MALE ERECTILE DISORDER (IMPOTENCE)
Definition
Persistentor recurrent inability to attain, or to maintain until completion of sexualactivity, an adequate erection.This is alsoknown as ‘Erectile Dysfunction’.
The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience, while others reports being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection, but lose it when attempting penetration. Still others report that they have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.
MaleErectile disorder is frequently associated with anxiety, fear of failure,pressure of sexual performance, and decreased sexual excitement and pleasure.This can disrupt marital relationship and may be the cause of unconsummatedmarriage and infertility
Etiology
Aging:
Withadvancing age,
The orgasmis less intensive,Theejaculate is reducedThe intervalbetween the two-successive act is increased.Psychologicalfactors:FatigueDepression,Stress,Mentaldisorders,Guilt,Fear of failure,Low self esteem
Religiousrestrictions
Homosexuality
Long/serious illness
Traumaticinitial experience
Negativefeeling towards the partner
ResentmentHostility
Lack ofinterest
Vascular causes:Use oftobacco/alcohol
Atherosclerosis
Peyronie’sdisease
Diabetes
Hypertension
Venous leakor occlusion
Trauma
Surgery
Radiation
Hormonalcauses:
Hypogonadism
Hyperprolactinemia
Spinal cord disease
Drug related causes:Antiandrogens(cyproterone acetate, flutamide, estrogen)H2 receptor antagonists (cimetidine, famotidine)
Diuretics(spironolactone, thiazides)Antihypertensive(beta blockers, ace inhibitors, ganglion blockers)Anticholinergics(atropine, probanthine, dicyclomine)
Antidepressants(M. A. O., Tricyclic)Antipsychotics(tranquilizers)
CNS Depressants(barbiturates)Substance Abuse (heroin, marijuana, alcohol, tobacco)Miscellaneous Renal Failure Prostatectomy Pitfalls
A Detailed history is essential before arriving at the diagnosis of impotence.Many times, sexual stimulation is not adequate in duration and intensity.Morning erection while awakening is suggestive of psychological origin of impotence. Psychological aspects of erectile problem should always be evaluated in all the cases of erectile difficulty even when the cause is organic.Performance anxiety, fear of failure, over concern with pleasing the partner,ignorance about sexual anatomy and physiology are major causes of erectile problem. The degree of penile erection required for successful vaginalpenetration should be enquired. There are individuals who feel that they need a steel hard erection for penetration. This is not necessary. Nature has designedvagina in such a way that the male gets maximum erection followed byejaculation in the vagina. The male needs to be convinced that if the alignment of vagina and penis is perfect, and the women is stimulated enough, the male will be successful in penetration even if he gets partial erection. Fur there he gets the rigidity during penile thrusting.restrictions
Investigations
Blood Sugar estimation:
Fasting and P.P.Lipid Profile
F.S.H.,L.H., Prolactin & Testosterone
T3, T4,T.S.H.