When the Pump Won't Work

When the Pump Won't Work

There's encouraging news for men who have experience impotence

Impotence is a treatable condition in more situations today than ever before. For those experiencing difficulties, the stock advice that psychological counselling should be sought may still apply at times, but doctors now have a far better understanding of the physiological conditions that can cause what is known technically as erectile dysfunction.

Factors can include everything from high cholesterol intake to prescription drug side effects. Dr. Irwin Goldstein, a professor of urology at the Boston University School of medicine and a leader in erectile dysfunction research, compares the penis to a hydraulic system: “All hydraulic systems have to be activated or initiated, they have to thave a high pressure hose to bring the fluid in, and they have to store the fluid. Failure of any of those systems means impotence.”

Here, Dr. Goldstein explains the risk factors and what to do about them:

Causes

Aging: There is a direct correlation between aging and impotence. Studies show that 40 percent of men at age 40 suffer from impotence. 50 percent of men at 50, 60 percent at 60, and so on. Like any other plumbing system that receives constant use, the vascular system simply begins to wear down.

Psychological factors: To attain an erection, your brain has to tell the system to start the flow of blood to the penis. Its failure to do so is the classic psychological basis of impotence. Part of being potent is being in control, so stress, anger, fear, and something called “the inverse of dominance” - which is just what impotence, also a synonym for powerless, means – can all affect performance.

Hormonal imbalances: A testosterone imbalance or thyroid condition can also lead to problems with initiation. The hydraulic mechanism is fine, but the desire to have intercourse is simply not there.

Medication: Make your doctor aware of any and all medications prescribed to you. Many of them can cause impotence: medications to treat high blood pressure, diabetes, heart disease, and depression.

Diabetes and heart disease: Erectile dysfunction stemming from diabetes or heart disease can be a symptom of the illness or of the treatment, as noted before. Both illnesses can cause nerve damage, blood vessel damage, or tissue damage, thus leading to a complete breakdown of the hydraulic systems's ability to initiate an erection because the nerves are out; fill the penis with blood because the vessels are shot; or retain the blood because the tissue has lost its holding power.

Hypertension : Raising blood pressure raises erections, but chronic exposure to high blood pressure can injure the lining of the blood vessels, which leads to blocked arteries and impotence.

Cigarettes : Though cigarette smoking doesn't appear to be significant factor in and of itself, there is evidence that it is a secondary risk factor among people with heart disease or hypertension. Cigarettes tend to aggravate damage to the lining of blood vessels, which is always a problem.

High cholesterol intake : If you eat a lot of fatty food, it will clog the circulation to the heart, it will clog the circulation to the penis. Without that blood flow, an erection is difficult or impossible to maintain.

Physical trauma: Performance-affecting injuries can occur not only to the exposed penile shaft, but to the internal part of the penis in the pelvis and the perineum (the area between the scrotum and the anus). Trauma can also occur when the erect penis is bent during intercours or masturbation, which can actually fracture it. This causes the tunica (the lining material of the penis) to develop holes and prevents the penis from storing blood, a condition called Peyronie's disease.

I love you enough to tell the truth, but you must be brave enough to accept it (Megan Jorgensen). Photo : Elena

Treatments

Prophylactic care: Theoretically, preventive measure are the most effective. Don't smoke. Watch what you eat. If you need psychological treatment, seek it. Avoid trauma – recognize that your penis is not made of concrete. It can be fractured, so use lubrication during intercourse and if you are in an unusual position with your partner that causes pain, stop.

Hormonal treatment: This treament is reserved exclusively for those who have hormonal problems. It should not be used indiscriminately to boost your libido, because it can cause your prostate to grow, which can lead to prostate cancer. Moreover, if the problem is with your plumbing, hormonal treatment will simply be ineffective and add frustration to an already serious problem.

Oral medications: There are no FDA-approved oral treatments for erectile dysfunction. But several drugs are recognized in the medical community as being effective: Yohimbine, which is used to raise blood pressure; Trazodone, an antidepressant; and pentoxifylline, which makes the red blood cells more slippery, to improve circulation in clugged arteries. Some experimenting is also being done with sub-lignual drugs that are dissolved under the tongue.

Topical medications: Because it is difficult to predict the appropriate amount of drug to apply to the erective tissue, the topical approach is less effective than oral medication. But drugs like minoxidil (used for hair growth) and nitroglycerin can relax the blood vessels in the penis to induce an erection. Inrea-urethral (applied via the urethra) drugs are being developed as well.

Vacuum constrictive devices: A vacuum tube can be used to reduce the pressure around the penis and thus draw blood into it. Once an erection is attained, a rubber band is snapped around the base of the penis to retain the blood. It's a very effective method, but it does prevent ejaculation and can also be quite uncomfortable.

Penile prostheses: About 25,000 penile prostheses are inserted every year. There are two approaches. The first is a malleable rigid device that is inserted in the penis. The downside, the penis remains eternally erect. A more complex inflatable device also can be inserted that includes an internal manual pumping device, which will alow more flexibility.

Vascular surgery: This is a bypass operation for people who are suffering from impotenc brought on by blunt trauma to the artery leading to the penis. It is not effective in cases of impotence brought on by hardening of the arteries.

Injections: FDA approval is expected soon for drugs like prostaglandin-E that can be injected directly into the penis. They work like the nitric oxide that is released naturally during foreplay to dilate the blood vessels in the penis.

Causalties of Desire

Sexual dysfunction by gender

Experience pain during sex – women 14%, men 4%.

Sex not pleasurable – women 22%, men 8%.

Unable to achieve orgasm – women 24%, men 8%.

Lack interest in sex – women 33%, men 17%.

Anxiety about peformance – women 11%, men 17%.

Climax too early – women 10%, men 28%.

Men unable to maintain erection – 10%.

Women have trouble lubricating – 18%.

(Source: The Social Organization of Sexuality – Sexual Practices in the United States, University of Chicago Press, 1994).