Posts Tagged ‘impotence’

Opiate Drugs and Impotence

// October 30th, 2010 // No Comments » // Impotence

Morphine, heroin, and methadone fall into a class of drugs known as opiates. They have a profound negative effect on the hormonal regulation of male sexual function. All serve to depress the normal pattern of secretion of the hypothalamic hormones that trigger the release of LH and ultimately testosterone. Low testosterone production, decreased libido, and impotence are all common among chronic heroin, morphine, and methadone addicts.

Hormones, Impotence, and the Temporal Lobe

// October 29th, 2010 // No Comments » // Hormones, Impotence

Our understanding of the hormonal interplay necessary for normal male sexual function continues to evolve. Medical professionals used to consider the pituitary the master gland, the agent that doled out specific instructions to regulate the function of the other endocrine glands — thyroid, adrenals, and testicles. Twenty years ago, it became clear that the pituitary could not discharge this important regulatory function on its own but was beholden to a higher hormonal power located in the hypothalamus. The pituitary was then more properly recognized as an intermediary existing to fulfill the hormone directives issued by the hypothalamus.

Just as we became comfortable with this concept, another area of the brain, the temporal lobe, entered the playing field. The role of the temporal lobe in hormone secretion appears to be more meddlesome than regulatory. This is especially true when viewing the effect of temporal lobe influences on male sexual function.

Scientists studying the temporal lobe in humans were fully aware of its critical role in the reproductive and sexual function of animals. Experimental destruction of a specific portion of the temporal lobe (the amygdala) caused testicular degeneration in male rats and cats. Implants of estrogen in rabbits’ amygdalae provoked hyperprolactinemia. But how do these animal experiments relate to humans?

As mentioned, some men suffer from a temporal lobe disorder called temporal lobe epilepsy (TLE). They have decreased libido and are often impotent. Some of these men have low serum testosterone levels; others have increased blood levels of prolactin.

TLE is different from other forms of epilepsy. Early symptoms are subtle and are characterized by a series of “spells.” Sudden attacks of abdominal pain, dizziness, fugue states, bed-wetting, and rage as well as auditory hallucinations may be clues to the presence of a temporal lobe disorder. The coexistence of a form of epilepsy and a hormone disorder initially created a dilemma for the physician. Which condition should be treated first?

Experience provided the answer. Patients with TLE and hypogonadism are, at first, unresponsive to testosterone injections, and those with TLE and hyperprolactinema do not benefit from bromocriptine. (This distinguishes them from other hypogonadal or hyperprolactinemic men.) Antiseizure medications such as phenytoin (Dilantin) or carbarnazepine (Tegretol) must be the first line of treatment. Then conventional hormone therapy is beneficial. (Frequently, the antiseizure medications not only control TLE symptoms but also allow serum hormone levels to return to normal.)

The diagnosis of TLE requires specialized testing. An unusual type of brain-wave test, the sleep-deprived electroencephalogram (EEG), detects subtle disturbances in temporal lobe electrical activity. A new diagnostic probe, single photon emission computerized tomography (SPECT scan), may also help. The SPECT scan registers different colors in relation to blood flow. Areas of greatest blood flow in the brain show up with the whitest colors. Since increased blood flow is one characteristic of seizureprone brain tissue, these areas light up on SPECT scan.

Hormone disorders are perhaps the most easily diagnosed causes of impotence, and hormone measurements should be an integral part of the early evaluation of the impotent man. Hormone abnormalities, once detected, can be treated with some dispatch and considerable success.

Male Sexual Chemistry and Viagra

// October 25th, 2010 // No Comments » // Impotence

From the moment Viagra came on the market, men, and women, too, have been intrigued by this new “potency pill.” In this chapter, you will find answers to many of the commonly asked questions about Viagra.

