Sexual impotence, also known as erectile dysfunction, is man's inability to initiate and / or maintain a penile erection sufficient for sex. In this paper we expand on the causes, symptoms and treatment of sexual impotence.
Sexual health is currently an important factor for life quality. Sexual impotence, although is not a health problem that brings risks to life, can bring undesirable consequences to the patient's personal life, influencing relationships and self-esteem, and may even cause depression.
It is important to note that having difficulties with erection is not considered to be impotence. Erectile dysfunction is a situation when a man is incapable of obtaining or maintaining erections in at least 75% of attempts. Not getting a satisfactory erection from time to time is absolutely normal and happens to all men, even young.
It is important to differentiate between impotence and lack of sexual libido. Erectile dysfunction is when a man feels sexual desire but is unable to maintain or initiate a satisfactory erection. In case of absence of libido, erection does not occur due to lack of sexual interest.
The prevalence of impotence increases with age and the presence of other diseases such as diabetes, hypertension, heart disease, obesity etc... It is estimated that between 30-40% of men over the age of 40 have some degree of erectile dysfunction.
The male sexual function is controlled by the interaction of the neurological, hormonal, vascular and psychological systems. Any disturbance in one of these systems can cause erection problems. Knowing how the erection comes it is also important to understand sexual impotence and the current treatment, such as the famous Viagra.
Roughly speaking, we can summarize the erection as a vascular event, triggered by neurological signs and facilitated by an adequate hormonal and psychological milieu. Let us explain.
A penile erection occurs when the corpora cavernosa, two spongy structures in the form of parallel cylinders inside the penis fill with blood. The penis is filled so that the veins are compressed preventing blood from returning to the rest of the body. The corpora cavernosa is thus filled with blood, maintaining an erection till the end of sexual stimulation. When there is an orgasm or when the stimulus for the erection ends, the cavernous body is empty, the penis again becomes flaccid.
When the corpora cavernosa is filled with blood it takes a signal from the central nervous system, releasing a substance called nitric oxide. This neurotransmitter relaxes the blood vessels of the cavernous body, helping the entry of blood in it. Until there is nitric oxide in the corpora cavernosa, the penis will remain engorged with blood, and therefore, erect, when nitric oxide level falls, the erection ends.
Psychological and hormonal factors such as changes in levels of testosterone and thyroid hormones, for example, can interfere with this neurological system-vascular erection.
Nocturnal penile erection is a normal phenomenon that occurs during deep sleep and is not related to the existence of erotic dreams. This type of erection begins in adolescence and lasts for much of man's life. The presence of normal nocturnal erections in men with erectile dysfunction spoke in favor of psychological causes for the problem, while men who do not even have erections during their sleep, usually have some organic problem. Men who have difficulty achieving deep sleep stages also may not have that kind of erection.
Although age is popularly known as the main risk factor for erectile dysfunction, indeed, ageing itself is not as guilty as the diseases that come with it. An older person and completely healthy without drugs is fully capable of achieving satisfactory erections in most cases. A healthy man of 65 years may have more "power" that a man of 40 years with a history of diabetes and cardiovascular disease.
Among the diseases and problems related to erectile dysfunction there are:
Chronic illnesses may increase the risk of impotence, and, to worsen the situation, lots of drugs used to treat these diseases also work for erectile dysfunction. It is estimated that up to one quarter of cases of impotence are caused by these drugs. Antidepressants and medications for hypertension (all classes) are the main villains.
There are other causes for erectile dysfunction, including the following: chemotherapy in the pelvic trauma, radiotherapy in pelvic surgery for prostate cancer, surgery in the pelvic region. Cycling for too long can also cause erectile dysfunction (for professional cyclists).
Most of these diseases cause disturbances in one of two main systems of erection:
Not all erectile dysfunction is related to some organic disease, psychological factors may also be responsible. Stresses of everyday life can cause loss of concentration and decrease in libido, interfering with male performance. Professional, financial or problems in marriage are the most common causes.
In addition to the stresses of everyday life, anxiety for the sexual act is also a common cause of impotence. The obligation that society imposes on the man that he always has to be ready to meet the woman, turning a failure into something shameful, ends up experiencing a lot of pressure for some people. The anxiety about performance just growing if the man has erectile difficulties experienced previously. In some cases concern with having and maintaining an erection ends up becoming the main focus, making the sexual act itself secondary. This nervousness turns into a snowball, causing new episodes of impotence, which in turn leads to more anxiety.
Depression is another cause of erectile dysfunction. As with anxiety, this process can be self-feeding. Many men do not accept the fact that their sexual performance will decrease over years, and in some cases, episodes of inability to maintain erection can lead to depression.
For many years sexual impotence has been considered a natural consequence of ageing, as older people had no right to an active sex life. As older people did not seek medical help because of impotence, erectile dysfunction was accepted as something unavoidable.
As explained above, erectile dysfunction does not always have an organic cause. When there is a known chronic disease, the dosage of blood thyroid hormones, testosterone and prolactin are necessary to determine whether there is a hormonal environment adequate for erection.
A better control of chronic diseases, the suspension of the hormonal environment, when possible, drugs that may be disturbing, are important in the treatment of erectile dysfunction.
At the end of the 1990s there was a revolution in the treatment of impotence with the advent of drugs that inhibit Phosphodiesterase type 5 (PDE5 inhibitors). The main drugs in this class are:
