Note: Vasectomy does not cause erectile dysfunction. When impotence occurs after this procedure, it is often in men whose female partners were unable to accept the operation.
Hormonal Abnormalities
Hypogonadism (Testicular Failure). Hypogonadism in men is a deficiency in male hormones, usually due to an abnormality in the testicles, which secrete these hormones. It affects 4 - 5 million men in the United States. In addition to impotence, hypogonadism causes reductions in energy, sex drive, lean body mass, and bone density. Hypogonadism can be caused by a number of different conditions. Among them are:
- Disorders in the pituitary or hypothalamus glands
- Malnutrition
- Genetic factors
- Myotonic dystrophy.
- Orchitis (inflammation of the testicles)
- Physical injury
- Mumps
- Radiation treatments
- Exercise-induced hypogonadism. Only a few cases of exercise-induced hypogonadism have been identified in men. Some researchers believe, however, that certain athletes may be at risk, including those who began endurance training before full sexual maturity, have very low body weight, and have a history of stress fractures.
Low Testosterone Levels. Only about 5% of men who see a doctor about erectile dysfunction have low levels of testosterone, the primary male hormone. In general, lower testosterone levels appear to reduce sexual interest, not cause impotence.
Other Hormonal Abnormalities. Other hormonal abnormalities that can lead to erectile dysfunction include:
- High levels of the female hormone estrogen (which may occur in men with liver disease).
- Abnormalities of the pituitary gland that cause high levels of the hormone prolactin are particularly likely to cause impotence.
- Other uncommon hormonal causes of impotence include an underactive or overactive thyroid or adrenal gland abnormalities.
Varicoceles
A varicocele is an enlarged (varicose) vein in the cord that connects to the testicle. Varicoceles are found in 15 - 20% of all men and in 25 - 40% of infertile men. When varicoceles occur in both testicles, they may contribute to hormone imbalances that cause erectile dysfunction.
Other Problems in Sexual FunctionPremature Ejaculation Premature ejaculation is the most common male sexual dysfunction and occurs in as many as 40% of men. It is defined as the inability to delay ejaculation to the point where both partners are satisfied. This can vary widely depending on the preferences of the partners. Younger men tend to have this problem more than older men. Anxiety is a major factor at any age. In general, the longer the duration between ejaculations, the faster they are. Various techniques are available to help delay orgasm. The standard medications used for this condition are selective serotonin reuptake inhibitors (SSRIs), which include Prozac and Paxil. Some studies suggest that sildenafil (Viagra) in combination with an SSRI may be helpful. A new serotonin-related drug, dapoxetine, showed promise in several clinical trials but was ultimately rejected by the FDA in 2005. There is still no drug specifically approved for treating premature ejaculation. Peyronie's Disease Peyronie's disease is an accumulation of scar tissue within the penis shaft, which causes it to curve. The curvature can make erection and intercourse difficult and painful. This condition may be associated with an injury to the penis, but no clear information exists on its origin. Some men may not even be aware that they have it, and there is some evidence that it may be more common than currently believed. In one study, 6.7% of men with an average age of 62 had signs of curvature, but only 2.2% were aware of any difficulties. The disease often goes into a type of spontaneous remission, and some individuals who had previously experienced erectile dysfunction are able to resume sexual activity. Scarring may still cause erection problems, however, even in these cases. Treatment for Peyronie's Disease. If Peyronie's disease is treated early, ultrasound, heat application, and anti-inflammatory drugs may help reduce scar formation. Some experts believe that the extracorporeal shock wave therapy (ESWT) is the safest and most effective first-line therapy. ESWT uses sound waves to break up scar tissue. It has been used with some success. Studies also suggest that the calcium channel blocker verapamil may be very beneficial. It can be administered using injection, as a gel patch, or through a process called electromotive drug administration (EMDA), also referred to as iontophoresis. EMDA delivers the drug through an electrical transport of charged molecules. Some studies are reporting good success with EMDA delivery of verapamil along with the steroid dexamethasone. In severe cases of scarring, the only treatment is surgery to straighten the penis and reduce the curve. Penile implants may also be beneficial. Priapism Priapism is a sustained, painful, and unwanted erection that persists despite a lack of sexual stimulation. Generally, priapism results when the smooth muscle tissue remains relaxed so that a constant flow of blood into the vessels of the penis occurs with no leakage back out. The development of priapism has been associated with urinary stones, certain medications, neurologic disorders, and, more recently, with self-injection therapy used for impotence. Treatment of Priapism. If priapism occurs, applying ice for 10-minute periods to the inner thigh may help reduce blood flow. Erections that last 4 hours or longer require emergency care. |
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