1. What is so special about Viagra?
2. Understanding male sexual chemistry: What makes Viagra work?
3. How does Viagra differ from other impotence treatments?
4. Is Viagra effective for every impotent man?
5. What are the side effects of Viagra?
6. Is there reason to fear Viagra?
7. Death after sex and/or Viagra: What is the risk?
8. What are the fantasies, fears, and reality of philandering after Viagra?
9. Can Viagra take the worry out of sex?
10. How can Viagra be used for maximum benefit and minimal risk?
11. The politics of male sexuality: Who will pay for Viagra?
12. Does Viagra work for women?
13. What’s next after Viagra?

His Cheshire cat smile, renewed vigor in stride, and different gaze — firm, straight-ahead, no longer oblique or downcast — tells me what I want to know before Michael opens his mouth.

“It worked!”

Eager to elaborate, he went on: “I took the pill around 9 P.M., watched a little TV, then in the middle of the 10 o’clock news decided to join my wife on the couch and started in like when we were first dating.”

“I’m waiting to hear the weather, she protested.”

“This will be more interesting than the weather,” I insisted, feeling myself starting to swell.”

“What’s gotten into you?” she wanted to know.”

“I’ll tell you later.”

Before long our clothes were off, we were in the bedroom, and my penis was firm. Then the more we played, the firmer it became. I could not remember the last time I was this powerful or excited. The more we played, the harder it got, and when we made love, it was exciting and wonderful, like it was before I had, you know my problem. Now I feel like a new man,” Michael enthused.

Michael and millions of men just like him, once impotent and fearful of entering into any sexual activity because of lingering doubts about whether they would be able to “perform” during sexual intimacy, can now look forward to enjoying sex once again, all because of a tiny blue pill.

In the past “the Pill” referred only to the oral contraceptive birth control pill. That “Pill” liberated women, allowing them to enjoy sex and be sexually active without fear of pregnancy. The new “Pill” is equally revolutionary because it deciphers the mystique of a man’s sexuality.

Maybe it was inevitable. Sooner or later someone had to solve the riddle of a man’s unique sexual chemistry. Once doctors knew what controls a man’s sexual urges and his ability to have sexual intercourse, they believed they would know all there was to know about men’s sexuality. For too many years, everyone, scientists and public included, attributed all male behavior to too much or too little testosterone. Now we know that testosterone is still important, even vital, for many male directed sexual behaviors. Indeed, today we have a better and much more sophisticated understanding of the promises and perils of this prototype male hormone.  But testosterone alone is not the whole story.

Men’s sexual chemistry depends on even more. Once scientists understood the chemical reactions involved in the transformation of a man’s penis from limp to erect, they could develop a “designer potency pill.” The goal was to recharge a man’s sexual batteries and make it possible for a man who, for one reason or another, had lost the ability to have sex to reclaim his manhood. Such a pill would allow a sexually impaired man to feel confident about his ability to have erections and take pleasure in sexual intercourse once again.

Over the years, many pills containing yohimbine, vitamin E, and zinc were hawked as male restoratives. Many are still used to bolster a man’s sexual appetite and power and continue to enjoy great popularity today. However, none of these oral medications achieved the immediate stardom or instantaneous success of sildenafil (Viagra).

From the beginning, the buzz on Viagra was extraordinary, like that for no other new drug in the history of medicine. Viagra’s FDA approval shouldered aside, at least temporarily, the public’s obsession with President Clinton and Monica Lewinsky. The prestigious column-one slot in the New York Times was devoted to FDA approval of this pill to treat impotence. Every major newspaper and news magazine followed suit, and overnight Viagra became a household word.

More causes of impotence

// October 25th, 2010 // No Comments » // Impotence

Prescription Medications

Several drugs, specifically antihypertensives and antidepressants, as well as those commonly used to treat ulcers, can impair sexual responsiveness. Frequently, an adjustment in medication type or dosage is all that is needed to restore sexual potency.

Other Chemical Use

The chemicals in prescription medications are not the only substances responsible for disrupting male sexual function. Thus, the routine medical history contains questions concerning alcohol consumption, cigarette smoking, and use of marijuana, cocaine, and heroin. All these substances, when used in excess, can sabotage the operation of internal systems responsible for sex drive, erections, and ejaculation.

