What do you know about erectile dysfunction? Before you face it you never think about it seriously. It seems to be the condition that will surely come someday but not tomorrow. And even then it is not going to be such a problem because there are lots of medications that are able to deliver from ED within a few minutes. In other words, sexual life will become a little bit more complicated because of taking certain medicines, but it will not end absolutely.
Unfortunately, when men begin dealing with erectile dysfunction they discover that it sometimes turns out to be a challenge to pick out the right medication that will be both effective and safe for male health. This is the main thing My Canadian Pharmacy pays special attention to.
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• Propecia (getting back men’s hair and confidence in their own power)
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• VPXL (firmer and harder erections for over a longer period of time are guaranteed)
• Pink Female Viagra, being an ED drug for women, increases women’s libido and boosts the desire
Though the main attention of the pharmacy is focused on medications that help treat impotence, there is a wide range of other drugs which can bring relief from lots of other conditions, including the following:
• viruses and infections – antibiotics
• psychological disorders – antidepressants, sedatives
• different kinds of pain – pain killers
• high blood pressure – blood pressure normalization medications
• allergies – anti-allergic meds
• dermatological illnesses, rashes – skin care pills and many others.
In case you don’t know what medicine you should take in your particular condition, you can always turn for medical advice to a professional team of doctors and pharmacists who will gladly recommend you the drug and dosage according to your symptoms.
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Erection dysfunction is indicated from the failure to protect an erection within the span of sexual performance. This article covers a few of the plenty of options agreed to males experiencing sexual issues. Recognizing the options would be the initial part of managing the problem.
It may occasionally be related to external companies like fun drugs or pollutants. Smoking and alcohol intake also subscribe to ED. If medicine is evoking the annoyed, transforming to some numerous manufacturer could often resolve the problem.
Additional additional unpleasant but fairly effective therapy options can be found to customers. Additional overthecounter products purpose by increasing awareness. Lots of males resort to prescription supplements that handle an enzyme that regulates blood circulation. Any medication causes unwanted effects. The individual and doctor need to choose would be the results outweigh the bad.
Secure and usually very useful holistic remedies usually include developing consumption of zinc and vitamins A, b complex, and E. Levidus and other natural remedies are among the most favored having little or no unwanted effects. They truly are available overthecounter and on the web.
Neurogenic disorders like Alzheimer’s Disease and Parkinson’s Disease often affect efficiency; spinal and head injuries inside the similar method. The mind cannot promote the muscles essential.
For almost any condition it is best to find guidance from the healthcare professional. If it may be not, then it may be protected to continue discovering the therapy possibilities.
Exercise and healthy diet regime launch enjoyable substances in to the body.
Some males use the usage of machine treatment to deal with their symptoms. A penis pump can be an equipment installed within the penis. Having a guide or electric push, the tube produces suction.
Sustaining an erection have to not be considered a supply of pressure. Erection dysfunction therapy in Canadian Health Care Mall is available in numerous easily available forms.
Penile Injections
Activity at this point in the erectile process negates the need for sexual excitement in achieving erection. This discovery made available an inexpensive, safe, repeatable treatment buy viagra pills online in Australia that was effective in a very high percentage of men with diverse origins of impotence.
Other injectable agents soon followed, each affecting the erectile mechanism at different points in the signaling process. The drug phentolamine induces erections by blocking norepinephrine. Prostaglandin induces cAMP production, which then causes cell relaxation in the same way as papaverine. Because these drugs act at different points in the erection process, they can act to optimize one another’s effects. Researchers have taken advantage of this, and now combinations of the drugs are widely used as an intracavernous injectable mixture.
Although these injectable drugs are effective in about 80 percent of patients, they require some advance planning, as there is about a 10-minute waiting period before erection. In addition, side effects, which are seen in a very small percentage of users, can include corporal scarring and penile pain. The most significant disincentive for their use, however, appears to be the psychological barrier to self-injection.
The inclusion of injectable treatments in the recommendations of a 1992 National Institutes of Health conference on impotence helped to legitimize the treatment of erectile dysfunction in the eyes of the government. Subsequent approval by the Food and Drug Administration of Caverject (an intracavernous injection of prostaglandin) and MUSE (a prostaglandin intraurethral pellet) brought about Medicare reimbursement for some nonsurgical treatments of erectile dysfunction on HQ Canadian Pharmacy.
Other Approaches
Some treatments are designed to correct an imbalance that may exist in male sex hormones, which can also cause erectile dysfunction. Cases of significantly low levels of testosterone, often resulting from a congenital abnormality or from trauma or vascular injury to the testes, can be corrected with monthly intramuscular injections of the hormone or daily application of transdermal skin patches. Hyperprolactinemia, an overproduction of the hormone prolactin caused by an anterior pituitary tumor, can be treated with the drug bromocriptine or by surgical removal of the pituitary gland (pituitary hormones must be supplemented after surgery).
The use of topical agents for various types of erectile dysfunction, though not very effective in the past, are undergoing clinical trials. These vasodilating creams do not seem to show much promise, however, because the drugs probably need to enter general circulation to achieve a practical effect.
