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Impotence – The Big Picture

The drug phenomenon of the year is far and away the appearance of a long awaited drug that taken orally produces an erection. Viagra (chemical name Sildenafil) was approved by the Food and Drug Administration and allowed it’s manufacturer Pfizer to distribute to rave reviews by patients and physicians.

Record number of prescriptions continue to be written, and although some reactions and side effects have been noted, it can be anticipated that the trend will continue in light of the fact that new compounds such as Zonagen’s, Vasomax and TAP’s Apomorphine are being investigated as oral agents for erectile dysfunction. However, the diagnosis and treatment of impotence is not recent, and we should always recognize that this problem might have various causes that may be evaluated and treated by different means.

The causes of impotence can be physical, psychological or a combination. A preliminary evaluation including obtaining a history, physical examination and basic laboratory tests can guide the physician in the right direction.

Psychological causes such as depression, adjustment disorders and stress are among the treatable conditions that can cause a sexual dysfunction that can be managed by psychiatrists, psychologists and sex therapists. It is not uncommon to see, in a urology practice, patients who fit this description; it is also not uncommon to see wonderful results from therapy, sometimes in just a brief period of time.

Physical causes are more common and sometimes more complex. Causes include:

Vascular disease or damage to the blood vessels can result from injury, diabetes, smoking, high cholesterol, high blood pressure and other disease processes provokes inadequate blood supply to the pelvis resulting in impotence. Depending on the severity and length of time the problem has been present, treating it may restore some potency but sometimes the damage is too severe and may require alternative treatments as described below.

A recently discovered cause is bicycle riding. The constant pressure from the narrow, pointed seat seems to cause damage to the arteries to the penis when comparing this active population to runners of similar physical condition and activity. Nerve damage or disease can also result from injury, diabetes, multiple sclerosis and other conditions and may require correction or alternative therapy to treat the erectile dysfunction.

Hormone imbalance is another physical cause of impotence and can come from medication side effect, certain types of brain tumors and the aging process. These may also have impotence-reversing treatments or require alternatives. Among the alternative methods of treatment are other oral drugs such as Yohimbine and Testosterone (for those with low levels of the naturally occurring hormone).

There are a number of treatment options, including:

  • Vacuum devices, which function by drawing blood into the penis and providing rigidity to allow sexual function to occur.
  • Injections of vasoactive-type drugs (active on blood vessels) such as papverine and prostaglandin directly into the penis may allow an erection to develop and help some patients.
  • Penile prosthesis (implants) have for several decades assisted some patients with erectile dysfunction but must be performed after most other options have been tried due to the surgical nature of this treatment and potential complications. The other treatments also have side effects including priapism, a painful, sustained erection requiring immediate attention and treatment.

In summary, the development of oral medication for the treatment of impotence is a welcome event for patients who suffer from this condition. There is no question that a new segment of patients have now sought attention, considering the previous methods of treatment difficult to accept (surgery, injections, pumps, etc.) The medical community will continue to see impotence as a condition involving the patient and treat the patient with the appropriate method; Viagra jelly may be the solution for some patients but the initial evaluation by the physician must always be the first step.