Menstuff® has compiled information on the issue of impotency
and infertility. Remember, November is National Impotency Awareness
Month.
Take This Quiz First
Impotency (ED)
Defined
Impotence: Causes and Solutions
What Lifestyle Changes May Help Prevent or Treat Impotence?
More on Erectile Dysfunction
Psychological
Impotence: How to avoid it. How to fix
it.
- Molly Barrow
Rx for Healing Low Desire: Six
Homework Assignments
Older patients often "left in the dark"
about treatment options
Older Lovers Are Less Desirable
Fathers
If He Can't Perform in Bed, Don't Get Mad,
Get Him a Doctor
Impotency and
Cholesterol
The Marlboro Man may be
impotent
Infertile men at greater risk of
testicular cancer
Men,
Sex & Diabetes 
Remedies for Impotence. Who
Said?
How Does a Man Find Out If He's
Infertile?
Newsbytes
Books
Resources
Additional
Resources
Related issues: AIDS, Bacterial
Vaginosis, Blue Balls, Chancroid,
Chlamydia, Condoms,
Contraception,
Crabs, Genital
Herpes, Genital Warts, Gonorrhea,
Hepatitis A,
B, C,
D, E,
Infertility, Nongonococcal
Urethritis, Pelvic Inflammatory Disease,
Reproduction, STDS,
Syphilis, Trichomoniasis,
Yeast Infection
For scoring purposes, give yourself two points for each right answer. The answer to questions 1-6 are "True." If your score is 8 or above, you have a pretty good understanding of Erectile Dysfunction. Read on…
If you answered "False" to two or more questions between 7-12, you
may want to talk to your urologist about ED.
Impotence: Causes and Solutions
Impotence, the persistent inability to achieve and maintain an erection for intercourse, affects as many as 18 million men in the United States between the ages of 40 and 70. Until recently, doctors thought impotence was mainly rooted in psychological causes. Now it is believed that 50 to 70 percent of all cases are caused by physical problems. Erection difficulties tend to increase with age, but that is not the only or even the most important factor. Your general physical and psychological health, as well as lifestyle habits and certain medications, can all cause impotence, but you don't have to live with this problem. In most cases, impotence can be successfully treated.
In order to get an erection, several parts of the body must work together. The brain sends a message of sexual arousal through the nervous system to the penis. This message causes the muscles along the penis to relax. At the same time, the artery to the penis dilates to twice its diameter, increasing the blood flow sixteen-fold, and the veins which carry blood away from the penis are blocked. As a result, the two spongy-tissue chambers in the shaft of the penis fill with blood and the penis becomes firm. A breakdown in any of these systems makes getting or keeping an erection difficult.
Virtually all men occasionally fail to get an erection. That's normal. But if a man has trouble getting or maintaining an erection about 25 percent of the time, he should see an urologist. These physicians specialize in disorders of the kidneys, bladder, prostate, penis and urethra.
Usually, after asking questions about when and how the impotence developed, the urologist will give the patient a complete physical exam to determine if his hormone levels are normal and if the blood vessels, nerves and tissues of his penis are working properly. If this initial work-up doesn't pinpoint the cause of the problem, a nocturnal penile tumescence test can be done.
Men with no physical abnormalities almost invariably have nightly erections during sleep. The patient may spend a few nights in a sleep laboratory where a gauge that measures the frequency and duration of nocturnal erections is attached to the base of the penis. A home version of this, the snap-gauge test, can also be used. Before going to sleep, the patient attaches the gauge to the base of his penis. During the night, the gauge will break at different degrees of penile rigidity and show whether a partial or full erection has taken place during sleep. If nocturnal erections do not occur, the impotence is most likely physical. Additional testing is then required to identify the precise cause of the problem.
What Are the Physical Causes of Impotence?
Physical impotence occurs when there is a problem with any of the systems needed to get or maintain an erection. The good news is that potency can usually be restored when a man is treated for underlying medical conditions, when medications are adjusted or when lifestyle habits are changed.
Here are some of the top causes of impotence:
What Are the Psychological Causes of Impotence?
