Overview – What is it?
Impotence is also known as erectile dysfunction (ED) and is a common form of sexual dysfunction in men. This dysfunction is characterised by the consistent inability to get and sustain an erection, firm enough to have sexual intercourse.
It can be caused by smoking, heath conditions such as diabetes and hypertension, among other factors.
Its main symptom is the inability to have an erection during sex or having an erection and not being able to sustain it long enough for sex.
Erectile dysfunction can be diagnosed by carrying out a physical exam and through a test like the nocturnal penile tumescence test (NPT).
The treatment of erectile dysfunction can be done using medication and lifestyle changes, such as quitting smoking, among other changes.
To prevent this problem, a man should not smoke and should get treatment for, or manage, any conditions that can lead to erectile dysfunction.
Causes – What causes it?
Impotence is brought about by a number of factors but before discussing the factors, it may be helpful to know how an erection occurs. An erection takes place when there is increased blood flow into the penis which can be caused by sexual thoughts or by direct contact with the penis. The increased blood flow happens when penile muscles relax allowing the blood to flow through penile arteries. The blood fills the two chambers inside the penis known as corpora cavernosa, and as these chambers fill up, the penis becomes rigid.
Men with erectile dysfunction have problems in any stage of the erection process and these problems can be caused by:
- Medication: Some medications such as antiandrogens used for prostate cancer and antidepressants can cause erectile dysfunction.
- Health conditions and diseases: Some health conditions and diseases such as type 2 diabetes and chronic kidney disease can cause erectile dysfunction.
- Injury: Injury to the penis, spinal cord, prostate and bladder can cause erectile dysfunction. Injury resulting in erectile dysfunction can also occur during treatment for prostate cancer such as surgery and radiation therapy.
- Psychological or emotional issues: Erectile dysfunction can be brought about by psychological or emotional factors such as depression and anxiety.
Other factors that can increase the risk for erectile dysfunction are:
- Alcohol abuse and use of illegal drugs like cocaine and heroin,
- Lack of physical activity, and
- Being overweight or obese.
Symptoms – What do you feel?
Erectile dysfunction is characterised by:
- The inability to have an erection each time you want to have sex,
- Not being able to have an erection at any time, and
- Being able to have an erection, but not long enough to have sexual intercourse.
Diagnosis – How do you diagnose it?
- Medical and Sexual history: The first step to being able to diagnose impotence is by understanding a man’s medical and sexual history by finding out information such as:
- How often he is able to maintain an erection during sex,
- How often he finds sex satisfying,
- Whether he has an erection when he wakes up in the morning, and
- Whether he has undergone any surgery that might have damaged his nerves.
After collecting this information, a doctor can:
- Carry out a mental health and physical exam: This helps the doctor to diagnose any psychological or emotional issues that may be causing the erectile dysfunction. The physical exam, on the other hand, helps in:
- Examining the penis to find out whether it is sensitive to touch.
- Finding out whether it has any disease such as the Peyronie’s disease that causes the penis to bend.
- Checking the body for any extra hair that may indicate hormonal problems that can cause erectile dysfunction.
- Checking blood pressure and circulation of blood to determine whether you have any circulation problems.
Other tests that can be done include:
- Lab tests: These include blood tests that can be done to test for conditions such as diabetes, chronic kidney disease and other conditions that can cause erectile dysfunction.
- Imaging tests: These can be used to detect problems that can cause erectile dysfunction such as poor blood flow.
- Nocturnal penile tumescence (NPT): This test is done to determine whether a man has erection when he is asleep by wearing a battery-powered device on the thigh while sleeping. The device evaluates the quality of nocturnal erections (erections at night) and stores the data which can be accessed by the doctor later to help in better understanding of the penis function and the dysfunction.
- Intracavernosal Injection test: In this test, a medicine is injected into the penis or inserted into the penis through the urethra to cause erection. A doctor or health care professional then evaluates how full the penis becomes and how long the erection lasts which helps in determining the cause of the erectile dysfunction.
Treatment – How do you treat it?
The treatment of erectile dysfunction depends on the underlying cause of the condition. The treatments available are:
- Medication: These can be used to manage the symptoms of the condition. Some of the medicines used are testosterone, sildenafil and vardenafil. These medicines can cause side effects and therefore you would need to talk to your doctor to change the medicine and find one that meets your needs. If the condition is being caused by medication for other conditions such as antidepressants, you may need to change the medication.
- Talk therapy: This is used to address psychological or emotional issues that may be causing the erectile dysfunction such as post-traumatic stress disorder (PTSD), depression, stress and anxiety.
Alternative treatments include:
- Pelvic floor muscle exercise: These exercises help to strengthen the muscles around the bladder and penis.
- Acupuncture: It involves placing very fine needles in various parts of the body to relieve pain and stress which can help in the treatment of erectile dysfunction.
- Prostatic massage: This massage helps to clear the prostatic duct. It can also help to interrupt infection and eliminate blocked fluids.
- Lifestyle changes may also be necessary in the treatment of ED. These may include:
- Avoiding alcohol intake,
- Quitting smoking,
- Eating healthy, and
- Exercising regularly.