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WHAT IS IMPOTENCE? | CAUSES | ordering

NOT LIFE THREATENING BUT:

Impotence is not life threatening, of course. It can be symptomatic, however, of other serious problems, such as atherosclerosis, diabetes, and hypertension. Impotence can also be indicative of an injury, age-related changes in tissue, or the possible long-term effects of risky behaviors such as smoking, heavy drinking, or an unhealthy diet.

Psychological factors related to impotence can be significant. Erectile dysfunction can have a devastating effect on a relationship and can cause extreme depression, which may become chronic if the erectile dysfunction is not treated.

What Tests Can Be Used to Diagnose Impotence?

Medical and Personal History

There are several tests available to assist physicians in diagnosing impotence and its causes. The first step is, of course, talking openly -- the patient must be as frank as possible in order to assist his physician in making a diagnosis. In addition to reporting any past and present medical problems, the patient should report any medications or drugs he is taking and any history of psychological problems, including stress, anxiety, or depression. The physician also requires a sexual history. This should include the nature of the onset of the dysfunction, and the frequency, quality, and duration of any erections, and whether they occur at night or in the morning. The physician might also ask about the specific circumstances when erectile dysfunction occurred, details of technique, the man's motivation for and expectations of treatment, and whether problems exist in the current relationship. The man should not interpret these questions as intrusive or too personal if he expects to obtain help; they are very relevant and important for determining the proper approach to the problem. If appropriate, the physician might also interview the sexual partner.

Physical Examination

The physician should then perform a careful physical exam, which includes examination of the genital area and a digital rectal examination to check for prostate abnormalities. Evidence of other medical conditions should be sought, particularly hypertension, diabetes, atherosclerosis, and nerve damage.

Trials Using Erectile Function Treatments

Physicians now usually recommend a trial of sildenafil (Viagra) to test for an erection response. This often can replace more invasive and expensive tests, such as an injection of papaverine or prostaglandin E1, medications that dilate blood vessels in the penis. After the injection in men with normal blood circulation in the penis, an erection will occur in 10 to 15 minutes. The physician then observes the erectile response, curvature of the penis, and response after erection.

Laboratory Tests

Blood tests may be used to measure testosterone levels and, if necessary, prolactin levels to determine if there are problems of the endocrine system. The physician may also screen for thyroid and adrenal gland dysfunction. In addition, various specific tests for erectile dysfunction can be performed.

Monitoring Night-time Erections

The snap-gauge test monitors the man's ability to achieve an erection during sleep. It is a very simple test. When the man goes to bed, he places bands around the shaft of his penis; if one or more breaks during the course of the night, it provides evidence of an erection. In this case, a psychological basis for the erectile dysfunction is likely. A more sophisticated device is the RigiScan monitor, which makes repetitive measurements of rigidity around the base and tip of the penis. This test is quite accurate but may fail to detect mild cases of erectile dysfunction. Neither of these methods is helpful in determining a physical cause for erectile dysfunction if erection does not occur during sleep.

Penile Brachial Index

The penile brachial index is a measurement that compares blood pressure in the penis with the blood pressure taken in the arm. Problems with the arterial flow to the penis can be detected using this method.

Imaging Techniques

Dynamic infusion cavernosometry and cavernosography (DICC) is a four-part test that is usually only given to young men in whom some blockage of the penis or physical injury of the pelvic area is suspected. After an erection is induced with drugs, the penile brachial index is taken, the storage ability of the penis is gauged, an ultrasound of the penile arteries is performed, and an x-ray of the erect penis is taken. Unfortunately, this test and other similar imaging techniques used to determine blood flow in the penis are currently not very effective or accurate in diagnosing and determining treatment. Ultrasound may prove to be useful in detecting some causes of erectile dysfunction, such as leakage from blood vessels. Less expensive imaging tests are showing promise. Anyone considering these tests should have them done in a specialized setting with professionals experienced in the use of the diagnostic instruments and in analyzing the data from them.

What Lifestyle Changes May Help Prevent or Treat Impotence?

Maintaining General Health

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.

Frequent Erections

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.

