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IMPOTENCE
Impotence, condition in
which a man is unable to attain an erect penis
that is rigid enough for sexual penetration or
sexual satisfaction. This condition is also
called erectile dysfunction. The word
“impotence” can be considered to have a broader
meaning than just the medical one: it can also
be used to mean “powerless” or “decrepit”.
Impotence should not be confused with premature
ejaculation, loss of libido, or absence of
orgasm; in all of these cases satisfactory
erection is obtained. It has been estimated that
4 per cent of men in Europe suffer from some
degree of impotence, although only a small
minority of these (about 5 per cent) seek
medical advice. The incidence increases with age
and it is thought that 25 per cent of men over
65 are impotent.
Diseases may also contribute towards impotence;
diabetes mellitus predisposes men to develop
erectile dysfunction, with about 25 per cent of
all patients suffering from impotence. It is
also thought that the rise in incidence of the
condition is due to the increasing longevity of
the population, with sexual activity more common
among older people.
CAUSES OF IMPOTENCE
Normally, when a man
becomes sexually aroused, his penis increases in
size, becoming erect and rigid, enabling him to
penetrate his partner’s sexual orifices. The
penis is normally between 7 cm (2.7 in) and 10
cm (4 in) long; when it is erect it increases in
size to about 17 cm (7 in). Leonardo da Vinci
showed, in his anatomical illustrations, that
the penis fills with blood in order to cause an
erection. Indeed, an erect penis contains six or
seven times the volume of blood of a flaccid
penis. This process is controlled by the
autonomic nervous system. The rate of blood flow
into the penis is greater than the rate at which
the blood is draining out, which leads to an
accumulation of blood.
Impotence may have psychological causes. For
example, if a man has suddenly lost his job, his
feeling of failure may lead to temporary
impotence. It can also be caused by disorders of
the blood system, nervous system, or brain, or
by hormone deficiency, as well as by damage or
surgery to the pelvis or penis. However, the
most common cause in men who seek medical help
is an iatrogenic one—that is, their impotence is
caused by a drug that they are receiving as a
treatment for some other disorder. Diuretics,
tricyclic antidepressants, H2 blockers,
beta-blockers, and hormones can all cause
impotence; once the drug treatment is halted,
normal erections should resume. Excessive intake
of alcohol is one of the main causes of
temporary impotence.
It is possible to tell if the cause of a man’s
impotence is solely psychological; if he still
experiences normal erections during rapid eye
movement (REM) sleep there is unlikely to be any
physical reason for his impotence when
conscious. However, in some cases a physical
condition which is not severe enough to produce
impotence on its own may make a man more likely
to develop impotence if minor psychological
factors are also present.
TREATMENT
The treatment of impotence
needs to take into account both the physical and
psychological causes of the condition. Since the
early 1980s it has been possible for affected
men to learn how to inject a drug into the
corpus cavernosum of the penis. This allows the
relaxation of smooth muscle tissue, and allows
the inflow of blood, thereby initiating the
erectile mechanism and producing an erection,
which lasts for about an hour. (If this is used
over a long period of time problems with
scarring may occur.) Alternatively, a prosthesis
may be inserted into the penis under anaesthetic.
This may be a semi-rigid rod or an inflatable
rod. There are also several devices available,
known as vacuum constriction devices, which are
used to produce an erection. The penis is
inserted into the device and the vacuum draws
blood into the corpus cavernosum, causing the
penis to become erect. An elastic ring is placed
round the base of the shaft of the penis in
order to maintain the erection.
Treatments based on various forms of
psychotherapy are also widely used. In 1970, an
American gynaecologist William Masters, working
with a psychologist, Virginia Johnson, proposed
a programme of behavioural therapy to be
undertaken by the affected man and his partner.
This method has been widely accepted, and
involves the couple not attempting sexual
intercourse for several weeks while they develop
other aspects of their physical relationship.
Intercourse is attempted only when the man is
able to have an erection and sustain it on
several occasions.
In March 1998 the drug company Pfizer launched
Viagra in the United States. Within a year some
3.6 million prescriptions for Viagra had been
issued in that country. It was licensed for use
in the European Union in September 1998. This
orally prescribed drug has been shown to be
effective in increasing the body's ability to
achieve and maintain an erection.
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