What is Impotence?

Impotence is the failure to get an erection, or keep an erection long enough for satisfactory lovemaking. It isn't a disease, but a symptom of some other problem, either physical, psychological or a mixture of both. Contrary to popular belief, the majority of cases have physical causes, with only one in ten cases of impotence being caused by psychological problems. It is normal to experience the occasional bout of impotence. Unless it persists, there is no reason to be concerned.

The two types of impotence include:

• Total impotence - when a man has never had an orgasm during sex. This can happen if the sex organs were damaged at an early age. This condition is also known as primary impotence.
  
• Partial impotence - when a man can sometimes get and keep an erection, or can get a partial erection, or is only impotent in certain situations. This condition is also known as secondary impotence
  
  

Causes of Impotence

There are 4 main causes of impotence :

• Physical illness - there are many diseases that interfere with functioning of the penis by either reducing blood flow or affecting the nerves. Some of these diseases include heart and blood vessel diseases, diabetes, multiple sclerosis and alcoholism. When the impotence is caused by a physical illness, it usually develops slowly. Most causes of impotence are physical. Some prescription drugs, like narcotics, sedatives and blood pressure medication, can give you impotence as a side effect.
  
• Psychological factors - a man's sexual drive or performance can be affected by stress such as problems at work, relationship difficulties, or financial worries. Psychiatric conditions and feeling depressed or anxious about poor sexual performance can also result in a failed erection. Only one in ten cases of impotence are caused by psychological factors.
  
• A combination of physical illness and psychological factors - physical problems with maintaining an erection may cause the man to feel anxious about lovemaking, which makes the problem worse.
  
• Unknown - in a few cases, neither physical nor psychological causes can explain the loss of sexual functioning.
  
  

Treatment for Impotence

It is important to seek treatment for impotence. The treatment for impotence includes:

--Psychotherapy and counselling

--Drug Therapy

--Vacuum Devices

--Surgery

Psychotherapy

Psychotherapy includes using techniques to decrease the anxiety involve with sexual intercourse. The partner of the patient can help to cure by applying some techniques which includes gradual development of intimating and stimulation. This will helps to relieve anxiety when impotence from physical cause is being treated.

Drug Therapy

Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat impotence or ED. In August 2003, the FDA gave approval to a second oral medicine, vardenafil hydrochloride (Levitra). Additional oral medicines are being tested for safety and effectiveness.

Taken an hour before sexual activity, Viagra and Levitra work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for Levitra is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. Lower doses of 5 mg and 2.5 mg are available for patients who take other medicines or have conditions that may decrease the body's ability to use Levitra.

Neither Viagra nor Levitra should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, Levitra should not be taken with any of the drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure.

Oral testosterone can reduce impotence in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs--including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Vacuum Devices

Vacuum devices helps erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after erection is attained and during intercourse.

Surgery

Surgery usually has one of three goals:

· to implant a device that can cause the penis to become erect

· to reconstruct arteries to increase flow of blood to the penis

· to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure--intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.