| Impotence (erectile dysfunction) is characterized by the failure to attain or maintain an erection sufficient to complete satisfactory intercourse. Ejaculation may or may not be affected. Many classifications have been proposed for male sexual dysfunction. The most commonly used classifications employ general headings such as neurological, endocrinological (hormonal), vascular (arterial and venous), and psychogenic (psychological).
The causes of sexual dysfunction are many and varied, and men with erectile dysfunction frequently have more than one cause for their dysfunction. It can be caused by low testosterone levels, arteriosclerosis, high blood pressure (hypertension), drug abuse (narcotics or stimulants), medication (high blood pressure medication, anticholinergics, antihistamines, psychotherapeutic drugs, narcotics, estrogen), kidney failure, circulatory or heart failure, liver disease caused by alcoholism, smoking, and complications from urologic procedures, such as prostatectomy, excision of one or both testes (orchiectomy), and radiation therapy. Impotence also can result from various surgical procedures, including peripheral vascular and back surgery, as well as procedures to treat bladder or rectal cancer. Impotence can be caused by trauma (disc or spinal cord injuries), endocrine disturbances (diabetes mellitus, hyperthyroidism, Addison's disease), zinc deficiency, neurologic injury or disorders (multiple sclerosis, tumors, peripheral neuropathies), pernicious anemia, or urologic disorders (tight foreskin [phimosis], Peyronie's disease). Impotence can result from penile implants or prostheses that are not functioning properly, as well as any injury to or inflammation of the penis. Prolonged bicycle riding may cause temporary erectile dysfunction. Psychological factors, including stress, anxiety, fear, or depression, may contribute to the condition.Risk: Erectile dysfunction is more common in men over age 65, although it can occur at any age (Mayo Clinic Staff). Incidence and Prevalence: Impotence affects approximately 15 to 30 million men in the US (Mayo Clinic Staff). |
Source: Medical Disability Advisor
| History: The failure to achieve or maintain an erection is the main physical complaint. Pertinent history includes prior difficulties, whether the onset was sudden or gradual, how long erectile dysfunction has existed, the degree of dysfunction (chronic, occasional, or situational), the presence or absence of normal erections (such as in the morning, during the night, or with masturbation), difficulty urinating, changes in penile sensation, or psychological factors including stress, performance expectations, or change in sexual partners. The individual is questioned in order to evaluate aggravating factors such as medications, recent surgeries, alcohol consumption, smoking history, changes in emotional state, and physical problems. Physical exam: The genitalia and secondary sexual characteristics are evaluated, as well as neurological, vascular, and endocrine status by a thorough physical examination. Injury, scarring, or abnormalities of the genitals are noted. The prostate will also be palpated for abnormalities. Tests: Blood tests are used to check levels of such hormones as testosterone, gonadotropin, prolactin, follicle stimulating hormone, and luteinizing hormone. A complete blood count (CBC) and blood screen including glucose levels, urinalysis, thyroid function tests, and lipid profile is useful. Tests used to determine the organic cause of erectile dysfunction include the injection of vasoactive substances into the base of the penis, test of nighttime erections (nocturnal penile tumescence, or NPT), blood flow velocity (duplex or Doppler ultrasound), voiding studies (voiding cystourethrogram), nerve conduction tests (NCV), cavernosometry and cavernosography. Psychosocial examination or psychological tests may reveal psychological factors contributing to erectile dysfunction. |
Source: Medical Disability Advisor
| Treatment depends on the underlying cause of the impotence and may include behavior-oriented sex therapy, supplemental testosterone injections, use of a vacuum constriction device, injections of vasoactive medication into the penis (penile injection therapy), prosthetic devices surgically implanted into the penis, and vascular reconstruction to restore blood flow to the periphery.
Drugs such as peripheral vasodilators, some antihypertensive medications, and prostaglandin may be injected into the penis, and topical vasodilators may be rubbed on the surface of the penis to enhance erection. Prostaglandin pellets (medicated urethral system for erection [MUSE]) may be inserted into the urethra.
However, use of a phosphodiesterase inhibitor is the method most commonly employed in the treatment of erectile dysfunction. Many of the previously mentioned treatment modalities have been replaced by the administration of a phosphodiesterase inhibitor and are little used except in refractory cases.
If medication is the cause of erectile difficulties, the drug may be changed, stopped, or adjusted. Arterial abnormalities may respond to expansion of the narrowed artery using an inflated balloon (balloon angioplasty), removal of the lining of an artery narrowed by atherosclerosis (endarterectomy), or actual surgical repair or bypass of the involved vessel. Hormones may be prescribed when a deficiency is detected. Smoking must be discontinued, and if impotence is found to be secondary to liver disease, alcohol consumption must stop. |
Source: Medical Disability Advisor
| Conservative management using medication, vacuum constriction devices, and injection and intraurethral therapy may not be successful in treating impotence. The avoidance or alteration of aggravating factors may not affect the underlying problem. The individual may retain a strong sexual drive in spite of impotence, causing feelings of vulnerability and frustration. Impotence may persist due to underlying conditions. When this happens, surgery (penile implants, reconstructing arteries, and repairing veins) may be considered. |
Source: Medical Disability Advisor
| Performing the Kegel exercise can help with the recovery. |
Source: Medical Disability Advisor
| The presence of more than one causative factor will complicate treatment. A partner who will not participate in therapy will also hinder recovery. Accumulation of scar tissue within the penile shaft (Peyronie's disease) and sustained, painful, unwanted erections that occur despite a lack of sexual stimulation (priapism) can also present complications. |
Source: Medical Disability Advisor
| There are no restrictions or accommodations associated with most treatment options. Surgery may result in restrictions on activity or lifting for a brief period. Emotional difficulties associated with impotence may result in depression. Counseling and participation in support groups are recommended. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was a thorough physical and psychological exam done to detect organic or psychological components to the impotence?
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If the cause was uncertain, were appropriate diagnostic tests done to rule out other conditions with similar symptoms?
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Does individual have any underlying situational events, physical problems, or medication use that may be contributing to the problem?
Regarding treatment:
- Was the cause(s) of the impotence determined?
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Has the condition improved with conservative treatment interventions?
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Was drug therapy successful?
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Has individual been compliant with lifestyle modifications, such as weight management, smoking cessation, limiting alcohol, and eliminating certain medications?
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Did treatment options include use of a vacuum constriction device, penile injection therapy, intraurethral therapy, or revascularization and venous ligation?
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Would individual benefit from consultation with an appropriate specialist (urologist, sex-therapist, psychologist)?
Regarding prognosis:
- Does individual have any underlying physical or psychological conditions that may affect response to treatment and prognosis? Is more than one causative factor present? Have comorbid conditions been addressed in the treatment plan?
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If unresponsive to more conservative measures, is individual a candidate for a surgical implant?
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Are individual and his partner receiving appropriate behavioral or psychological consultation?
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Is partner participating in therapy when appropriate? If not, does partner understand that being a willing and active participant in therapy is important, and that lack of participation will hinder recovery?
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Source: Medical Disability Advisor
| Mayo Clinic Staff. "Erectile Dysfunction." MayoClinic.com. Mayo Foundation for Medical Education and Research. 13 Oct. 2004 <http://www.mayoclinic.com/invoke.cfm?id=DS00162>. |
Source: Medical Disability Advisor
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