Faqs: Frequently Asked Questions About Impotence & Penis Development

Welcome to a page about one of America’s fastest growing public health problems, sponsored by Impotence World Association (IWA) in cooperation with our Sponsor Companies.

Impotence, also known as erectile dysfunction, is the inability to achieve or maintain an erection suitable for intercourse.

If you, or someone you know, is concerned about impotence, here are some “fast facts” you might find of interest.

• You are not alone: More than 30 million men in the U.S. alone suffer some form of impotence — mild, moderate, severe, acute or chronic.

• You may have a more serious problem: Impotence can be a symptom of a more serious medical condition, such as diabetes or cardiovascular disease. Other factors such as smoking, drinking, some prescription medications, surgery, stress or depression may also contribute to impotence. For more information about medical conditions and medications that can cause impotence, see our “causes of impotence” section.

• It is treatable nearly 95% of the time: There have never been more treatment options and most men regain their ability to have intercourse using one or more of the treatment options available. Accept impotence for what it is — a treatable condition, like heart disease or diabetes. For more information of the various treatment options available, see our Treatment page.

• Treatment works regardless of age: The likelihood of impotence increases with age but is not an inevitable consequence of aging. Impotence is especially prevalent in men over 40; one in three men over 60 are impotent. The aging process can contribute to physical cause of impotence, but young and old alike can be helped.

• See a specialist and seek help early: There are urologists and therapists who specialize in treating impotence. Other professionals may not be as well informed. Early treatment gets better results. After several weeks of symptoms, seek treatment. For a list of physicians who specialize in treating impotence, the physician listing.

• Partners have a major role to play: Impotence can be a relationship killer. It affects the relationships of more than 50 million Americans. If you are a partner, you can make a difference through support and education.

What can You Do to Prevent ED?

Occasionally, patients will ask what they can do to prevent the onset of ED, given that an increased incidence of ED is a normal concomitant of aging. Someday, we will probably be able to profile our relevant DNA cohort,  take a dose of a corrective gene codon, and be assured of perpetual potency! However, until then, measures to prevent the onset of ED can only be aimed at minimizing risk factors.  The following outline is not intended to be a recipe for clean (and certainly not ascetic) living but is an attempt to cover the common risks to erectile function.

Vascular disease: atherosclerosis, hypertension,  small vessel and arterial-medial disease:

  1. Control of hypertension, diabetes, hypercholesterolemia.
    B.    Avoid rather specific trauma-ride bicycles with a wide atraumatic seat (to avoid chronic trauma to the pudendal arteries.)   Planning for pelvic surgery, radiation or cryosurgery should take into account predictable insult to the pelvic arterial circulation.
    C.    DO NOT SMOKE !!!
    D.    There is some evidence that alcoholic liver disease is associated with small vessel disease, so excessive drinking is to be avoided. However, there is also some evidence that moderate ethanol use, possibly red wine, is good for vascular maintenance.
    E.     Hormone replacement therapy in women and men is beneficial to maintain vascular tone.

Corporal fibrosis

Penile arterial insufficiency leads to corporal hypoxia and thus to corporal fibrosis.  Therefore, the measures described above also should tend to prevent corporal fibrosis.  True absence of erectile activity (including nocturnal erections) can lead to corporal fibrosis, because of decreased corporal oxygenation, eg after radical prostatectomy. To prevent this, urologists have used vacuum erection therapy and pharmacologic-injection to maintain erections and oxygenation during the revascularization period. “Use it or lose it” is more than an addage.

Untreated or recurrent priapism results in corporal fibrosis and impaired erections.  The two leading causes for this are the use of psychotropic medications (especially SSRI’s) and sickle cell disease. Such medications should be used with care, and all black patients should be screened for sickle cell disease.  Recreational drugs (Heroine and cocaine) have been reported to lead to priapism; patients at risk for using these substances should be so advised.

Peyronie’s disease is not known to be preventable. However, as the pathogenesis is considered to be an individual fibrotic reaction to microtears and microhematomas  in the septal portion of the t.albuginea of the penis, and, if Peyronie’s patients have a distinguishing biochemical feature accounting for the fibrotic reaction, then this should be subject to genetic manipulation once illucidated. Work for the future!.

Penile trauma, especially when there is a  possible corporal tear, should be attended to promptly and repaired, to prevent corporeal insufficiency then and later.

Taking antioxidants to prevent corporal fibrosis and maintain corporal muscle mass has been suggested and often used. There is experimental evidence to support its use (1), but there is no good clinical data to show that they work.

