiological erection very well;
- The latter, instead, foresee the placement, inside the penis, of a malleable semi-rigid material, which guarantees a constant semi-erection that can be easily masked.
Can the physical exercise be beneficial?
Currently, the therapeutic power of physical exercise towards impotence is being studied.
According to some researches - which however deserve further investigation - moderate-intense physical activity would be beneficial.
Prognosis
The prognosis in case of impotence depends on the traceability of the triggering cause: if the causal factor is treatable, the prognosis tends to be favorable; if, on the other hand, the causal factor is incurable or poorly treatable, the prognosis tends to be negative or otherwise unfavorable.
It is important to note that, today, thanks to medical advances in recent years, anti-impotence drugs are much more effective than they used to be.
Prevention
Surely, they reduce the risk of impotence, healthy behaviors such as: not smoking, maintaining normal body weight, eating healthy foods, not taking drugs and not abusing alcohol.
Does physical activity protect you from Impotence?
The entire medical-scientific community agrees that a healthy and constant physical activity reduces the risk of impotence, as it prevents many of the latter's risk factors.
