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Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Physicians often use the term erectile dysfunction to describe this disorder and to differenciate it from other problems that interfere with sexual intercourse such as a lack of sexual desire or problems with ejaculation.
It is believed that impotence affects about 10 to 15 million American men. It usually has a physical cause such as disease, injury, drug side-effects or any illness or disorder that impairs blood supply in the penis. Incidence rises with age. So between 20 and 25 percent of men at the age of 65 are affected.
It is important to know that impotence is a treatable condition in all age groups.
Anatomically erection is achieved by relaxation of the muscles of the two swelling chambers called corporae cavernosae resulting in an increased arterial blood flow into the penis. The tunica albuginea, a tight sort of inner skin around the corporae cavernosae hinders the blood outflow and helps to retain the blood in the penis.
On the contrary, erection is relaxed when muscles in the penis contract. Erection begins with sensory or/and mental stimulation.
Damage to arteries, smooth muscles and fibrous tissues is the most common cause of impotence. In this context, diseases such as diabetes mellitus, arteriosclerosis and chronic alcoholism account for about 60-70 percent of cases of impotence. Also so called iatrogenic injury (iatros = physician), for example after radical prostatectomy can cause erectile dysfunction. Also many drugs such as high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants and cimetidine (an anti-ulcer drug) can cause impotence.
Experts believe that about 10 to 15 percent of cases are due to psychological causes. These include stress, anxiety, guilt and fear of sexual failure. On the contrary, more than 80 percent of impotence cases have underlying physical causes.
Other possible causes of impotence are smoking, disturbed blood flow in arteries and veins and hormonal abnormalities. The diagnosis is made by careful questioning of the patient, physical examination and laboratory determination of hormonal status as well as liver and kidney function.
There are various therapeutic possibilities for impotence. They must be suited to the individual and his needs.
One treatment consists of intracavernous injection of prostaglandin E1 or papaverin, which increase blood flow to the penis and consequently build and sustain penile erection. Vacuum-system devices that create a vacume around the penis and draw blood into corporae cavernosae.
Patients with psychological cause of impotence are treated by psychotherapy.
Newer drugs such as prostaglandin E1 supositories are applied through the urethra from where they can enter the corporae cavernosae directly. Since 1998 Viagra (Sildenafil) is available. It is taken orally and hinders the outflow of blood from the corporae cavernosae.
A definitely more invasive mode of therapy is the implantation of a corpus cavernosum prosthesis connected to a pump system to induce penile erection. This method should only be employed in patients where all other therapy modalities have failed and the patient insists upon an implant. Possible complications of such systems are the general surgical complications such as infection, bleeding and scaring. Furthermore, functional failures or defects of the pump system may occur and require reoperation. Such prosthetic divices are usually not covered by health care insurance in Switzerland.
Surgerical repair of penile arteries is performed mainly in younger men after fracture of the pelvis or other trauma with consequent vascular injury and consequent erectile impotence. On the other hand, ligation of veins can reduce the drainage of blood and prolong rigidity of the penis during erection. This treatment is still contraversial among specialists.