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Jan 17, 2008

Erectile Dysfunction And Impotency

© Dr Vandana Patni 2008

Word 'Impotency ' is used more commonly when actually there is problem with erections. Erectile dysfunction is the repeated inability to get or keep an erection firm enough for sexual intercourse.

Impotency is a wide term which describes some other complex concept which interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation and orgasm. 

Erectile dysfunction or ED can be total inability to achieve erection, an inconsistent ability to do so or a tendency to sustain only brief erections.
It is impossible to know actual incidence of ED but it is estimated that 10% of male population face this problem in younger age and in later age over 60 years of age more than 20% males have this problem.

Causes of Erectile Dysfunction

Erection of penis is a sequential event. And any disruption in this sequence can cause ED.The sequence includes nerve impulse in brain,spinal column, area around penis and response in muscles,fibrous tissue,veins and arteries in and around corpora cavernosa.

Damage to nerves,arteries,smooth muscles,fibrous tissue often as a result of disease is the most common cause of ED.

Physical Causes:
Most cases (70-80% cases)have some underlying pathology behind ED. In older men, ED usually has a physical cause. Incidence increases with age.

A. Diseases

1. Diabetes- Between 35 and 50 percent of men with diabetes experience ED.
2. Kidney disease
3. Multiple sclerosis
4. Atherosclerosis
5. Vascular disease
6. Neurological disease
8. Parkinson's disease
11. Cardiovascular system diseases.
All these disease account for about 70 percent of ED cases.

B. Medicines

1. High blood pressure drugs(Anti hypertensives)
2. Antihistamines
3. Antidepressants
4. Tranquilizers
5. Appetite suppressants
6. Cimetidine (an ulcer drug)
7. Some illegal drugs are used in various parts of world which causes ED.
Drug effects account for 25 percent of ED cases.

C. Other Causes

1.Smoking- smoking reduces blood flow in veins and arteries of penis.
2.Chronic Alcoholism- Long time alcoholism cause ED.
3. Hormonal Abnormalities- low level of Testosterone hormone.
4. Obesity- overweight person who avoid exercise have higher incidence.
5. Injury- surgery (especially radical prostate and bladder surgery for cancer) can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to ED by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Psychological Causes

It is believed that 10-20% cases has Psychological Causes of ED.
1. Stress
2. Anxiety
3. Depression
4. Guilt
5. Low Self Esteem
6. Fear Of Sexual Failure
7.Interpersonal conflicts with a sexual partner

Searching for cause of Erection Dysfunction

1. Sleep erections-
Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable.

2.Clinical tests used to diagnose ED

A:Duplex ultrasound
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Measurements are compared to those taken when the penis is flaccid.

B:Penile nerve function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease.

C:Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge.

D:Penile biothesiometry
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence.

E:Penile Angiogram
Invasive test - allows visualization of the circulation in the penis and is used during the repair of a priapism.

F:Dynamic Infusion Cavernosometry (DICC)
Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. To do this test, a vasodilator like prostaglandin E-1 is injected to measure the rate of infusion required to get a rigid erection and to help find how severe the venous leak is.

G:Corpus Cavernosometry
Cavernosography is an adjunct to Dynamic Infusion Cavernosometry, where a contrast material is injected and then it is x-rayed to visualize any leakage.

H:Digital Subtration Angiography (DSA)
In DSA, the images are acquired digitally. The computer crates a mask from lower-contrast x-rays of the same area and digitally isolates the blood vessels (this is done manually through darkroom masking with traditional angiography).

I:Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies. Aside from the IV used to introduce the contrast material into the bloodstream, magnetic resonance angiography is noninvasive and painless


Treatment proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.
Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered. Psychotherapy often treats psychologically based ED using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when ED from physical causes is being treated.
A small percentage of men undergo vascular re constructive surgery to improve blood flow to the penis. Revascularization involves bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage. Penile implants involve surgical insertion of malleable or inflatable rods or tubes into the penis.

General tips to overcome ED

1. Consuming herbal preparations to rejuvenate the reproductive organs.
2. Massaging the body with a herbal oil which gives a relief from physical exertion and also acts as aphrodisiac.
3. Practicing Yoga and Meditation to overcome mental exertion and to cope up with stress.
4. Sleep at least for 8 hours a day.
5. Avoiding the consumption of alcohol, tobacco, heroin etc.
6. Exercise regularly.
7. Avoid hot, spicy and bitter foods.
8. Favor sweets, milk products, nuts and urad dal.
9. Add little ghee in your diet.
10. Give a gap of four days between two consecutive intercourses.

Homeopathic Treatment

Homeopathy offers almost 421 remedies for men suffering from erectile dysfunction .Unlike conventional medicines, homeopathic remedies are non-toxic and not addictive. Homeopaths frequently treat patients suffering from anxiety, fear of failure to do sex, ED associated with stress and high blood pressure.

Pressure of work, mid-life crisis and other issues affect men’s health in various ways. Men facing the challenges of aging, retirement and finding new identities for themselves, find a particularly appropriate therapy in homeopathy, which addresses them on mental, emotional and physical levels. When combined with the benefits of good nutrition, exercise and relaxation, homeopathy can provide optimum support for such patients.

Where the cause of ED is with other system diseases and due to drug effects, there also homeopathy provides better option to start homeopathic therapy for those diseases to stop side effects.

Most Common Homeopathic Medicine:

Agnus Castus, Anacardium, Antim Crud, Argentum Nitricum, 
Aurum Met, Caladium, Causticum, Coccus Cacti, Digitalis, Fluoric Acid, Ginseng, Ignatia, Kali Brom, Kali Phos, Lycopodium, Merc Sol, Moschus, Nuphar Luteum, Nux Vom, Onosmodium, Phosphoric Acid, Picric Acid, Pulsatilla, Rhus Tox, Selenium, Staph, Thuja etc.

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