Impotence overview

HOW DOES AN ERECTION OCCUR?
The penis contains two chambers, called the corpora cavernosa, which run the length of the organ (see figure 1). These chambers arexfilled with a spongy tissue. They are surrounded by a special membrane, which is called tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. Penis contains the urethra, the channel for urine and ejaculation. Urethra runs along the underside of the corpora cavernosa.

Sensory and mental stimulation helps to achieve erection. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. In this way, corpora cavernosa get the pressure because of blood flow and penis expands. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.

WHAT CAUSES IMPOTENCE?
It is known that erection needs a sequence of events. And when any of these events is functioning badly, impotence can take place. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Causes of the impotence can be various. Mostly, it is caused by a disease, which, in its turn, results in ill arteries, smooth muscles and fibrous tissues. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence.

Impotence can be also caused by some kinds of surgery. For example, prostate surgery may damage nerves and arteries near penis, thus resulting in impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

It was already stated that impotence may be a result of drug side effects. Among such medicines are: high blood pressure drugs, antistamines, antidepressants, tranquilizers, appetite suppressants, cimetidine, which is an ulcer drug.

Among some other factors of impotence there are mental causes. According to statistics, it happens in about 10-20% of cases. Psychological factors include: stress, anxiety, guilt, depression, low self-esteem, fear of sexual failure. Usually, these factors follow some physical causes and occur in about 80% of cases.

Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

How Is Impotence Diagnosed?
Patient History the stage and the cause of impotence can be defined with the help of medical and sexual histories. Due to medical history we can
reveal the diseases which can lead to impotence. And just describing sexual life, it is possible to differentiate such sexual problems like: problems with erection, ejaculation, orgasm or sexual desire.

There can also be a chemical cause for the impotence. That is, when you use some prescribed or illegal drugs. This is the cause of impotence in 25% of cases. Simply reducing or substituting the medicines, impotence may go away.

Physical Examination
It is necessary to go through physical examinations, because they can reveal some systemic problems. For instance, if penis gives no response to some touch, expected to evoke this response, the cause may be hidden in the nervous system. Problems with endocrine system, that is hormonal problems, can be revealed due to some abnormal secondary characteristics, like hair pattern. There are some diseases of the penis itself which can be the cause of impotence. For example, it may be the result of Peyronie’s disease, if the penis is bending during the erection.

Laboratory Tests
Along with physical examination, certain laboratory tests should be made, because they can help to make a diagnosis. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. When we observe low sexual desire, one should go through the measurement of testosterone in blood, thus pointing to the problems with endocrine system.

Other Tests
Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of impotence. Night erections are a normal thing and usually healthy men have involuntary erections during sleep. But if these erections do not occur, then we should speak about physical cause of the impotence, but not psychological. Although, one cannot rely on these tests for the whole 100%. Scientists have not agreed yet, when and in what way they should be taken to gain best results.

Psychosocial Examination
We have said that some psychological factors may be revealed with the help of tests, examinations. But it is also true, that these problems may be disclosed due to psychological examinations and questionnaire. For the better results, men’s sexual partner should also be interview to find out the expectations and perceptions during sexual intercourse.