Causes of Impotence and Available Treatments
Impotence is a common condition affecting more than 50% of men over 40 years old in the US, according to the International Journal of Impotence Research. This disorder is fully treatable nowadays.
As stated in the same article in the International Journal of Impotence Research, 30% of men with impotence receive treatment while the remaining 70% choose to refrain from it and from sexual life altogether. Below is the list of factors that cause erectile disfunction.
Physiological Factors of Impotence
Up to 90% of all cases of impotence result from physiological factors such as diseases and aging.
Heart disorders or vascular conditions interfere with normal sexual function. A study carried out in New England Research Institute reports that 39% of men with treated heart disease suffer from erectile dysfunction, which is 4 times higher than the same showing in healthy male population of the same age.
The list of cardiovascular disorders causing erectile dysfunction of varying severity includes coronary heart disease, atherosclerosis, history of infarction, PVD (peripheral vascular disease), hyperlipidemia. Having high blood pressure worsens men’s sexual performance over time.Available treatments:
First-line: PDE-5 Inhibitors – Viagra, Levitra, Cialis, Stendra and their generics, if their use is approved by the doctor. These medications improve blood flow in pelvic region and facilitate erection.
IMPORTANT: concomitant use of PDE-5 inhibitors with nitrates is risky for the patient’s health and life.
Serious cardiovascular disorders require a dosage adjustment. For example, the usual dosage of Viagra is one 50mg pill taken before sex. This needs to be reduced to half a pill or less in patients with heart disease.
Second-line: apomorphine or Uprima – not available in the US, androgen replacement therapy, penile prostheses, vacuum erection devices, etc.
Comorbidity of diabetes and erectile dysfunction is widespread. Between 35% and 75% of diabetics experience erection problems. Men with Type 1 diabetes are more likely to get erectile dysfunction compared to patients with Type 2 diabetes.
Diabetes causes cardiovascular problems and neuropathy. Both the vascular and the nervous systems are involved in erection mechanism, so damage to them may result in sexual disorders.Available treatments:
- First-line: PDE-5 Inhibitors – effective only in 60-70% of patients with diabetes. Should also be used with care in case of concomitant cardiovascular disorders.
- Second-line: alprostadil (as injections or suppositories), penile prostheses, vacuum erection devices, etc.
Correct functioning of the nervous system is vital for healthy sexual performance since erection is triggered by chemical nerve signals (nitric oxide) being released when a man is receiving sexual stimulation. The list of neurological conditions that affect the ability to achieve erection includes stroke (over 50% of men with a history of stroke experience partial or complete impotence), multiple sclerosis, epilepsy, Parkinson’s disease, multiple system atrophy, etc. Impotence may result from spinal cord injury in sacral region of the spine.Available treatments:
- First-line: PDE-5 Inhibitors
- Second-line: alprostadil suppositories, intracavernosal injections (alprostadil, papaverine, phentolamine or combination thereof), penile prostheses, vacuum erection devices, etc.
ED treatment had long been shaped by the belief that impotence can be caused by testosterone deficiency. However, recent studies show that low testosterone levels do not necessarily result in erection problems.
Certain hormonal disorders are often accompanied by impotence. These include overt hyperthyroidism, hypothyroidism, high estradiol and prolactin levels. The exact causes of such dependency are unclear.Available treatments:
- First-line: management of hormonal imbalance – hormone replacement therapy when their levels are too low, or medications that block certain hormones if their levels are too high.
- Second-line: PDE-5 inhibitors, intracavernosal injections (alprostadil, papaverine, phentolamine or combination thereof), alprostadil suppositories, penile prostheses, vacuum erection devices, etc.
Pelvic Trauma or Penis Injury
Healthy blood circulation in pelvic region is necessary for male sexual function. Many conditions such as direct injury of the penis or blunt trauma of the perineum result in decreased blood flow and, consequently, erectile dysfunction.Available treatments:
- penile revascularization
Psychological Factors Causing Impotence
Viagra and other PDE-5 inhibitors are not used to treat ED caused by psychological factors. That is because this type of ED calls for libido management rather than an erection pill. The psychological causes of impotence listed below are managed with the help of counseling.