THE PHYSICAL EXAM

After taking the medical history, the doctor will perform a physical exam and will look for previously undiagnosed high blood pressure, diabetes, heart disease, and prostate problems. In addition, there are several unique features of the exam when sexual difficulties are involved.

Visual Field Exam

This test helps determine whether any loss of vision has occurred in the corner of the eyes. Pituitary tumors press on the portion of the eye nerves responsible for lateral or peripheral vision. They may also interfere with testosterone production, resulting in impotence.

Thyroid

The thyroid gland sits in the neck in front of the windpipe (trachea). The thyroid regulates virtually all the metabolic processes of the body and, when not functioning properly, can have a profound effect on desire and potency. The doctor can feel whether the thyroid is large or lumpy; patients whose impotence is caused by an over- or underactive thyroid (hyper- or hypothyroidism) have distortions in thyroid anatomy that can readily be detected.

Pulses

As noted, adequate blood flow to the penis is essential for normal erections to occur. The easiest way to evaluate blood flow is to feel a patient’s pulse, particularly in the arteries in the groin and lower legs. Men with atherosclerosis or other problems that restrict blood flow have dampened pulses. If weak or absent pulses are found, blood flow to the genitals may also be inadequate.

Neurologic Exam

Signs of nerve damage (neuropathy) can be detected by simple maneuvers. Decreased sensation to the touch of a feather or a pinprick or sluggish or absent knee and ankle reflexes suggest a defect in the nerves that normally carry sensation and activate reflexes.

Penis and Testicles

The penis is checked for any firm, fibrous bands or distortions in shape that would indicate underlying Peyronie’s disease Testicular size is estimated. A substantial variation exists. Nevertheless, testicles less than 3.5 centimeters (one and one-half inches) are considered small. Truly atrophied testicles appear as pea-size nubbins in the scrotum.

It is also important to determine whether both testicles have descended fully into the scrotum. Normally, the testicles descend immediately before birth. Some testicles do not complete the migration; they become nonfunctional and can produce neither adequate amounts of testosterone nor sperm.

The length of the penis is rarely a factor in sexual dysfunction. For the very few men whose erect penis is too small for penetration, reconstructive surgery is possible.

Impotence and Heart Disease

// October 25th, 2010 // No Comments » // Impotence

During sex, heart rate and blood pressure increase. The heart requires additional oxygen. If the arteries leading to the heart are narrowed because of atherosclerosis (hardening of the arteries), they cannot provide a sufficient supply of oxygenated blood to accommodate those increased demands of the heart. When this occurs, a frightening chest pain called angina pectoris can develop. The pain acts as a powerful countervailing force to continued sexual activity. If a man has experienced such pain during sexual intercourse, his physician will want to schedule diagnostic studies to determine whether the pain is due to coronary artery disease or other problems.

The increase in heart rate and blood pressure during sex is so predictable that sexual activity can be thought of as a “stress test” that stretches the limits of cardiac reserve. But bear in mind that men who have had heart attacks and even those who have had cardiac surgery can, after a period of recuperation, return to a normal sex life. However, an appropriate amount of time must elapse to allow the damaged heart muscle to recover and surgical wounds to heal.

An extensive patient-doctor discussion of the wisdom of continued sexual activity is prudent. Then a collaborative decision to develop a plan for an appropriate and safe pace of physical activity leading to the resumption of sexual intercourse is sensible.

Diabetes Mellitus and Impotence

// October 25th, 2010 // No Comments » // Impotence

Impotence is a common problem for diabetic men. Sexual problems do not surface when diabetes first appears, but after some years, the diabetic process can damage blood vessels and nerves needed for erections. The large or medium-size arteries become clogged, and blood cannot reach the penis with sufficient force to create an erection. Diabetes can scar smaller arteries, restricting the “breathing room” of the penile erectile cylinders so they cannot expand sufficiently for a fully rigid erection.

