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Reason For Impotence
By Sid Martin
There are various
reasons for male impotence or erectile dysfunction. Below is a quick
list of reasons and pointers. It is important to know what type of ED
you may be suffering from to know which treatment is right for you.
What is erectile dysfunction? Ageing Physiological reasons
Psychological causes of ED Physical causes of ED Diabetes High blood
pressure Hormones Other physical causes of ED what is erectile
dysfunction? The definition of impotence or erectile dysfunction (ED)
is the inability to achieve or maintain an erection sufficient to
achieve the kind of sex desired. The Erection is a complex process with
many psychological and physical aspects. Therefore there are many ways
in which ED can be caused. As a result ED is one of the commonest forms
of sexual problem a man can have.
ED is one of the most
common male
sexual problems, with over 50 per cent of men bewteen 40 and 70 years
old experiencing it to some degree. To read more about ED click here
Aging Age is a factor that increases the likelihood of ED ? 5 per cent
of men aged 40 report complete inability to obtain a satisfactory
erection compared to 15 per cent at age 70. Many men therefore wrongly
accept ED as a normal part of the ageing process and the majority of
men with ED do not seek or receive adequate advice or treatment for ED.
Psychological reasons It's now known that psychological reasons alone
account for about a third of ED cases, with the rest being due to
physical conditions or, much more frequently, to a combination of
physical and psychological causes.
As ED commonly gives
rise to anxiety
in men and can be a cause of stress in a relationship it is probably
true to say that all men with ED have some degree of psychological
component to their condition. Fortunately both the public and the
medical profession have become better informed about ED, particularly
in the past few years because of the recent appearance of far better
treatments. Psychological causes of ED The presence of ED, for any
reason, will almost always cause some worry or anxiety in a man about
his ability to have sex, which in turn will make it more difficult to
get an erection next time and so on. This 'performance anxiety' is a
common cause of temporary ED and there can be very few sexually active
men who have never experienced it in their lives. Being aware of this
vicious circle and taking a more relaxed approach to sex will often
defuse the anxiety.
If sex is only seen
as the achievement of
penetrative intercourse, and a failure if that doesn't happen, then it
can be pretty certain that anxiety-related ED will keep on happening.
Other commonly found psychological causes of ED include: relationship
difficulties. These may result in ED, or vice versa. Usually both
co-exist. Unresolved gay feelings or other hang-ups focused on sex.
Bereavement and depression. Tiredness. Stress. Human beings are complex
and don't usually fall into neat categories. Someone who is depressed
might also for example be drinking too much alcohol , which in turn can
cause or worsen ED. The depression might be secondary to some other
condition or come directly from having ED and not knowing where to go
for help, or knowing that ED is treatable.
ED is however highly
treatable and there are a range of methods including medication,
counselling, physical devices and surgery. See ' Treatments for
erectile dysfunction ' for a fuller explanation of what is available.
It is clear from the many surveys that have been done on erectile
dysfunction that it is: ? common ? gives rise to much stress and
difficulty both at a personal and a relationship level ?
under-diagnosed and under-treated. Some of the problems lie in
embarrassment about talking about ED or a feeling that ED is not a
'valid' or 'proper' medical condition, despite the obvious truth that
the reverse is the case. Although we have moved in the right direction
concerning ED over the past couple of decades we still have a bit to go
before it becomes a subject that everyone will necessarily feel able to
discuss openly even with their own partner or doctor . That said
however we have already reached a stage when effective treatment for ED
is available, and more men need to avail themselves of it.
Physical
causes of ED The various biological processes involved in an erection
are explained in the factsheet on the physiology of erection but in
brief, erection occurs in response to signals from the brain. The
erectile tissue in the penis consists of two cylinders of sponge-like
material, largely composed of muscle fibres, When the penis is flaccid,
these fibres are contracted and the sponge is 'wrung out'. When
pro-erectile signals arrive from the brain, the muscle fibres relax and
the sponge fills with blood, compressing the veins that normally drain
blood back out of the penis. As a result, the penis expands and becomes
rigid. Following ejaculation or the withdrawal of sexual stimulation, a
change in the signalling from the brain causes the muscle fibres within
the spongy tissue to contract again, the draining veins open up, the
pressure within the penis falls and it once more becomes relaxed or
flaccid. For all this to happen there needs to be an intact system of
nerves and blood vessels to the penis as well as connections within the
spinal cord between the nerves that are connected with the penis and
the higher centres in the brain. Conditions that affect either the
nerves or the blood vessels are therefore also a common cause of ED.
