Impotence in men. Earlier people thought that reduced sexual function and impotence is a normal part of getting older. Changed attitudes in the population and modern medicine have rejected this myth. As men and their doctors feel more comfortable talking about sexual problems, and new treatment options appear, there is no reason why men can not remain sexually active at high age.

An erection depends on bloodstream to the penis, which is triggered by touch and mental stimulation. With good stimulation, oxygen-rich, arterial, blood will flow into the small arteries inside the penis. As the blood vessels in the penis expand, blood flow and numerous blood channels increase – corpora cavernosa and corpora spongiosum – are filled with blood and lead to erection.

Also read: Impotent or not?

Impotence may be due to a disturbance at any stage in a series of events. Certain diseases such as diabetes and muscle dystrophy can cause impotence. Mental factors can also lead to impotence. Additionally, impotence can be a side effect to some common medication.

What is impotence and erectile dysfunction?

Impotence is a disorder in the male’s reproductive system and implies the inability to maintain an erection of the penis. The terms impotence and erectile dysfunction mean almost the same. It is understood an inability to achieve, or maintain, adequate penile erection to be able to conduct sexual intercourse. The diagnosis requires that the symptom occurs in at least 25% of situations where erection is desired before it is defined as a medical problem. The condition causes many to have significant negative effects on self-esteem and relationships.

The most common cause of impotence is mental conditions. Examples of this may be:

– Previously bad sexual experience
– Depression
– Performance anxiety

If the morning erection is intact, and if the patient usually experiences erection and orgasm through masturbation, this is important signal that can distinguish mental causes from body disease changes.

The condition affects 5% of all 40-year-olds, 10% of 50-year-olds and 20-25% of those over 65 years old. There are studies that show far higher incidence of the problem. In men with diabetes, there are between 30% and 50% with erection problems.

Causes of impotence

Achieving and maintaining an erection depends on several factors:

– Mental Conditions
– Nerve impulses
– Male sex hormone, testosterone, is required for sexual stimulation
– The bloodstream in the penis must also be intact so that a blood collection of the fungal bodies in the penis can occur

Defects in these systems will weaken the potency. In addition, various medications, especially medications against severe mental disorders, may adversely affect the sex drive and the ability to erect.

Diagnostics of impotence

The diagnosis is made after examination and conversation. As mentioned, psychological factors are the main cause of erectile dysfunction. The doctor will also take different blood tests, primarily to exclude diseases that may lead to erection failure.

Factors that suggest psychological cause:

– Problem suddenly started
– Short-term erection
– Good quality or better experience of spontaneous, self-stimulation or morning erection
– Premature ejactulation or no ejaculation
– Problems or changes in relationship with partner
– Important life events or psychological problems

Factors that may indicate bodily cause:

– Gradually start of the problem
– Lack of nocturnal erections
– Normal ejaculation
– Normal sex drive (libido)
– Bodily diseases such as diabetes, neurological disease or cardiovascular disease
– Operations, radiation or injuries in the abdomen
– Use of medicines
– Smoking, high alcohol consumption, doping use

In exceptional cases, a specialist may be required to conduct an intravenous injection test. In this study, vasodilators are injected into the fungal bodies of the penis. Then the amount of blood in the area will normally increase, causing erection. If successful, this may be a current treatment.

Treatment of impotence

There are several things you can do yourself to improve the situation.

– Reduced use of tobacco and alcohol may have effect
– Increased knowledge of the condition
– Call therapy, possibly with the partner, may be helpful when mental conditions underlie the erectile dysfunction

Also read: Stress and Impotence

Medical treatment of impotence

Most commonly used are sildenafil preparations (Viagra®), tadalafil (Cialis®) and vardenafil (Levitra®). These funds help both for mental and physical reasons. In heart disease such as coronary disease or angina pectoris, and in need of nitroglycerin, the use of such medicines may be unfortunate because they reduce blood supply to the heart. Men with such diseases should refrain from using such stimulants. The doctor who writes the prescription should make an assessment whether it is safe to use such medicine in your case. The most common side effects are headache, redness, upper stomach ache, nose tightness and dizziness. A few may experience visual disturbances. In a person with angina, the risk of triggering an angina attack or heart attack increases.

Sildenafil is found in several strengths and works primarily through increasing blood flow locally in the penis. The recommended dose is 50 mg taken as needed approx. 1 hour before sexual activity. The dose may be increased to 100 mg or reduced to 25 mg. Effect requires sexual stimulation and the medicine works for approx. 3 hours. Sildenafil has also been shown to be effective in the treatment of antipsychotics-induced erectile dysfunction.

Sildenafil (viagra)
The recommended dose for tadalafil is 10 mg taken 30 minutes to 12 hours before sexual activity. The dose may be increased to 20 mg if the effect is insufficient but not in patients with impaired liver or renal function. The effect of the preparation may last up to 24 hours. More than one dose daily is advised.

For vardenafil, the recommended dose of 10 mg is taken 25-60 minutes before sexual activity. The dose can be adjusted to 5 mg or up to 20 mg.

Alprostadil (Bondil®) is a means of local treatment. The preparation is placed into the urethra using a special applicator. The effect occurs relatively quickly and there is less risk of side effects than with sildenafil. Side effects are pain in the penis of about one third, and in addition there is a burning pain in the urethra of approx. 10%.

Self-injection of anesthetics is used by a few. The injection should then take place before the assembly and the effect lasts for 30-60 minutes. There may be side effects in the form of long and painful erection.

Shock Wave Treatment
Low intensity external shock wave treatment (LI-ESWT) is a new offer in the treatment of erectile dysfunction. LI-ESWT induces microtraumer in the penile tissue which, in turn, stimulates the renewal of blood vessels in the cavernous tissue. Studies confirm a clear improvement of the erectile function and blood circulation in the penis without any adverse effects. However, more studies are needed.

Penis ring and penis pump
The pencil is a vacuum pump that draws blood into the penis so that it becomes sufficiently stiff for intercourse. A penis ring can then be placed around the penis root after an erection to maintain the erection. These measures can be used individually or in combination. The problem with these measures is that they are often conceivable and unpleasant.

In some cases it may be advisable to correct any curvature of the penis by surgery. Operation to improve blood circulation in the penis may have effect, but is done very rarely. There is also the possibility of operating a penile prosthesis that can be blown up mechanically. 70% of men who get used to such a tool are satisfied and 90% of the partners are satisfied with the solution. This is a last resort, if you operate such a prosthesis, it will never be possible to get erection without using the pump.

The prognosis

As mentioned, there are many alternative treatments for problems with impotence. Most patients get improved erectile ability after different treatment options. In the long run, it depends on the cause of the plagues.

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