Diabetes also disables the nerves that normally signal penile blood vessels to start trapping blood to hold an erection. Symptoms and signs of this diabetic nerve damage (neuropathy) include numbness or tingling of the legs and feet and difficulty in fully emptying the bladder.

Impotence and High Blood Pressure

// October 25th, 2010 // No Comments » // Impotence

Hypertension can impair male sexual function. Impotence is about three times more common in untreated hypertensive men than in men of similar age who have normal blood pressure. We are not sure why. Persistent high blood pressure possibly invites hardening and narrowing of the small blood vessels in the penis. When this occurs, blood cannot flow with the same freedom into the erectile bodies, making it difficult for men with hypertension to achieve or sustain erections.

Almost all men with high blood pressure are treated with antihypertensive medications, some of which have sexual side effects

DOES AGING CONTRIBUTE TO IMPOTENCE?

// October 25th, 2010 // No Comments » // Impotence

Kinsey’s observation that older men experience problems with sex more often than younger men is accurate. But the reasons remain the subject of considerable controversy. Gerontologists have been studying a group of healthy older men age sixty to seventy-nine as part of the Baltimore Longitudinal Study (BLS) on aging. Men in the study were queried about their sexual activity during the course of a year. They were then divided into those who had “least,” “medium,” and “most” sexual events (intercourse and/or masturbation). Roughly equal numbers of men fell into each category. This suggested that some independent factor — not age alone — determines the level of sexual vigor for men over sixty. In this population of healthy men, only 25 to 35 percent reported difficulty achieving a functional erection.

Other investigators have challenged the BLS observations, maintaining that they are not reproducible. Dr. Alexander Vermeulen of Belgium arrived at a diametrically opposite conclusion. His data indicate that among sixty-o eighty-year-old men, only 25 to 35 percent do not have problems; rather, fully 65 to 75 percent do have problems. Some argue that it is not the aging process per se but other concomitant factors that are responsible for the diminished sexual ability of older men. The BLS study may be faulted because only men who were unusually healthy and free of common medical problems such as high blood pressure and diabetes mellitus qualified for inclusion. Since both high blood pressure and diabetes are common in older men, many investigators believe it is inappropriate to generalize observations from the BLS experience to other geriatric populations.

HOW COMMON IS IMPOTENCE?

// October 25th, 2010 // No Comments » // Impotence

It was not until the middle of the twentieth century that reliable information on the prevalence of impotence was available. As previously noted, Dr. Alfred Kinsey, in his Sexual Behavior in the Human Male, estimated that impotence occurred in less than 2 percent of men under the age of forty. The incidence increased gradually with age, so that, according to Kinsey, 6.7 percent of men were impotent by age fifty-five and almost 25 percent at seventy. Recent data suggest that Kinsey’s report significantly underestimated the total. Current surveys indicate that impotence plagues 30 million American men.

Part of the problem in collecting accurate data relates to men’s lack of candor when discussing sexual problems. Most men are more than willing to answer questions about their income, general health, smoking, and drinking habits. They are often disarmingly frank about their extramarital relationships, sexual preferences, and sex life. Still, the same men are recalcitrant when confronted with a questionnaire asking for truthful and accurate answers regarding sexual impairment. As noted, in a prior chapter, these times of extraordinary sexual enlightenment, impotence may be the only subject remaining in the closet.

Because it is important to have some estimate of the prevalence of impotence, investigators have devised a series of questionnaires with sufficient ingenuity to provide information that may have been overlooked in the past.

For example, two investigators, Drs. Anthony Reading and William Weist, recruited subjects in London, England, by proposing to examine attitudes relating to the development of a male contraceptive. During the course of the extensive interview, information was elicited relative to the volunteers’ current sexual function and dysfunction. The investigators found that among a group of presumably healthy, sexually active, heterosexual Englishmen (age twenty to thirty-five) involved in a stable relationship, 8.25 percent admitted having difficulty achieving and maintaining an erection satisfactory for sexual intercourse, and 18.5 percent said that they did not achieve an erection satisfactory for masturbation.

