Impotence or erectile dysfunction is the inability to have and maintain an erection during sexual intercourse. This condition is very common among older men, with approximately 50% of all men between age 40 - 70 currently suffering from it. Impotence may be due to physical or mental issues. The physical causes could be high blood pressure, hormonal problems, injury or surgery, while the mental causes of erectile dysfunction are mainly the thoughts and feelings experienced during intercourse that may distract a man and make it difficult to have or maintain an erection.
A penile erection occurs when blood enters the penis through biological hydraulic action. The process is often an unconscious reaction, initiated by sexual arousal or stimulation. Once the blood is in the penis, sponge-like structures retain the blood within the penis until ejaculation, when the blood leaves the penile muscle tissue and returns back to the vessels. Those suffering from impotence have no blood flowing into their penis or are unable to hold the blood in the muscle tissue once erect. Absence of an erection while waking up or sleeping (nocturnal erection), is a test often used to determine whether the cause of impotence is either psychological or physical. This is all done under andrology, the study of erectile dysfunction, a sub-field in urology. There is no specific medical test used to diagnose erectile dysfunction. Blood tests may be done to rule out diabetes, hypogonadism, or prolactinoma. If a patient has never had an erection before, the the problem is more likely to be physical rather than psychological, or physiological. Other methods of diagnosing erectile dysfunction in men could be: a duplex ultrasound to check blood flow, a bulbocavernosus reflex test to check for nere sensation in the penis, a dynamic infusion cavernosometry to check vascular pressure, or a magnetic resonance angiography to check the condition of the penile blood vessels.
Treatment depends on what is causing the dysfunction. Aerobic exercise is a good natural way of treating impotence. Other methods include medication, penis pumps, herbal treatments, or surgery. Beware of herbal treatments as there are no proven clinical trials and the effectiveness of the se products in treating impotence is questionable. Some drastic methods involve surgically fitting a rigid penile implant into the penis, this will however put you at a high risk of developing priapism. Priapism is a condition where the penis fails to return to its normal size after an erection, causing damage to the blood vessels, and resulting to gangrene in more serious cases. Any penile erection that lasts for more than six hours could cause priapism. Medical treatments involve first checking for underlyng causes like arsenic contamination or potassium deficiency, then putting the patient on PDE5 inhibitor drugs like Viagra or Sildenafil. These drugs block the action of hormones that cause the penis to degragate after an erection. The drugs have also been proven to be useful in treating pulmonary hypertension, a disease where water fills the lungs due to damage in the hearts left ventricle. Other medical treatments involve the injection of prostaglandin, phentolamine, or papaverine into the penis.