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Sexual dysfunction or Impotence - Its importance to Seniors

Sex researchers have found that while sexual prowess gradually diminishes with age, men should expect to be able to enjoy sex well into their later years.

All men experience temporary periods of impotence at some time in their lives, and these need not cause alarm. A large number of men (10 million) suffer from more long-lasting impotence.

Impotence is a man's inability to produce, or maintain, a penile erection. For this reason, an impotent man cannot have sexual intercourse. Medical specialists define impotence as the persistent inability to achieve an erection of the penis.

Masters and Johnson (sex therapists) have formulated a more precise definition: the inability to achieve or maintain enough of an erection for sexual intercourse--sufficient to penetrate the vagina--at least once in four attempts.

Impotence is a common problem. Surveys show that it occurs in at least 2% of American men under age 35, 10% of those age 55, and 50% of those age 75 and older. A few decades ago physicians and sex therapists believed that impotence was mostly an emotional or psychological problem in 90% of the males. Now, with recent research the sex specialist believes that 50% to 60% of impotence has a physical basis, which is a sign of a medical problem.

During a single night, most normal men will experience several periods of erection lasting for a total of one to three hours. When investigators checked impotent men during sleep, they were surprised to find that half of them experienced erections. The occurrence of erections during sleep was almost always evidence that a man's physical erectile capacity was intact. When an impotent male did not have erections during sleep, in all likelihood his impotence had some physical cause.

HOW THE SYSTEM WORKS

The physical mechanism that makes an erection possible includes the corpora-cavernosa, two unique blood vessels that are filled with spongy matter. These cigar-shaped vessels flank the underside of the penis. They begin just behind the pubic bone, where the penis is attached to the trunk, and run along the length of the shaft to the head. Two sets of valves regulate the flow of blood to the corpora-cavernosa. One allows blood to be pumped into the vessels, changing the penis from flaccid and pendulous to hard and erect. An erection can increase the size of the penis from 20% to 200%. The other set of valves allows blood to drain off, returning the penis to its pre-aroused state.

Also important in the erectile process is the corpus spongiosum tissue surrounding the urethra (the tube that runs from the bladder through the center of the penis to its end). The male hormone testosterone also is essential to normal sexual functioning. It acts not only on the penis, but also on the prostate gland, the testicles, and the sex centers of the brain.

PSYCHOLOGICAL CAUSES OF IMPOTENCE

A man who has normal erectile responses during masturbation, or who regularly awakens with an erection, is likely to have a psychological basis for impotence.

The brain can help bring about an erection and it can prevent one. The upper portion of the brain known as the cerebral cortex can be involved in blocking the reflex action that causes an erection. By this means, thoughts or emotions can inhibit the erectile mechanism and cause so-called psychogenic impotence. Psychogenic impotence seems to feed on itself because its number one cause is fear of the possibility of failure to perform. Other factors in psychological impotence are guilt, depression, and boredom with the subject of sex stimulation.

PHYSICAL CAUSES OF IMPOTENCE

Some of the physical factors that lead to impotence are:

  • Diabetes--It ranks high on the list of physical problems that cause impotence. Half of the men who suffer from diabetes are impotent because the disease damages the nerve controlling the valves of the corpora-cavernosa.
  • Medications--Some of the drugs currently being used to treat high blood pressure and heart disease produce this unwanted side effect in many men.
  • Clinical, locked-in depression.
  • Alcoholism.
  • Deficiencies of testosterone or thyroid hormones.
  • Elevated level of prolactin, another hormone involved in sexual function.
  • Hardening of the arteries.
  • Physical deformities of the penis.
  • Spinal cord injuries.
  • Brain damage.
  • Endocrine abnormalities--Impotence is often the first important sign of a hypothalamic-pituitary abnormality.
  • Damage of the vital nerves that control erection and ejaculation.
  • Poor circulation--Increased incidence of impotence with age is because of the increasing degree of fatty-cholesterol deposits blocking the circulation to the penis.
  • Weight problems--Controlling weight may lower blood pressure and make high blood pressure medicine unnecessary, or decrease the amount to the point that impotence is no longer a problem. It must be added that excessive weight loss or fad diets can also be a cause of impotence.