Dr. Ellen Frank and her associates at the University of Southern California decided that the optimal way to verify descriptions of male sexual function was to direct the same questions to both husband and wife. Dr. Frank, like others, recognized that reliable descriptions of sexual function are most  likely to be obtained by using a subtle approach. Her extensive fifteen-page questionnaire, therefore, contained only one and one-half pages relating to sex. In her survey of one hundred married couples in their mid-thirties, Dr. Frank identified surprisingly high levels of sexual dysfunction reported by the men and confirmed by their wives. Sixteen percent of the men reported difficulty acquiring or sustaining an erection. In addition, 36 percent felt they ejaculated too quickly, and 4 percent were unable to ejaculate at all. This number is roughly twenty times Kinsey’s estimate for a similar age group.

Dr. Michael Slag of the Minneapolis Veterans Administration expanded on Frank’s observations, providing data from a different perspective. He interviewed men attending a Veterans Administration outpatient clinic for problems unrelated to sexual function and found that of 1,180 men, 401 (34 percent) complained of impotence. But this patient population differed in several respects from the couples studied by Dr. Frank.

The men in Dr. Slag’s study were older; the average age was fifty. In addition, all had some medical problem that prompted them to visit the clinic. In many cases the illness itself was the primary cause of sexual dysfunction. It is also worth noting that men attending any clinic can be expected to receive medication, and many medications can affect sexual function. In fact, Dr. Slag was able to incriminate medications as a direct cause of the impotence in 22 percent of the impotent men in his study.

Dr. Leslie Schover, a psychologist at the State University of New York at Stony Brook, surveyed 300 men with a mean age of 55 and reported that 21 percent of them complained of impotence.

erectile dysfunction help

// October 25th, 2010 // No Comments » // Impotence

You Are Not Alone

what is impotence

what is impotence

Whether he calls it impotence or ED — erectile dysfunction — the man experiencing a sexual problem often believes his predicament is unique to him. As we start to talk honestly about sex, it is becoming increasingly apparent that more and more men and women are having sexual difficulties. This chapter provides answers to the most frequently asked questions about male sexual dysfunction, or ED, including these: How common is it? Is aging a factor? Do common medical problems like hypertension, diabetes, and depression cause impotence, or is it the medications used to treat these conditions that disrupt a man’s sexual function? Can you do anything to prevent impotence?

When a man is unable to achieve an erection satisfactory for intercourse, he is considered impotent. Today the term “erectile dysfunction)” or “ED” has supplanted “impotence,” probably because ED is a less emotionally charged term. This is not surprising because the dictionary defines the word “impotent” as (1) lacking physical strength or vigor: weak, (2) powerless; ineffectual, (3) incapable of sexual intercourse. This definition is more than just demeaning, for it strikes at the very fabric of a man’s maleness.

Generally speaking, the phrase “erectile dysfunction,” or “ED,” has been promulgated by those who are frankly promoting different impotence treatments and are themselves more comfortable saying that they have a new product to correct ED than a novel impotence treatment. However, the individual man with sexual problems rarely comes to the doctor saying, “My primary problem is that I have ED” or “Doc, now that you’ve helped lower my blood pressure, I wonder if I could discuss my erectile dysfunction with you.” Men, if they discuss their sexual difficulties at all, either resort to euphemisms such as “I can’t get it up anymore” or fall back on the embarrassing admission “I guess I’ve become impotent.”

However you choose to label it, the truth is that many men, if not all men, have at one time or another experienced isolated episodes of ED, or impotence. Often this is transient, a result of fatigue, excessive drinking, or preoccupation with business or family problems. Under these circumstances, it would be inappropriate to saddle the man with a diagnosis of complete impotence; instead he is said to have experienced situational erectile dysfunction. Criteria established by Masters and Johnson indicate that a diagnosis of impotence is appropriate only when a man experiences failure more than 25 percent of the time during attempted intercourse.