Kegel Exercises

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


	REAL VIAGRA \| home WHAT IS IMPOTENCE? \| CAUSES \| ordering NOT LIFE THREATENING BUT: Impotence is not life threatening, of course. It can be symptomatic, however, of other serious problems, such as atherosclerosis, diabetes, and hypertension. Impotence can also be indicative of an injury, age-related changes in tissue, or the possible long-term effects of risky behaviors such as smoking, heavy drinking, or an unhealthy diet. Psychological factors related to impotence can be significant. Erectile dysfunction can have a devastating effect on a relationship and can cause extreme depression, which may become chronic if the erectile dysfunction is not treated. What Tests Can Be Used to Diagnose Impotence? Medical and Personal History There are several tests available to assist physicians in diagnosing impotence and its causes. The first step is, of course, talking openly -- the patient must be as frank as possible in order to assist his physician in making a diagnosis. In addition to reporting any past and present medical problems, the patient should report any medications or drugs he is taking and any history of psychological problems, including stress, anxiety, or depression. The physician also requires a sexual history. This should include the nature of the onset of the dysfunction, and the frequency, quality, and duration of any erections, and whether they occur at night or in the morning. The physician might also ask about the specific circumstances when erectile dysfunction occurred, details of technique, the man's motivation for and expectations of treatment, and whether problems exist in the current relationship. The man should not interpret these questions as intrusive or too personal if he expects to obtain help; they are very relevant and important for determining the proper approach to the problem. If appropriate, the physician might also interview the sexual partner. Physical Examination The physician should then perform a careful physical exam, which includes examination of the genital area and a digital rectal examination to check for prostate abnormalities. Evidence of other medical conditions should be sought, particularly hypertension, diabetes, atherosclerosis, and nerve damage. Trials Using Erectile Function Treatments Physicians now usually recommend a trial of sildenafil (Viagra) to test for an erection response. This often can replace more invasive and expensive tests, such as an injection of papaverine or prostaglandin E1, medications that dilate blood vessels in the penis. After the injection in men with normal blood circulation in the penis, an erection will occur in 10 to 15 minutes. The physician then observes the erectile response, curvature of the penis, and response after erection. Laboratory Tests Blood tests may be used to measure testosterone levels and, if necessary, prolactin levels to determine if there are problems of the endocrine system. The physician may also screen for thyroid and adrenal gland dysfunction. In addition, various specific tests for erectile dysfunction can be performed. Monitoring Night-time Erections The snap-gauge test monitors the man's ability to achieve an erection during sleep. It is a very simple test. When the man goes to bed, he places bands around the shaft of his penis; if one or more breaks during the course of the night, it provides evidence of an erection. In this case, a psychological basis for the erectile dysfunction is likely. A more sophisticated device is the RigiScan monitor, which makes repetitive measurements of rigidity around the base and tip of the penis. This test is quite accurate but may fail to detect mild cases of erectile dysfunction. Neither of these methods is helpful in determining a physical cause for erectile dysfunction if erection does not occur during sleep. Penile Brachial Index The penile brachial index is a measurement that compares blood pressure in the penis with the blood pressure taken in the arm. Problems with the arterial flow to the penis can be detected using this method. Imaging Techniques Dynamic infusion cavernosometry and cavernosography (DICC) is a four-part test that is usually only given to young men in whom some blockage of the penis or physical injury of the pelvic area is suspected. After an erection is induced with drugs, the penile brachial index is taken, the storage ability of the penis is gauged, an ultrasound of the penile arteries is performed, and an x-ray of the erect penis is taken. Unfortunately, this test and other similar imaging techniques used to determine blood flow in the penis are currently not very effective or accurate in diagnosing and determining treatment. Ultrasound may prove to be useful in detecting some causes of erectile dysfunction, such as leakage from blood vessels. Less expensive imaging tests are showing promise. Anyone considering these tests should have them done in a specialized setting with professionals experienced in the use of the diagnostic instruments and in analyzing the data from them. What Lifestyle Changes May Help Prevent or Treat Impotence? Maintaining General Health 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. Frequent Erections 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. Kegel Exercises 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