Diabetes is the
condition in which the level of blood glucose
(sugar) is too high and for reasons that are not completely understood
a high glucose level, if present for years, can damage the function of
muscle fibres within blood vessles and vascular tissues, including the
erectile tissue of the penis, and of the small nerves and arteries
throughout the body. Thus ED can affect many men with diabetes, with
some studies reporting that up to 60 per cent of diabetic men will
eventually develop the problem. Although the chances of this occurring
are reduced by good treatment of the diabetes they cannot be reduced to
zero.
A further and
increasingly common problem is that the type of
diabetes commoner in older people (called Type 2 or non-insulin
dependent diabetes) can be accompanied by relatively few symptoms in
the early stages, which mean that many people with Type 2 diabetes
already show some damage to the nerves and arteries by the time they
have their diabetes diagnosed. In the Massachusetts study 28 per cent
of treated diabetic patients had complete ED. High blood pressure
People with high blood pressure are more likely than average to develop
'hardening of the arteries'. The medical term for this is
atherosclerosis (or arteriosclerosis). In atherosclerosis the arteries
throughout the body tend to develop thicker walls and become narrower
inside, so reducing the flow of blood through them.
If this develops in
the arteries going to the penis then it will be more difficult for the
penis to fill with blood and so ED may result. Smoking is the other
major factor that increases the chance of atherosclerosis developing
and smokers have an increased risk of developing ED. Many of the
medicines used to treat high blood pressure might also cause ED as a
side effect, particularly those called diuretics (water pills) and
beta-blockers. High blood pressure is however a very important problem
that needs to be treated too, and it is essential never to stop taking
prescribed medication for it (or any other condition) without
discussing the matter with your doctor. Many men who think that they
have ED as a side effect of the drugs they are taking do not mention
the problem to their doctor, who in turn may omit to ask if ED is
happening. It is therefore important to mention ED either before your
start taking treatment for high blood pressure, or if it develops after
you have been given medication for it, as quite often a medication
change will be possible and cause fewer side effects. Hormones
Testosterone is important in the development of the unborn male foetus
and in the growth and development of the genitals and other sexual
characteristics around puberty. In the mature man, it plays a role in
maintaining sexual desire and affects nerve signalling within the brain
and nervous system.
However, a lack of
testosterone alone is only very
rarely the cause of ED. In such cases, the man will usually notice a
marked reduction in sexual desire and an absence of night-time or early
morning erections. However, this has not stopped testosterone being
widely promoted as a treatment for ED and a range of other conditions
by unscrupulous or poorly informed (or both) outlets. The Internet
allows such uncontrolled advertising on a wide scale and anyone who
uses email regularly will probably be familiar with unsolicited 'spam'
messages promoting this type of treatment and its availability by mail
order. Taking unnecessary testosterone is potentially harmful ? it can
adversely affect cholesterol levels or accelerate the growth of a
pre-existing prostate cancer for example, so should be strictly
avoided. Your doctor can check whether a lack of testosterone is a
problem. Other physical causes of ED Any condition in which the nerve
or blood supply to the penis is damaged can potentially cause ED so it
can arise, for example, following prostate surgery or after some types
of prostate cancer treatment. It could also possibly occur after injury
to the genital area or pelvis. Surgery to the lower abdomen (within the
pelvis) can carry the risk of unavoidable damage to these nerves.
Multiple sclerosis is a disease of the nervous system in which the
function of many nerves throughout the body can become impaired,
usually over the course of many years. Spina bifida can also cause ED,
although this will have been a lifelong problem if it were the sole
cause. Spinal cord injury, renal transplantation and renal failure are
also possible causes of ED.
Polio, Parkinson's
disease, and single gene
neurological disorders are conditions that are unlikely to cause ED but
are relevant as they are listed as conditions in the presence of which
the National Health Service will allow GP prescription of certain ED
treatments. A fuller explanation of this is in the fact sheet
Prescriptions for impotence treatments Written By an Associate From
www.my-medicare.com References: American Foundation for Urologic
Disease Impotence Information Center National Kidney & Urologic
Disease Clearinghouse The international Index of Erectile function
(IIEF): a multidimensional scale for assessment of erectile dysfunction
- Rosen RC et al [Urology. 1997 Jun;49(6):822-30]
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