Impotence

Posted in Men's Health Info

Man Experiencing Impotence

Impotence or Erectile Dysfunction is a very common problem that affects 20 million (approximately 1 out of 5) American Men. Erectile dysfunction is the result of a single, or more commonly a combination of multiple factors. At one time impotence was thought to be the result of psychological problems but we now know that 90% of the cases are organic in nature. Some of the many causes of impotence include, diabetes, high blood pressure, heart and vascular disease, stress, hormone problems, pelvic surgery, trauma, venous leak, and side effects of frequently prescribed medications.

No matter what the cause, most men have a secondary psychological reaction that can worsen the situation. Feelings of performance anxiety, guilt, and low self-esteem are common. For many years impotence was a problem that was not talked about because of its personal nature.  Men suffering from this condition often do not know about the various treatment options availible to them and do not seek help.

TREATMENT

Treatment options for erectile dysfunction can be divided into four broad categories, pharmacological, mechanical, surgical, and psychological.

Pharmacological treatment involves delivering medication which can help restore erections. There are several different types of medication and ways of administering them.In general, medical therapy is the most appealing form of treatment and can be highly successful.

MEDICATION ROUTE MECHANISM EFFECTIVENESS
Yohimbine (Yocon) Oral Alpha receptor agonist Poor
Testosterone Injection, Patch, Oral Good (only in men with
low testosterone levels)
Prostaglandin E1 (Caverject) Penile injection Dilates penile arteries Very good
Papaverine/ regitine/ prostaglandin Penile injection Dilates penile arteries Very good
Prostaglandin E1
(MUSE)		 Intraurethral pellet Dilates penile arteries Moderate
Sildenafil (Viagra) Oral Increases penile blood flow Research data  very good
Phentolamine Oral Increases penile blood flow Research only (at this time)
Mechanical treatment involves the use of a vacuum erection device or “pump” along with a constriction ring. The penis is placed in a vacuum tube and the air is pumped out. This creates negative pressure and allows blood to flow into the penis. Once the penis becomes erect, a rubber ring is placed around the base of the penis to prevent the blood from leaving. The vacuum tube is then removed. This non-invasive mode of therapy is effective in treating erectile problems form most causes although the device can be cumbersome to use.

Surgical therapy is the most invasive form of treatment for erectile dysfuction. The penile implant is a very good option for those men who have failed medical therapy or have a severe arterial or venous causes of impotence. Penile microsurgical revascularization procedures are reserved for those men who have a discrete identifiable penile arterial blockage. This surgery is technically challenging and must be performed by an experienced microvascular surgeon. The overall results are good in carefully selected patients. Penile vein ligation surgery has met with some controversy over its effectiveness but may yield fair  results in patients with a  venous leak.

SURGICAL PROCEDURE CAUSE OF DYSFUNCTION EFFECTIVENESS
Penile implant
Semi-rigid
 All Excellent    penis always in semi-rigid state
Inflatable All Excellent    penis looks more natural
Arterial Revascularization Discrete arterial blockage Moderate to good
Penile Vein Ligatation Discrete venous leak Poor to moderate
Psychological therapy is very useful in those cases of erectile dysfunction which are a direct result of psychological causes. These patients may also benefit from pharmacologic or combination therapy.

The treatment of erectile dysfunction is rapidly changing as our understanding of erectile physiology expands. Men are becoming increasingly aware of the many different solutions availible for this problem and are actively seeking help. Wives and partners are becoming more  involved in the treatment process. If you or a loved one suffers from erectile dysfunction, help is just a phone call away.

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