Neurologic disease

Nerve-sparing surgery (during radical prostatectomy, cystectomy, hysterectomy, and during retroperitoneal and rectal surgery)  should be done when possible.  Avoidance of  trauma and other intercurrent disease is obvious, but  hard to plan.

Certain vitamin deficiencies (B6 and B12, Vit D) can lead to neuropathies which interfere with erections. Avoiding these deficiencies would therefore have preventive value.

Careful of bike riding – chronic compression of pudendal nerves and arteries has been shown to interefere with erectile ability. Use a padded and wide seat.

Control diabetes to prevent diabetic neuropathy. Avoid excess alchohol to avoid alchoholic neuropathy, both short-term(reversible) and long-term(not reversible).

Occult disc disease should be kept in mind. Cases of voiding dysfunction presenting as the only symptom of lumbar disc have been documented. Similarly, we have all seen ED patients with a history of disc disease, currently without pain, who demonstrate classic denervation hypersensitivity to pharmacologic injection during penodynamics.

Neurosensory disorders, such as multiple sclerosis, are often associated with sexual dysfunction. Pending the development of genetic profiling and therapy for these, a seasoned degree of diagnostic acuity is the best preventive factor.

Hormone deficiencies

Actual surveillance of serum testosterone in older men has been suggested by enthusiasts but has not been accepted by most geriatricians.  If there are libido changes, then measurement and replacement is indicated.

Hormone Replacement Therapy is accepted for women, not routine in men.  If testosterone replacement is considered in men, be sure PSA is ok and is monitored closely.

Hormone supplements taken for other reasons must be watched -testosterone will turn off endogenous production and lead to testicular atrophy; DHEA can lead to estrogen excess and give gynecomastia and decreased erections.

Chronic ethanol abuse can lead to testicular toxicity (2), which can lead to low testosterone levels.  Alcoholic liver dysfunction, when severe, can also lead to decreased hepatic metabolism of adrenal estrogen, increased serum estrogen, with additional testosterone suppression.

Drug interactions

There are many drugs, particularly antihypertensives, certain anti-peptic, cholesterol-lowering, and antipsychotic drugs (and SSRI’s), antihistamines, and a-adrenergic drugs which have been reported to interfere with libido and erections, but a much smaller number which have been shown in controlled experiments to interfere with erection. Rather than developing a “drug blacklist” it is more practical  just to monitor the  effect of any newly-started medication on erection, and to change the drug if an obvious negative effect occurs.

Pelvic muscle tone

During erection and ejaculation, the bulb of the penis is compressed by the surrounding musculature, increasing intracavernous pressure and adding to rigidity. Maintenance of pelvic muscle tone, many believe, aids and abets this process. Therefore, regular exercise which maintains pelvic tone (real exercise, not Kegel and not sitting on a magnet) may be helpful and certainly can’t hurt.

Libido and depression

  1. Regular exercise keeps up endorphins which do maintain sexual drive.
    B.     Signs of depression, which secondarily reduces libido, eg anorexia, insomnia, should be recognized and treated promptly.
    C.      Marital discord should be addressed promptly.  When relationships sag and/or turn sour, the concomitant estrangement makes subsequent sexual rehabilitation less successful.

Acute Prostatitis

Can make erections and ejaculation painful, and thus be inhibiting. Those men who have had recurrent prostatitis, should avoid the common prostatic irritants (caffeine, pepper and alcohol), and maintain good hydration and regular ejaculation.

ED Myths vs Reality

M Y T H S
R E A L I T Y
Impotence is a condition you must learn to live with – it’s just a result of aging. Impotence is treatable in almost every case and men, young and old, do not need to remain chronically impotent.
Most men never experience impotence. Nearly all men experience occasional impotence, with an estimated 30 million (one in three) suffering from chronic impotence.
When things change in my life, this problem will go away. Many treatments for impotence work best in the first year. It is a mistake to put off seeking help once chronic impotence is suspected.
Impotence originates in a man’s head, not his body. 80 percent of chronic impotence is a result of physical causes such as malfunctioning nerves or circulation, with related psychological complications.
Only men are affected by impotence. Partners of impotent men often experience similar psychological effects as their partners, such as anxiety, depression, self-doubt and a tendency to avoid sexual relations.
If the partner were more attractive, the man wouldn’t be experiencing impotence.

 

If the cause of impotence is organic, the appeal of the partner will not overcome the physical problem.
Only a limited number of expensive, ineffective treatments are available for impotence. There have never been more proven, affordable treatment options available to men and their partners.