A man who is depressed, under stress, or worried about his "performance" during sex may not be able to have an erection. Qualified therapists or counselors who specialize in the treatment of sexual problems can often help diagnose and sort through these problems. Some impotence problems can be solved when a man understands the normal changes of aging and how to adapt to them. For example, as men get older they generally need more direct stimulation to achieve an erection. They may also have less firm erections, take longer to ejaculate and need more time between erections.
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Relationship woes can interfere with potency and so can job stress, depression or financial worries. Impotence may also be the result of deep-seated emotional trauma, such as having been sexually abused as a child. Qualified psychotherapists can diagnose such problems and help men understand and overcome them.
What are the Treatment Options?
When treatment of underlying physical or psychological problems fails to restore potency, a man and his sexual partner can consider one of the following solutions:
The penis is a vascular organ which requires exercise. A healthy male will normally experience 3 to 4 erections during their sleep which may last a hour or more each. They are a normal body function whose purpose is to oxygenate the penile erectile tissue. Its inability to achieve and maintain an erection suitable for vaginal intercourse is called "male erectile dysfunction" (ED) or impotency, for short. Impotency affects over 30 million men and their partners. To some men impotency is a symbol of the loss of their manhood, and can be critical to a man’s ego and self-image. And often, because of this, some men are afraid to seek help. And, often when he does, the physician feels uncomfortable or is unable to help because many aren’t aware of the options. If the truth were known, however, virtually 100% of impotency problems can be successfully diagnosed and treated, whether physical or emotional, unless there is permanent injury or severance of the nerves and or vascular supply necessary in the erectile process.
The appropriate treatment for impotence depends upon whether the cause is physical or psychological. A man whose impotence is psychologically based generally still has erections during sleep, whereas an individual whose impotence is physical in origin usually does to. One easy, inexpensive way to test for nocturnal erections is with postage stamps. Glue a strip of stamps around the shaft of the penis before going to bed. If the ring of stamps is broken in the morning, the cause of the impotence is likely psychological. If the strip is unbroken, the impotence is likely physiological. You can also purchase a kit called Snap Gauge from UroHealth Corporation. This test is designed to detect the measure the rigidity of erections experienced during sleep. Call 800.328.1103 for more information.
This will give you some background on the subject. Circumcised
men, it is said, have a much higher rate of impotency than
uncircumcised men. This will be examined as a separate subject and
the information will be presented soon. The important thing to
remember is "Don’t wait." The longer you wait, the greater the
worry, the more difficult the treatment and recovery, and you’ll
miss out on a lot of great evenings in bed, too. So, find a qualified
doctor who is knowledgeable of the latest medical therapies. If you
need help in locating someone, one of the following organizations can
help: Impotence Institute of America & Impotence Anonymous -
1.800.669.1603 or Male Potency Centers of America - 1.800.438.7683.
The Institute also offers anonymous groups where men can hear the
experiences of other men which usually relates to what they are going
through. And, there is an excellent tape discussing all of the causes
of impotence, diagnostic treatment options and therapies by Dr.
Aubrey Pilgrim for $15 + shipping by calling 1.714.644.7200.
Viagra: Time to Separate Reality from Hype
When Viagra-the first pill to conquer male impotence-was approved earlier this year, doctors couldn't keep up with their patients' demands for prescriptions. All the brou-ha-ha is easy to understand. If normal sexual function can be restored by simply swallowing a little pill, why bother with devices, injections or implants? Still, the wonder drug that can has its limits. And reports of deaths among men taking the sex pill is causing some alarm.
Viagra seemed to burst on the scene out of the blue, but it does have a track record. Sildenafil citrate, the active ingredient in Viagra, was originally developed to treat high blood pressure. It didn't work for that disorder, but in 1993, Pfizer Pharmaceuticals, the drug's manufacturer, started clinical trails of Viagra involving more than 3,000 men with varying degrees of impotence associated with diabetes, spinal cord injury, history of prostate surgery, and other illnesses. The results: 48 percent of men with severe impotence were almost always able to get aroused when using Viagra, and 70 percent of men with milder problems had success using the pill. Men with diabetes or radical prostate surgery had somewhat less improvement than did other groups.
One of the little love pill's major assets is that men who take it get turned on "naturally." That is, Viagra does not directly cause erections as do other impotence treatments. Rather it affects a man's response to sexual stimulation. Taken one hour before sexual activity, the drug acts by enhancing the effects of a chemical the body normally releases into the penis when sexually aroused. This increases blood flow into the penis, which results in an erection. (Viagra should not be taken more than once a day.)
On the down side, there have been reports of deaths and severe side-effects in some men taking Viagra. Men with a history of heart trouble, heart attacks, and low blood pressure should be examined carefully before getting a prescription for the drug, and heart patients taking nitroglycerin or other nitrate-based drugs must not take Viagra because the mix may cause a deadly dip in blood pressure. Other adverse effects of Viagra may include headache, flushing, indigestion, and temporary changes in vision -- including seeing a 'blue haze.' Opthalmologists are concerned that the long-term effects of Viagra on vision are not yet known. Men with sickle cell anemia, leukemia, or multiple myeloma should also avoid Viagra because it is feared that they may develop priapism -- a persistent, painful erection that can permanently damage the penis. Additionally, men are cautioned against using other treatments for impotence while taking Viagra as such combinations have not been tested yet.
Despite problems linked to the sex pill, enthusiasm for it among patients and doctors is still riding high. But men are cautioned to use common sense. They should not take it before having a thorough medical history, including a review of medications, and a physical examination. Viagra is a drug with potentially serious health consequences and is meant only for men diagnosed with impotence. It is not a novelty item for men who achieve normal erections and simply want to heighten their sexual prowess.
Sources
American Foundation for Urologic Disease, Provides free information on impotence and how to assess treatment options. 800.242.2383
Impotence Information Center Provides free literature on impotence. 800.843.4315
National Kidney & Urologic Disease Clearinghouse Offers free literature on a number of urological problems, including impotence. 800.669.1603
Impotence Institute of America, Offers literature on impotence and doctor referrals for a $3.00 shipping charge. 800.669.1603
Health Pages. Publication: Impotence: Causes and Solutions. 1998.
www.thehealthpages.com/articles/ar-impot.html
Men who are currently using medicines that contain nitrates, such as nitroglycerin should not use Viagra because taken together they can lower the blood pressure too much. Viagra should not be used by women or children.
General Precautions with Viagra:
You should have a complete medical history and exam to determine the cause of your impotence before taking Viagra.
Men who have medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma or who have an abnormally shaped penis may not be able to take Viagra.
There are several medications that are known to interact with Viagra, so be sure to tell your doctor about all medications you are taking including those you can get without a prescription.
Viagra has not been studied with other treatments for impotence, so use in combination with other treatments is not recommended.
How should I take Viagra? Your healthcare provider may prescribe Viagra as one tablet once a day, about 1 hour before sexual activity. However, Viagra may be taken anywhere from 30 minutes to 4 hours before sexual activity.
What are some possible side effects of Viagra? (This list is NOT a complete list of side effects reported with Viagra. Your healthcare provider can discuss with you a more complete list of side effects.)
Viagra is generally well tolerated. If any side effects are experienced, they are usually mild and temporary. The following is a listing of the most common side effects:
For more detailed information on Viagra, ask your healthcare
provider.
What Lifestyle Changes May Help Prevent
or Treat Impotence?
Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease. Such good habits include a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Men who drink alcohol should do so in moderation. A regular exercise program is extremely important. Quitting smoking is essential.
Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.
The Kegel exercise is a simple exercise commonly used by people who have urinary incontinence and by pregnant women. It may also be helpful for men whose erectile dysfunction is caused by impaired blood circulation. The basic technique consists of tightening and releasing the pelvic muscle that controls urination. Since the muscle is internal and is sometimes difficult to isolate, doctors often recommend practicing while urinating on the toilet. The patient tries to contract the muscle until the flow of urine is slowed or stopped and then releases it. People should perform 5 to 15 contractions, attempting to hold each contraction for 10 seconds, three to five times daily.
Changing or Reducing Medications Causing Impotence
If medications are causing the problem, the patient and the physician should discuss alternatives or reduced dosages. In treating high blood pressure, for instance, ACE inhibitors are less likely to cause sexual dysfunction than many other medications.
Psychotherapy and Behavioral Therapy
Some form of psychological, behavioral, sexual, or combination therapy is often recommended for individuals suffering from impotence, regardless of cause. In such cases, it is beneficial to have the partner involved in this process whether sexual therapy is part of the treatment or not. The value of sex therapy itself is questionable. In one study 12 out of 20 of men whose dysfunction had a psychological basis and who were advised to enter a sex clinic resisted sex therapy out of embarrassment or because they felt it wouldn't help. Of the eight who entered therapy only one actually achieved satisfactory sex. Some kind of interpersonal, supportive, or behavioral therapy, however, can be of help to a patient during all phases of the decision-making process with regard to possible methods of treatment. Therapy may also ease the adjustment period after the initiation or completion of treatment.
Copyright 1999 Nidus Information Services, Inc. Well-Connected
Report: Impotence (Erectile Dysfunction). June 1999. www.well-connected.com
In a totally unrelated development (unrelated to aging, that is), National Institute of Aging supported scientists from the University of South Carolina have found yet another compelling reason to avoid cholesterol. Men with lower blood cholesterol or higher amounts of the beneficial high-density lipoprotein (HDL) cholesterol may be less likely to develop erectile dysfunction or impotence.
According to the researchers, atherosclerosis (hardening of the
arteries), which may impede blood flow to and from the penis, is one
primary cause of impotence. While a positive link between blood
cholesterol and atherosclerosis, the association between cholesterol
and impotence has only been suggested until now. The South Carolina
scientists conducted a study of more than 3,200 generally healthy men
between the ages of 25 and 83. Data indicated that the men with total
cholesterol over 240 milligrams per deciliter (mg/dl) of blood had
nearly double the risk of penile dysfunction as men with readings of
180 mg/dl. A similar pattern held true in patients with significant
amounts of HDL cholesterol. Those with HDL readings of 60 mg/dl or
greater were one-third less likely to develop dysfunction than were
men with less than 30 mg/dl HDL.
Older patients often "left in the
dark" about treatment options
At the same time the world patient population is rapidly expanding. The number of males suffering from moderate to severe erectile dysfunction (ED) now tops 170 million globally.
"The increasing need for better treatments will have important implications for healthcare providers, insurance companies, governments and academia", said leading specialists, sponsored by scientific organizations from around the world, including the International Society for Impotence Research (ISIR) and the American and European Associations of Urology, and co-sponsored by the World Health Organization.
Fifty to sixty percent of oral treatments, such as sildenafil (Viagra, Pfizer), are likely to have the largest share of the market, particularly in the US. However, the demand for Viagra is slowing, and injection therapy with alprostadil (Caverject, Pharmacia & Upjohn, or Edex, Schwarz Pharma), either alone or in combination with other compounds, will still account for 30-40% of treatments, due to greater safety and efficacy, urologists suggested at the meeting.
However, several of the experts complained that the hype for the oral pill has pushed other and perhaps better treatments into the background. "In one group of 1,000 patients attending my clinic, up to 40% of men and their partners said they preferred alprostadil because it provides a more rigid and more predictable erection", said Dr. Hartmut Porst, an international specialist in male impotence from Hamburg, Germany. "It is also easy and safe to use, even for patients who have a health problem. But, presently they are not getting enough information about such therapies".
One very large target group for injection therapy includes men who have become impotent after radical prostatectomy, and those who have suffered a pelvic or perineal trauma.
"Only 8-10% of these patients will respond to oral treatment, whereas up to 70% can be treated successfully with injection therapy. The same considerations apply to the large number of patients who have erectile dysfunction as a consequence of diabetes. Less than 40% will respond to the pill, compared to 70-80% with self-injection", Dr. Porst commented.
Results from a world survey covering nearly 300 medical centers and about 100,000 patients, were reported by Dr. Ronald Virag of Paris, France. The overall assessment was that injection therapy would remain an important treatment option. It continued to be widely used in many countries, and in over 50% of the centers, alprostadil was the preferred drug. In addition, combination of injection therapies and other medications often increase the success rate in certain patients.
In 62% of cases, patients preferred to give the injection manually, while about 30% used an auto injector. In some situations, the patient would begin with the auto injector, and go on to the manual method. In 7-10% of cases, patients used both methods. Many centers also gave patients the option of using the pill and injection therapy either alternately or in combination.
Dr. Virag emphasized the importance of a proper initial patient consultation, including a careful diagnostic and medical check-up, and regular follow up. "Doctors should not just hand out the pill like candy", he commented. Where there was good follow -up, drop out rates were much lower, averaging about 20%. Switching patients from injection therapy to the pill was occurring at a rate of 18% in some parts of the world to 60% in others. However, there were also many patients who experimented with oral therapy, and then returned to self-injection.
"We notice a big difference between patients who have only had oral therapy, and those who have also had injection therapy, in regard to their sense of satisfaction about their sex lives. That difference is something every patient has a right to experience", said Dr.Virag.
In terms of success rates for the different types of therapy, injection therapy was assessed at about 90% according to the global data. This compared with 50% for the oral pill, and 25-35% for topical therapy, Dr. Virag also reported.
"Meanwhile, there is a growing number of drugs in the research pipeline" noted, Dr. Robert Kramer of Boston University, and former president of the International Society of Impotence Research. He was chairman of a committee of leading scientists and researchers who reviewed the field of pharmacological therapy in a report to the meeting.
He mentioned two upcoming new oral medications:
Other upcoming drugs include:
Summing up, Dr. Kramer cited, " researchers are now actively
exploring new molecular targets." He added, "for example, that the
enzyme PDE5, on which sildenafil acts, is only one of a group of at
least 12 enzymes, and more may be discovered." New combinations are
also being tested, such as apomorphine, sildenafil and phentolamine,
and apomorphine and phentolamine. Margaret Pearson, MPH MARGPEAR@aol.com
If He Can't Perform in Bed, Don't Get Mad,
Get Him a Doctor
While it used to be thought that impotence was primarily a
psychological problem, doctors now tell us that physical causes
predominate. Among the most common: atherosclerotic disease (vascular
disease), which usually starts affecting men as they age... in the
50s, 60s, and especially in the 70s; diabetes; alcoholism; neurogenic
problems, such as MS (multiple sclerosis); spinal cord injuries;
hormonal deficiencies; certain medications, such as those used to
treat high blood pressure, tranquilizers, sedatives, and
amphetamines. Joel R. Cooper, The Medical Reporter, jcooper@medreport.com
Older Lovers Are Less Desirable
Fathers
It was suggested that this effect was due to the accumulation of
genetic mutations during cell division which is more likely to be
seen in sperm cells which are manufactured through adulthood rather
than eggs which are produced during fetal development. Daughters
would receive an X chromosome from an older father with more
mutations in it than would daughters from young fathers
According to the researchers, atherosclerosis (hardening of the
arteries), which may impede blood flow to and from the penis, is one
primary cause of impotence. While a positive link between blood
cholesterol and atherosclerosis, the association between cholesterol
and impotence has only been suggested until now. The South Carolina
scientists conducted a study of more than 3,200 generally healthy men
between the ages of 25 and 83. Data indicated that the men with total
cholesterol over 240 milligrams per deciliter (mg/dl) of blood had
nearly double the risk of penile dysfunction as men with readings of
180 mg/dl. A similar pattern held true in patients with significant
amounts of HDL cholesterol. Those with HDL readings of 60 mg/dl or
greater were one-third less likely to develop dysfunction than were
men with less than 30 mg/dl HDL.
The Marlboro Man may be impotent
Infertile men at greater risk of
testicular cancer
Remedies for Impotence. Who Said?
Does Chocolate Help with
Impotence?
Medicare Will Just Say No to Impotence
Drugs
Another Drug Targets Impotence
New Impotency Drug Levitra Taking Off
Can A New Gel Make Men More Virile?
Pesticides Tied To Semen Trouble
Scientists Identify Crucial Male Fertility
Gene
How to Know When to Stop Treatment
Viagra at bedtime may prevent erectile
dysfunction
Male sexual dysfunction device approved
for over-the-counter
New Impotence Treatment may be on the
Horizon
Scientists find way to select
healthiest embryos
Singapore pioneers babies from frozen
eggs, sperm
When fertility technology can't
help
Contents: One Penis, Assembly
Required
Topical ointment may help premature
ejaculation
Viagra Finds Unsexy but Lifesaving Use
Treats rare, deadly blood-pressure disorder
Sex and the City Tackles
Impotence Problem
At-Home Semen Analysis Fertility
Kit
Until now, a male patient had to get a prescription from a doctor to
have this very personal test done at a local hospital. The specimen
is collected and sent overnight to our certified lab in a
preservative solution. Results are directly mailed back to the
patient in an unmarked envelope for privacy. This report can be
brought to their doctor.
