Understanding Male Impotence
Male impotence means having difficulty in achieving or maintaining an erection firm enough for sexual intercourse. Erectile dysfunction (ED) is a common problem affecting approximately two million men in this country and it is estimated that 1 in 5 relationships break down because of erectile dysfunction.
What causes Impotence
Factors such as diabetes, blood circulation problems and stress all have a contributory role in causing impotence. Generally the causes can be divided into physiological or psychological origin. Our lifestyle can have an effect too and issues such as smoking, obesity and lack of exercise will play an important role. Doctors realise also that Erectile dysfunction is a symptom of other illness not a disease in itself. Recently I attended a conference where patients cardiac disease had been discovered as a direct result of visiting their doctor because of erectile problems.
The most common of the physiological causes are Damage to the penile nervous system most commonly through diabetes, surgery, spinal injury or multiple sclerosis. Disruption of the penile blood supply such as arteriosclerosis or venous damage. Changes in hormone levels which in turn affects sexual desire and libido.
Amongst the Psychological or lifestyle causes, stress is the number one culprit but also depression, guilt and problems within a relationship can effect a man’s erectile ability.
Anxiety about the normal slowing down, with age, of the male sexual response can also build up to the point where impotence becomes a constant problem. As a man ages he requires much more visual and manual stimulation to achieve an erection. Whilst he may be able to masturbate quite easily with a partial erection, those sufficient for intercourse require more work! If a man has difficulty maintaining an erection on one occasion, for example because of excess alcohol, he can become so anxious about it that he loses the ability on other occasions, when no alcohol is involved.
The effect male Impotence has on Relationships cannot be underestimated. Men in long term relationships may feel embarrassed, guilty or frustrated by their inability to have a firm erection with their partner. Their partners may also feel rejected or angry, especially if they don’t know what is causing their partner’s problem. Many men may start to avoid intimate, loving contact with their partner for fear of being unable to complete the sexual act. I have spoken to many women who suspected that their husbands were having an affair rather than erectile difficulty. The couple may find it hard to talk about the problem themselves and even more difficult to talk with a Healthcare Professional. These deep emotional problems are often underlying many of the presenting problems which may be seen in both partners by medical practitioners.
Interestingly from 1999 it was recognised by the NHS that patients suffering from specified medical conditions are eligible to receive treatment for impotence on the NHS. These conditions are: Diabetes; multiple sclerosis; Parkinson’s disease; poliomyelitis; prostate cancer; prostatectomy; radical pelvic surgery; renal failure treated by dialysis or transplant; sever pelvic injury; single gene neurological disease; spinal cord injury and spina bifida. So if you are unfortunate enough to be suffering from one of these conditions and are experiencing erectile difficulty there is genuine help at hand.
In your penis, erections can be improved by one of the new tablets of the Viagra Group – Viagra itself, Cialis or Levitra (also known as PDE5 inhibitors). These work by allowing the natural processes of blood vessel dilation to work, letting more blood flow in and by keeping it there. These processes are under the control of the mind and you have to be thinking sexual thoughts to get the mechanism to work. You do also have to have quite a lot of physical stimulus to combine with the mental stimulus.
I must say here that many doctors are worried that if a patient has had a stroke for instance, they may be more likely to have further trouble. The rationale is that these tablets cause a slight fall in blood pressure possibly increasing the risk of a further stroke. This is not a very serious argument, unless you are also taking tablets in the nitrate group, which can lower the blood pressure too much if used with a PDE5 inhibitor. Lower doses should always be the start level, especially if you are over 70 and gradually work up. Your GP will be able to sort the dosage levels anyway.
Vacuum therapy is a treatment worth considering for male impotence which does not involve the use of any drugs. It can, however, be used in conjunction with drug therapy to improve penile blood flow and may be considered the “treatment of choice” in patients where drug treatment has failed or is contraindicated.
The first recorded vacuum therapy device was described by Dr John King in 1874 and during the past 125 years great improvements have been made. The principle of Vacuum Therapy is one of the safest and most effective options for dealing with male impotence. A pump is used to create a vacuum around the penis. This draws blood into the penis, creating a firm erection. A silicon ring is slipped over the base of the penis and the pump removed. The ring will maintain the erection to allow intercourse to take place. The ring is then removed after intercourse and the penis will resume its flaccid state.
You should be able to get one of these on prescription if you fall into the condition category I have mentioned before, and they are successful in 95% of users, although it takes a bit of practice to perfect your technique. The one I would recommend, that seems most popular, is the Rapport Premiere or Rapport Classic pumps. They are uncomplicated, well made, and if you do have to buy one, similar in cost to a year’s supply of Viagra.
Another product worth a mention are constriction rings. They come with a loading system and can be used as a treatment for impotence, for the man who can achieve an erection but is unable to maintain it. The construction ring presses on the veins near the surface of the penis and maintains the erection by preventing blood from leaving it.
For men who just need help to maintain their erections, the construction rings System can be used to apply penile rings without using a vacuum device to form the initial erection. This system is also helpful in cases of premature ejaculation, as it maintains the erection until the penile ring is removed.
A third method is by having Alprostadil in the form of a pellet which you gently put down into the penis. This gives an erection within 20 minutes and is successful in 50-60% of men. When successful, people are delighted with it. You would however have to get this from your GP.
There are two other methods now considered as “last resort” which are Intracavernous Injections (Injections Into The Penis) are a fast and effective means of restoring an erection. Medications such as alprostadil are injected into the spongy tissue inside the penis. These medications act by releasing chemicals in the penis that cause increased blood flow and accumulation at a high pressure, which makes the penis larger and rigid. Another very valid fact is that after a few chemically induced erections, many men find they can achieve erection again without the medication. Others may find they only are able to function with the injections, but are pleased to have something that will always work. Most describe the discomfort from the injection as mild and it even could be part of “foreplay”!
For many men where nothing else has worked and they want something “sure fire” this is a reasonable option. It has had great success in men with erectile dysfunction due to Psychological factors, such as the vicious circle of failure, and can restore sexual confidence. Neurological problems, such as diabetes or multiple sclerosis.
Vascular problems, such as high blood pressure or blockage of arteries and surgery, such as prostate surgery or colostomy.
What about surgery?
Back in the 1990s, there was great hope that surgery would cure a lot of men who had ED. Unfortunately, it hasn’t worked out like that, and it is fairly rare to see a man whose erection problems have been put right by a surgical operation. The types of surgery which are available for ED are:
Curing a venous leak. As we’ve indicated above, a few men lose their erections because blood leaks out of the penis through a leakage in the veins. Occasionally, this leak only occurs in certain sex positions. Where a leak can be clearly pin-pointed by special x-rays, a urologist may be able to operate in order to improve matters.
Insertion of internal splints. A skilled urologist can insert artificial splints inside the body of the penis. With the simplest type of splint (which is just a firm rod), the man merely lifts the organ into a vertical position when he wants to have intercourse. There are more sophisticated (and much more expensive) internal splints which you or your partner can inflate when you wish to make love. Some couples report being very pleased with these. But if anything goes wrong with the surgery – for instance, infection or bleeding – you could be in some trouble.
All in all there is help out there and men and indeed women can take positive steps to restore lovemaking in their lives because there are now real alternatives and real hope.
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