Impotence is a common symptom experienced by up to 70% of men suffering from depressive disorder or bipolar disorder. Some medications used to treat depression (including SSRIs) affect sexual performance in a negative way.Available treatments:
- psychotherapy, antidepressants that do not affect libido (addressing norepinephrine, dopamine, and melatonin systems) or a combination of both.
Stress and Performance Anxiety
It’s not only difficult to get sexually excited when you’re worried about your performance, body image or something else. When we’re anxious, our bodies release epinephrine and norepinephrine – the stress hormones that narrow blood vessels making it physically impossible to achieve erection.Available treatments:
Loss of Interest Towards Your Partner or Sex Altogether
Psychologically induced ED occurs when a man is no longer physically attracted to his sexual partner due to relationship problems, negative body image or other factors. A general loss of libido may have an underlying physiological cause, so it’s best to discuss it with your GP if your relationship is doing fine but you feel you’re losing interest in sex.Available treatments:
- couples therapy
Iatrogenic Factors Causing Impotence
Surgery and Radiation Treatment
Invasive surgery and radiation therapy in the pelvic region affect a man’s erectile function. This happens mostly when the therapy damages nerves or muscles that are involved in the mechanism of producing an erection.
Moderate to severe erectile dysfunction develops in patients undergoing therapy for prostate cancer. 85% of men after radical prostatectomy get ED.
ED is observed in patients receiving treatment for rectal cancer, intestinal fistulas and some orthopedic conditions affecting the pelvis.Available treatments:
- surgery to repair damaged nerves/muscles
Medications affecting potency
Research by Slag et al shows that the use of medications listed below affects the prevalence of impotence heavily. Up to 25% of all ED cases are directly linked to drugs’ side effects. Here are the groups of drugs that cause ED:
- High blood pressure drugs, antiarrhythmics, antihistamines and diuretics alter the blood flow
- Antidepressants, anti-anxiety and anti-epilepsy pills alter the function of nerve signals
- NSAIDs – how anti-inflammatory drugs affect erectile function is yet unclear
- Antiandrogens used for cancer treatment may cause ED due to hormonal imbalance
- Chemotherapy drugs
- Muscle relaxers
- Parkinson’s disease drugs
- regimen adjustment or the use of alternative drugs without adverse reactions affecting sexual function
Sexual performance in men is compromised by diseases, stress, depression, physical injury and age. Regardless of that, you should stay positive even if your erection isn’t as good as before. Impotence responds to treatment with PDE-5 inhibitors well helping over 80% patients. Vacuum erection devices are effective in 85% of the cases and intracavernous injections – in over 90%. NuMale Medical Center, for instance, reports successful treatment in over 98% of patients with impotence. Pick a treatment that works for you and you’ll be able to enjoy sex again.
- Prevalence of erectile dysfunction in US population - https://www.nature.com
- Impotence is usually due to physical factors - https://www.urologicalcare.com
- Impotence in male patients with diabetes - http://www.bumc.bu.edu
- Comparative prevalence of ED in men with Type 1 and Type 2 diabetes - https://academic.oup.com
- Prevalence of ED in men with a history of stroke - http://cochranelibrary-wiley.com
- Low testosterone is not necessarily an indicator of ED - https://www.ncbi.nlm.nih.gov
- Hormonal disorders and male sexual function - https://www.ncbi.nlm.nih.gov
- Up to 70% of men with depression have erectile dysfunction - https://www.aafp.org
- Selective Serotonin Reuptake Inhibitors cause sexual dysfunction and loss of libido - https://www.ncbi.nlm.nih.gov
- Up to 85% of patients after radical prostatectomy experience ED - https://www.ncbi.nlm.nih.gov
- Medications cause up to 25% of all impotence cases -
- Effectiveness of PDE-5 inhibitors -
- Intracavernous penile injections help over 85% of men with ED -
- VED therapy effective in over 90% of ED cases -
- NuMale Health Center reaches 98% success rate in treating ED -