EDL is an extension of Shore Institute for Reproductive Medicine located in Brick, NJ. Shore Institute is a full service medical infertility practice offering the full range of treatment such as in-vitro fertilization, artificial insemination, ovulation induction, and fertility surgery. The physicians at EDL have over 40 years experience in this specialty and semen analysis testing. Who could offer a better service with reliable results than a lab specializing in creating human embryos?
This new innovation is the first of its kind bringing the
cyber-lab into the consumers home, according to Evolution Diagnostic
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safe, reliable and at a reasonable cost. For more information contact
Allen Morgan, M.D., President of EDL at 1-800-932-8908 or www.spermconfirm.com
Study suggests new therapy for
impotence
This public interest in impotence is one reason scientists are scrambling to find new treatments.
In a study reported in this week's editions of the medical journal Nature Structural Biology, researchers at the University of Pennsylvania say nitric oxide may hold the key to treating the problem. It's found naturally in the body and aids in smooth muscle relaxation, a requirement for erection.
"Nitric oxide is the messenger, if you will, the signaling molecule, and without that signal you can't get that signal from the brain to the penis for the erectile process," said Dr. David Christianson of the University of Pennsylvania.
An amino acid call L-argenine produces nitric oxide in the body. Researchers say they have found that a natural enzyme, argenase, that breaks down the L-argenine and renders it useless to make nitric oxide. This results in impotence.
What they have done is create an amino acid to stop this breakdown of L-argenine.
Erectile dysfunction affects half of the male population over 40 and according to Viagra makers Pfizer, their drug does not work in three out of 10 men.
"Their hopes have been so high, that when you get a patient and it (Viagra) doesn't work, they are depressed. They feel devastated by the problem," Urologist Steven Morganstern said.
According to the study's authors, Viagra works later in the erection process than this new therapy. They hope their findings may one day help Viagra work better as well as help those who are unable to take Viagra for medical reasons.
Continued testing is planned, but researchers warn it could be
years before the therapy reaches the public.
Sexual dysfunction is widespread in
U.S., study says
"I think it gives us a base for explaining why we had this enormous response to Viagra," said the study's lead author, University of Chicago sociologist Edward Laumann.
Researchers are calling the findings the first of their kind since a 1948 report by Dr. Alfred Kinsey on human sexual behavior.
The study, published this week in the Journal of the American Medical Association, was based on data from the 1992 National Health and Social Life Survey, a collection of interviews with 1,749 women and 1,410 men aged 18 to 59.
Information from the national probability sample concerning sex was reviewed in the wake of Viagra's popularity in treating male impotence since it was put on the market last year.
Survey participants were asked if they had experienced sexual dysfunction over several months during the previous year, including lack of sexual desire, difficulty becoming aroused, inability to climax or ejaculate, premature orgasms, pain during sex, anxiety over sexual performance and not finding sex pleasurable.
Lack of interest in sex was the top problem for women. A third said they regularly didn't want sex, 26 percent said they regularly didn't have orgasms and 23 percent said sex was not pleasurable.
For men, about one-third said they had reoccurring problems with climaxing too early, 14 percent said they had no interest in sex and 8 percent said they regularly experienced no pleasure from sex.
In all, 43 percent of women and 31 percent of men said they had one or more reoccurring problems with sex. Sexual problems were most common among young women and older men.
In both women and men, sexual dysfunction was related to emotional and stress problems including poor health, poor quality of life and prior traumatic sexual experiences.
Researchers, who were surprised by the findings, said the study offers hope and comfort for those with sexual problems.
"Often they don't even admit it to their partners. It's the old
'I've got a headache' instead of, 'I don't feel like having sex,'"
Laumann said.
Men's biological clocks are running
down, too
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