Impotence Can Be A Disease

According to Prof. Lars Rydén, President of the European Society of Cardiology, all physicians should learn to listen more and help their patients with their impotence problems. A man who suffers erectile dysfunction often has a severely impaired quality of life. Still it is all too common that the subject is perceived as too sensitive to bring up with the patient.

Impotence is a common problem among middle-aged and elderly men. Studies show that at the age of 40, 5% suffer from total impotence, at 70 the frequency has increased to 15%. In the age group 40-70 years every second man suffers from some degree of impotence.  The man rarely admits openly that he suffers from erectile problems. Instead, he may retreat from his partner which in turn causes relationship problems. 

Disease Often The Cause

The development of erection in a sexual situation is a complicated process involving activity in a number of nerve centres in the brain and the spinal cord. The nerve signals normally effecting a slack penis must be turned off in order for the stimulating signal to have full effect. The blood vessels to the penis need to let the blood through in a normal way and that the smooth muscles recognise and respond to the signal for relaxation. In addition, the penile cavernous tissue must also contain certain amounts of chemical substances which transmit the nerve impulses to the smooth muscle fibres.

The risk for erectile dysfunction increases with age. But in 80% of the cases the erectile dysfunction is not a result of high age itself, but ageing brings risk factors like hypertension, other cardiovascular diseases, diabetes and various pharmaceuticals. Smoking contributes as well. Various psychological factors can also play a part and become a major or a contributing cause for the erectile dysfunction.

When impotence emerges gradually, this indicates that it might primarily have a bodily cause.  While psychological and social causes are more likely when impotence occurs suddenly. In men with suspected bodily cause some type of circulatory disturbance with impaired blood flow to the penis is found in three out of four cases.

In order to function sexually, good blood circulation and a well functioning nervous system are essential.

Cardiovascular Disease

Hypertension, angina, previous myocardial infarction, heart failure and other cardiovascular diseases significantly increase the risk for erectile dysfunction. In some studies it has been established that around every third man with known cardiovascular disease says that he has sexual problems. If the man is also a smoker the risk is multiplied.

No drugs against erectile dysfunction should be used by men for whom sexual activity is not advisable, e.g. patients with severe cardiovascular disease such as unstable angina or severe heart failure.

Diabetes

Close to half of all middle-aged male diabetics suffer from impotence. The most common causes are nerve damage and vascular disease. Diabetes brings an increased risk for cardiovascular disease, which probably accounts for some of the increased risk for impotence. Female diabetics do not have more sexual problems than women in general.

Depression

Depression in elderly is not uncommon. Decreased sexual desire is often an early symptom of depression. Even if the depression is treated pharmacologically and the psychological symptoms decrease the erectile dysfunction can remain. Anti-depressive drugs often have decreased sexual desire as well as decreased sexual ability as side effects. These side effects usually disappear when the drug is discontinued or replaced with another anti-depressive, however.

Treatment

Today there are several ways to restore the loss of erectile ability. Modern forms of treatment include injections directly into the penis, e.g. the drug Caverject. This is a method especially suited to patients with nerve damage and performance anxiety. Other tools are vacuum pumps, pubis rings, nitroglycerine paste and protheses. The pubis ring was one of the very first aids used for impotence and is represented on ancient Chinese paintings.

The latest treatment is sildenafil citrate, otherwise known as Viagra.  It has helped thousands of people with problems and the risk is very small, providing that the patient does not take nitroglycerine.  Many of the reported deaths have occurred in connection with a simultaneous use of drugs containing nitrate. Sildenafil citrate may increase the blood pressure reduction effect of nitrates and such drugs are never to be used in combination with sildenafil. It is therefore important that patients with for instance chest pain tell all medical staff in charge of their treatment if they have used sildenafil citrate during the last 48 hours. Moreover sildenafil citrate should not be prescribed to patients in need of nitrates.

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