Male impotence is the inability to maintain (or attain) a penile erection that is sufficient to permit sexual intercourse. It is distinguished from libido, which is sexual desire. The two function independently. Male impotence has many causes, and these increase in frequency with age. Difficulties with blood supply and neurologic changes are common causes of this dysfunction. Many drugs have impotence as a side effect as does alcohol. The problem requires a thorough evaluation. The best treatment is treatment of the underlying problem where possible.
Important Points in Treatment
Treatment may involve medical therapy with drugs, surgical therapy on blood vessels, psychologic treatment, or the use of mechanical devices to permit an erection. Your doctor will discuss the options that best address your problems and needs.
Psychologic therapy, although effective, is useful in relatively few patients because psychologic problems are an uncommon cause of male impotence. Surgical therapy directed toward restoring blood flow has little use in the elderly patient.
Mechanical devices are of two categories. There are external devices that use a vacuum to cause tumescence, which is maintained by placing a restrictive ring around the base of the penis. Not all patients find this device effective and/or acceptable. When used, the restrictive ring should not be left in place for longer than a half hour. Implanted devices in the penis require surgery and are subject to complications such as infection, pain, malfunction, and shortening of the penis. They are usually not offered unless nonsurgical techniques are ineffective.
Medical treatment may involve replacement of hormones where a hormone deficiency has caused the impotence or the use of drugs to promote tumescence. Some drugs (alprostadil, Caverject) may be delivered into the urethra or injected into the penis to cause the erection. These drugs have side effects and may cause scarring over time. Injections should not be used in patients on anticoagulants.
Only one oral medication is approved for the treatment of impotence. This drug, sildenafil (Viagra), acts directly on the muscles in blood vessels in the penis to promote erection when the individual is sexually stimulated. The drug is taken at least a half hour before intercourse is anticipated. The drug remains effective for up to 4 hours. When an erection occurs, it lasts for 10 minutes. The drug is not effective in all patients. The dose may need to be adjusted. There are few side effects. The drug should not be used by patients taking nitrates for heart disease.
Call Our Office If ...
- You have experienced difficulty achieving or maintaining an erection.