Say No to Erectile Dysfunction

Impotence can be of several types:

Arteriogenic: This form of impotence is when the arteries that supply the penis with blood can’t deliver sufficient blood to cause or sustain an erection. There are some patients who are susceptible to narrowing of the arteries, including the elderly, diabetics and people with high blood pressure, although some patients suffering from an injury to the genital area may also suffer from blocked arteries leading to the penis. Problems due to genital injuries are more predominant in younger patients. The injury can be major and sudden as after a vehicular accident causing a fracture of the pelvis or pubic bones, or low grade and gradual, as in bicycle and other riders, and occurs because sustained friction in that region causes a clot-like substance (thrombus) to develop in the artery to the penis. This clot gradually grows and ultimately blocks the blood supply to the penis completely.

Today, it has been established that erectile dysfunction (ED) is a marker, a warning sign, for future cardiovascular diseases like heart attacks and strokes. When disease within smaller arteries like the penis is discovered before they affect the larger arteries such as the heart or brain, treatment can be administered more easily. This should be a strong argument for the benefit of having erectile dysfunction diagnosed and treated early, as medical specialists can then help to detect any early warning signs of other problems developing, such as diabetes, high blood pressure and others.

In a case study, College student S.V.S., 23, became totally impotent following a vehicular accident in which he sustained a fracture of the pelvis and a rupture of the urethra. This involved hospitalisation for nearly a month and an operation. Prior to the accident, the patient reported a normal sex life with his fiance. When he went back to the doctors who treated the primary problem, he was told that his was a purely psychological problem and that everything would be all right in a couple of months. 12 months later and the patient noticed no improvement at all, forcing him to consider breaking his engagement. An article in a magazine brought him to an andrologist. Investigation using a phalloarteriogram revealed an artery leading to the penis was blocked. The patient was given a microsurgery operation to complete a penile revascularization procedure and was completely cured.

Arteriogenic impotence resulting from injuries is very common but often unsuspected because of ignorance of the causative conditions. In fact, some of these patients may be wrongfully sent to orthopedic or urology wards for treatment. The impotence is often discovered much later, after the more obvious wounds and fractures have healed. In these cases, it’s the patient who learns of the impotence issues, not the doctor.

Venogenic: This is a condition whereby blood leaks from the penis and stops a hard erection forming. In a male without this condition, veins within the penis shut down so that almost no blood can flow back out from the penis. In a normally working penis, blood will accumulate within the sinusoids, which will raise pressure so the penis becomes rigid.

Venogenic erectile dysfunction is very common. It is said to account for as much as 30-70 percent of all impotence. Primary venogenic impotence afflicts men from the time they’re born. Such men have never had a rigid erection all their lives. Yet there are some men who may develop secondary venogenic impotence suddenly later in life.

Neurogenic: The nerve supply to the penis is very complex. To achieve and maintain an erection, it’s necessary that the correct conduction of impulses along those nerves happens. It is these nerves that activate the arteries and the veins and alter the dynamics of blood flow within them.

There are plenty of things that may negative affect the nerve supply to the penis. Impotence can be caused by injuries to the back and particularly injuries to the spinal column.

There are other nerves that can be affected by other injuries, such as pelvic or perineal trauma. A wide variety of operations performed for other conditions can cause incidental injury to the nerves of the penis and cause impotence. Those surgeries can include rectum, prostate, urethra, spine, urinary bladder and more.

There are also some disorders of the nervous system that can affect the nerves to the penis, causing impotence, like multiple sclerosis, myelitis, tumour and others.

Another disease affecting the nerves to the penis is diabetes mellitus. Impotence is extremely common among diabetics. It’s thought that around 50% of diabetics have impotency problems. The cause of impotence in diabetics is mostly organic. The usual therapy given to diabetics to treat their diabetes won’t restore the damaged erectile function as the actual diabetes can’t be reversed. Unfortunately, diabetic treatments tend to only control the blood sugar levels and little else. Yet andrology is able to treat, and in many cases, cure patients suffering from diabetes-related impotence. This is another fact that is, unfortunately, not known to most people. Few diabetologists address erectile dysfunction (ED, impotence) in their patients.

Some drugs are also capable of damaging the nerve endings, which can cause neurogenic impotence. Among the primary culprits are anti-hypertensives used to reduce blood pressure and psychotropics. However, the list is quite extensive. Often, it is not known that the medicine (which is prescribed for some unrelated disease, such as duodenal ulcer) is the culprit.

Endocrinologic: Endocrinologic, or hormonal impotence, will occur if the patient has a hormonal imbalance or lack of sufficient sex hormones in the blood. It is believed between 5-10% of organic impotence cases come under this category. Generally, hormonal changes affect the libido (or sex drive) rather than the quality of the erection per se. A variety of disease conditions can cause these changes.

Mixed: Often, there may be multiple factors that can affect a patient. Systemic disease is usually the common denominator with these patients. Notable examples are diabetes, kidney failure and liver failure.

Another section of patients with mixed factors for impotence is where the erectile dysfunction itself may lead to other ailments and disorders, such as depression. Even though the underlying cause of the erectile dysfunction is organic, it may have been misdiagnosed or even treated incorrectly, so the patient is led to believe that the reason for his impotence is all in his mind.

Psychogenic: Of course there is still a very small percentage of men where the problem really is within the mind and is labelled psychogenic impotence. However, prior to giving a patient this particular label, it’s important to have an andrologist investigate for any potential organic or bodily causes that could be creating the problem first.

When this has been done, correct treatment can be applied to address the problem.