Dive into the complexities of impotence. Learn causes, treatments, and find support on Meri Sehat. Breaking the stigma, embracing solutions.

Impotence

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Impotence, or <a href="https://merisehat.pk/disease/erectile-dysfunction">erectile dysfunction</a>, is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. 
&nbsp;

According to studies, impotence is one of the most common types of sexual dysfunction in males, with a 2019 review in particular citing a range between 3 and 76.5% for global prevalence.

While older individuals are more likely to suffer from it, nearly 26% of young men aged 40 or below experience it, too.<a href="#accordion">[2]</a> 
&nbsp;

Impotence can be classified into:<a href="#accordion">[3]</a>

<ul>
	<li>Primary Erectile Dysfunction &ndash; Absence of complete, sustained erections since <a href="https://merisehat.pk/article/13-going-on-13-female-puberty-78792">puberty</a>; it&rsquo;s rare and usually due to anatomic abnormalities or psychological factors</li>
	<li>Secondary Erectile Dysfunction &ndash; Acquired later in life by someone who previously had normal erectile function; it&rsquo;s more common and mostly due to reactive psychological difficulties 
	&nbsp;</li>
</ul>

Sign and Symptoms

The characteristic symptoms of impotence include:<a href="#accordion">[5]</a>

<ul>
	<li>Difficulty getting an erection</li>
	<li>Difficulty maintaining an erection</li>
	<li>Difficulty engaging in sexual intercourse 
	&nbsp;</li>
</ul>

Individuals with impotence may also report feelings of frustration, embarrassment, and a negative impact on their self-esteem and overall quality of life. 
&nbsp;

Causes

The causes of impotence are multifactorial and can be categorized into:<a href="#accordion">[5]</a>

<ul>
	<li>Issues with the male reproductive system, such as prostate disease or treatments for enlarged prostate or prostate cancer, Peyronie&rsquo;s disease, and hypogonadism</li>
	<li>Physical factors, such as hormonal problems (e.g., hypothyroidism), certain medicines (e.g., antidepressants), atherosclerosis, spinal cord injury, Alzheimer&rsquo;s disease, and Parkinson&rsquo;s disease </li>
	<li>Psychological factors, including stress, anxiety, depression, and unresolved conflicts with a partner 
	&nbsp;</li>
</ul>

Diagnosis

While diagnosing the condition, it is important to mention that not all erectile problems mean impotence.

Men, normally, have trouble either getting or keeping an erection for nearly 20% of the time, without it affecting their sex drive. However, it is important to consult a doctor if the issue persists and the individual experiences difficulty getting an erection for more than 50% of the time.[2]

The diagnosis of impotence involves a comprehensive evaluation of the individual&#39;s:

<ul>
	<li>Medical history, including a history of herbal products and prescription drugs </li>
	<li>Symptoms of neurologic disorders (e.g., decreased perineal sensation), hormonal disorders (e.g., hypogonadism), psychological disorders (e.g., Depression, anxiety), or vascular disorders (e.g., endothelial dysfunction)</li>
	<li>Sexual history, including partner sexual dysfunction or partner interaction</li>
	<li>Physical examination, including pelvic trauma or surgery 
	&nbsp;</li>
</ul>

Doctors may recommend blood tests, penile Doppler ultrasound, and nocturnal penile tumescence testing to identify the underlying causes of impotence.

The International Index of Erectile Function (IIEF) is also commonly used as part of the evaluation of the severity of the patient&rsquo;s condition.

Further, it is vital to screen the patient for depression, as it may not always be apparent.<a href="#accordion">[3]</a> 
&nbsp;

Treatment

Treatment options include:<a href="#accordion">[1]</a>

<ul>
	<li>Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), which only work when the individual is sexually aroused.</li>
	<li>Testosterone replacement in the form of gel, patch, or injections, preferably when the testosterone level is low.</li>
	<li>Improving lifestyle, like avoiding smoking, sleeping well, eating a healthy diet, and exercising regularly.</li>
	<li>Psychological counseling, whether sex therapy or cognitive behavioral therapy, to address individual triggers.</li>
	<li>Surgical intervention, such as a penile implant, is the final line of treatment when all other measures prove ineffective in improving penile vascular inflow.</li>
	<li>A vacuum erection device, such as a battery-powered or hand-powered pump, to meet the individual needs. 
	&nbsp;</li>
</ul>

Impotence can have significant complications, including:<a href="#accordion">[6]</a>

<ul>
	<li>Decreased sexual satisfaction and strained intimate relationships</li>
	<li>Feelings of inadequacy, depression, and anxiety</li>
	<li>Reduced quality of life </li>
	<li>Reduced chances of conceiving a child 
	&nbsp;</li>
</ul>

Common risk factors for developing impotence include: <a href="#accordion">[2]</a>

<ul>
	<li>Age, with prevalence increasing with age</li>
</ul>

<ul>
	<li>Underlying conditions, such as diabetes, obesity, high cholesterol, hypertension, cardiovascular disease, and sleep disorders</li>
</ul>

<ul>
	<li>Obesity; nearly 79% of men with erectile dysfunction have a BMI over 25 
	&nbsp;</li>
</ul>

Common preventive measures to reduce the risk of impotence include:

<ul>
	<li>Adopting a healthy diet, being active, and managing normal weight</li>
	<li>Quitting smoking</li>
	<li>Getting regular health check-ups, especially if the individual has diabetes, hypertension, or cardiovascular disease </li>
	<li>Seeking professional help through counseling to accept and address psychological issues, such as stress and anxiety 
	&nbsp;</li>
</ul>

key points

<ul>
	<li>Impotence is defined as the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse.</li>
	<li>There are 2 types of erectile dysfunction &ndash; primary and secondary.</li>
	<li>Characteristic symptoms include difficulty achieving or maintaining an erection, reduced sexual desire, and negative impact on self-esteem and relationships.</li>
	<li>Common causes of erectile dysfunction include issues with the male reproductive system, psychological factors, and physical factors.</li>
	<li>Diagnosis involves a comprehensive evaluation of medical history, physical examination, and specialized tests such as blood tests and penile Doppler ultrasound.</li>
	<li>Treatment options include medications, lifestyle modifications, psychological counseling, and surgical interventions.</li>
	<li>Erectile dysfunction can lead to an overall reduced quality of life.</li>
	<li>Common risk factors for erectile dysfunction include age and obesity</li>
	<li>Adopting a healthy lifestyle, quitting smoking, getting regular health check-ups, and addressing psychological well-being are important preventive measures.</li>
</ul>