WHAT CAN BE DONE

The first step in correcting impotence is to identify the cause. If it is psychological, counseling is the right approach. Reassurance and confidence building are important aspects of psychological treatment. Training in giving and receiving affection is often needed. Often, the key is found in having a loving, intimate relationship without sex. A sexual partner's attitude is very important. She should be supportive. Some men are impotent because their wives are not interested in sex. Others have basic conflicts with their wives. When the basic relationship is not good, it usually is not good in the bedroom, either.

In the mature, experienced male, correcting an underlying medical problem may be the answer. That includes correcting a thyroid disorder, or other causes. If tests show an excess of prolactin, bromocriptine is the treatment of choice. When diabetes is present, tight control of the blood glucose levels may help. When medicines such as antihypertensive medications or antidepressants are the cause, changing the medications may be all that is required. Zantac can be substituted for Tagamet for those impotent patients with peptic ulcer problems. Eliminating alcohol can cause a significant improvement in testosterone levels and may correct impotence. The abuse of other drugs may also be a factor in causing impotence.

A man's lifestyle is important to both preventing and correcting impotence. That includes controlling all the factors related to developing fatty-cholesterol deposits that cause heart attacks and strokes. Not smoking, getting adequate exercise, avoiding obesity, and following a proper diet low in fat, low in saturated fat, and low in cholesterol all help to protect the arterial system that supplies the penis.

Testosterone may be given to men who have low testosterone levels. One of the newer methods of treating impotence consists of injecting medicine into the base of the penis that dilates the arteries and allows more blood to flow into the penis; papaverine and phentolamine have been most successful. These drugs cause an erection that lasts for 30 to 45 minutes.

Nerve damage is a common cause of impotence in men who have had spinal cord injuries. Now, with the use of an electric probe, there is a method of producing erection and ejaculation in men with this problem.

To men who cannot be adequately treated with medical and psychological modes, the answer is often a penile prosthesis--a mechanical device to support erection. The prosthesis will not increase sexual desire that is blocked by psychological factors. The oldest prosthesis is two silicone rods implanted directly into the cylinders of the shaft of the penis. There is also an inflatable penile prosthesis.

WHERE TO GET HELP?

Many men with impotence due to physical causes can be restored to normal sexual function. Heart patients often can be switched to other medications. Hormonal deficiencies can be made up with medications. Alcoholism can be treated. Many physical deformities can be corrected with surgery. For some, penile prostheses provide an artificial means to make a flaccid, impotent penis rigid. Often penile prostheses can enable sexually impaired men to recapture the intimacy that goes with a shared sexual experience, pleasing their sex partner and restoring their self-confidence.

Impotent men are understandably sensitive about their affliction, and so are reluctant to try to get help.

There is some good help available:

Impotents Anonymous
National Headquarters
5119 Bradley Blvd.
Chevy Chase, MD 20815

Depending on the nature of the problem, impotent men can also seek help from physicians, clergymen, family counselors, and sex therapists.

There is a professional organization that accredits sex therapists:

American Association of Sex Educators
Counselors and Therapists
1 East Wacker Dr., Suite 2700
Chicago, IL 60601

The inability to achieve or maintain an erection. Impotence is the most common male sexual disorder, affecting most men at some time in their lives.

In the majority of men, impotence is caused by psychological factors. They may be temporary (caused by stress or fatigue) or long-standing (caused by anxiety or guilt originating from childhood). Impotence may also be a symptom of depression in males.

Approximately 10% of impotence is caused by a physical disorder or by a neurological illness. It may also be induced by taking various drugs - particularly antipsychotic medication, antidepressants, antihypertensives and diuretics. Impotence is also common as men get older, possibly because of altered circulation or, less often, lowered levels of testosterone (male sex hormone).

DIAGNOSIS AND TREATMENT

If the cause is psychological, counseling or sex therapy (preferably with the person's partner) is successful in more than half the cases of long-term impotence. To eliminate the possibility of any physical disorder, tests may be performed. The physician may stop medication or alter the dose to aid in diagnosis; attempts are also made to treat any depression or alcohol abuse. Penile Implants help some men whose impotence is caused by disease.

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