Understanding impotence
Simple treatments available for this ‘hush-hush’ condition
By Cynthia Wolfe Boynton
Frank Carroll has never told anyone about his problems with impotence, and actually isnt that comfortable talking about it now.
With so many TV commercials touting drugs available to help, I finally decided to see a doctor, and my wife convinced me I shouldnt be embarrassed to talk about it. Though its not something I want to go into any detail about, says the 67-year-old Madison resident. Im trying to deal with it like any other medical condition and not dwell on the fact it has to do with a part of my body that generally is kept extremely private, and that used to work without any problems.
Impotence, medically called erectile dysfunction, is the inability to achieve or sustain an erection. Its not a disease, but usually a symptom or side effect of something else. Its an experience almost every man has at some point in life, and occasional episodes are perfectly normal. Yet up until several years ago, it was a taboo subject.
Perhaps what changed this mindset was the wave of prime-time TV advertisements for impotence drugs like Viagra and Levitra. The commercials, which feature vibrant men with beautiful women who talk openly about the condition, seem to have taken away at least some embarrassment and mystery. But, as Carroll asserts, its not yet dinner party conversation.
Regular occurrences of impotence is, however, a medical problem that calls for a conversation with your doctor, health experts assert. Aside from interfering with sexual performance and causing great anxiety, impotence can be the first sign of several serious illnesses, including high blood pressure; kidney, liver or hormonal disorders; or coronary artery disease, says Hospital of Saint Raphael attending urologist Richard J. Dean, M.D. Its also a common complication of diabetes. Indeed, as many as 50 percent of diabetic men experience impotence, because the disease can damage the blood vessels and nerves involved in having an erection.
Emotional problems like anxiety, guilt, depression, low self-esteem and fear of sexual failure can sometimes be a cause. So can smoking, which can affect blood flow to the penis, and hormonal abnormalities, such as insufficient testosterone. Surgery near the penis for prostate cancer, for example — can lead to impotence if nerves and arteries are damaged.
The National Institutes of Health reports many common medicines also produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants and some ulcer drugs.
There was a time when doctors believed that the majority of men with impotence had psychological problems, but we now know that most cases have a physical causes, Dean explains. Our understanding of this problem, and how to treat it, has improved dramatically over the past decade.
While impotence can occur at any age, it is most common in men over 65. At any given time, as many as 15 million American men suffer from the condition. Although because many men are uncomfortable or embarrassed to talk about the problem, that number could be higher. Why some men hesitate to come forward, and ask their doctor of help, is certainly understandable, says Ralph J. DeVito, M.D., Saint Raphael Urology section chief, but its not the best choice. In most cases, impotence can be successfully treated, leading to both better health and a better quality of life. Theres no reason for any man or couple to suffer in silence.
For many men, the first step in addressing impotence is understanding it, says DeVito.
A mans whole body is involved in having an erection: The senses take in information that make the man become sexually excited; nerve endings in the penis release a chemical messenger that widens penis blood vessels; and then the penis two erectile chambers, which are filled with sponge-like tissue, fill with blood and expand.
It tends to be a quick process in young men. As men age, erections can take longer to develop. But impotence is not an inevitable part of aging, DeVito stresses.
Erectile dysfunction is treatable at any age, he adds. The underlying causes can generally be determined with a few simple tests, and treatment in the great majority of cases leads to erections being restored.
Frank Carroll discovered this when he finally admitted his problem to his primary care physician. He was referred to a urologist, who spent most of Carrolls first appointment asking lots of questions about his current health; medical history; the prescription and non-prescription medications he takes; and recent physical and emotional changes. Blood was drawn to check for potential medical problems.
The blood tests showed a hormonal imbalance was most likely causing Carrolls problems, so oral medications were prescribed. The result? So far, so good, Carroll says. That really all people need to know. Im good. Better. Happy.
Other diagnostic tools frequently used to determine the cause of impotence include:
Ultrasonography. A form of ultrasound that shows whether blood flow to the genitals and penis is blocked or impaired.
Neurologic evaluation. A physical exam that looks for nerve damage that might be affecting genital touch sensations.
Cavernosometry and cavernosography. Two more tests that measure and examine blood flow into, and out of, the penis.
A test called a noctural penile tumescence can also help determine whether theres a physical (rather than emotional) cause. Most nights, healthy men have three to five erections while they sleep. So during this test, a small gauge is attached to the penis to detect erections during sleep. If at least one occurs, physical factors are probably not to blame for the problem while awake.
No matter what the cause physical, psychological or a combination of both impotence can become a huge source of mental and emotional stress for a man and his partner, Dean says. Seeking help from your doctor will only make you feel better. The treatments we offer work better than ever before. And if you have a spouse or partner, seeking help should only strengthen your relationship.
Several well-respectable and reliable agencies offer detailed information about impotence. Among them:
? The National Institutes of Healths Kidney and Urologic Diseases Information Clearinghouse at http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/;
? The American Urological Association at www.auanet.org;
? The American Diabetes Association at www.diabetes.org; and
? The American Association of Sex Educators, Counselors, and Therapists at www.aasect.org
So many men with this condition unnecessarily suffer in silence, DeVito says. Help is out there. Ask for it.