Though most clinicians do not have the luxury of a detailed assessment of sexual dysfunction, a simple and quick assessment of erectile function is possible. The first step is to ask about sexual problems of any kind. Many patients may not volunteer information about their sexual difficulties, unless they are presenting with such a complaint. Studies have found that patients still face obstacles in addressing these concerns with their health care provider, often as a result of the clinician’s avoidance of the issue. Research indicates that patients with sexual dysfunctions wait, on average, 4 years before they receive appropriate treatment for their problems. Therefore, a general question about sexual problems should be a standard part of any medical or mental health evaluation.
Once a patient has identified a sexual concern, the next step is to determine if he indeed has a sexual dysfunction. Despite society’s apparent openness about sexuality, ignorance and misinformation about sexual function still abound. One important intervention that clinicians are often called upon to provide is accurate information about normal sexual response. Simple education and reassurance are sometimes the only treatment necessary. This depends on a clinician having both the requisite knowledge and the appropriate attitude to discuss sexual issues with his or her patient.
If the patient is experiencing ED, the next step is to describe the problem more specifically. The most important distinction to be made is between “generalized” ED and “situational” ED. Generalized ED is defined as a problem that occurs on all occasions of sexual arousal. This can be determined most simply by asking one question, “Do you ever have a full erection?” A patient who answers “No” manifests a generalized form of ED. Usually, more detailed questioning is required to accurately categorize the problem by asking the patient about: sexual activity with any partner, selfstimulation (i.e., masturbation), nocturnal erections, and spontaneous sexual arousal. The goal of all of these questions is the same, i.e., to determine if the patient is ever capable of a full erection. If the patient is able to obtain a full erection in any of these situations, the problem is labeled a situational case of ED. Viagra Australia – ed medications online in AUstralia.
Of particular interest are the patient’s nocturnal erections. Surprisingly, most patients are not aware that healthy men experience 4–5 erections every night during periods of REM sleep. It is therefore helpful to explain this when asking about nocturnal erections. The presence of at least occasional normal nocturnal erections is strong evidence that “the plumbing works” and is often a relief to patients.
Mortal Limits
Biomedical ethicist Daniel Callahan wrote that, in our parent’s time, persons used to die of natural causes, but today we no longer have that luxury. Callahan was writing about the frenzied exercise of medicine to keep terminally ill patients alive, at great expense to survivors and soci ety. Commonly, family members and medical teams collude in the work of preventing death at all costs. Callahan commented that, in the medical culture shared by both doctors and patients, “natural causes” of death no longer exist; every death is treated as a preventable failure on the part of medicine.
The truth is, of course, that the body dies. Before death, gravity takes its toll on organs and tissues. What was taut and firm now points south. With aging, bodies get smaller, saggier, and weaker. For many, if not most persons, these hints of mortality are an insult. In response, Western culture is replete with strategies to counter this insult: elective plastic surgery, fat farms, and December-June marriages. The culture of youth is as vibrant as its television advertisements. The limits of mortality are denied. Against this denial of mortal limits, sex is a sign of life. And so it should be. It requires, as has been said repeatedly here, a minimum level of physiological health. In its procreative expression, sex promises future lives if not future life. But sex can also be used as a device to deny limits that, to borrow Callahan’s phrase, are “natural causes.” The loss or decline of sexual function is a hint of mortality. There is a distinct value judgment to be made about how attentive one should be to hints of mortality. If one takes the position, as I do, that hints of mortality are part and parcel of life that should be listened to, then one should listen to and accept the limits of sexual function without ceaseless somatic interventions. Employing somatic treatments over and over again to deny eventual mortality does little to enrich the sexual life of a couple. Indeed, it may do much to distract from an appreciation of their total life together during the time remaining to them.
The tragedy of September 11, 2001, gave rise to a cultural appreciation of the limits and fragility of life. Persons about to die called their dear ones on cell phones to express their love in their final minutes. Those of us who were survivors, like survivors everywhere, generally expressed in our grief a greater appreciation of “the important things of life” and an intention to “take time to do the really important things.” What made this possible was the terrible shout of mortality rising from the crashes of September 11. We heard our mortality and returned to our lives to live them more intentionally.
On a personal level, the many hints of mortality that an individual or couple receives can, and I suggest should, be used for the same purpose of living more intentionally. While somatic treatments for sexual dysfunction may be part of that living intentionally, they may also be part of a collusion to deny mortality at all costs.
SUMMARY
The disease perspective takes the somatic reality of sex seriously. It states that sex is, at its bedrock, a corporal event. To the extent that disease, injury, surgery, medication, and drugs compromise the physiological functioning of the body, to that same extent sexual functioning may be compromised. The clinician working to understand a sexual problem from the disease perspective evaluates the patient’s physical and psychological history as well as his or her family medical and psychological history. Although there may be many psychosocial factors that should be noted and treated in due course, the clinician employing the disease perspective wants to be sure that the body is working as well as it can. If somatic treatments will improve sexual functioning, the clinician informs the patient about them and assists in their integration. When the body signals that it has reached its highest level of sexual functioning given its limitations of disease or aging, the clinician understands that signal and turns to another perspective, the life story perspective, to assist the patient in heeding the meaning involved.
Disease
Diabetes and normal aging (menopause) are two real somatic conditions that affected Mark and Esther’s ability to function sexually. As such, the diabetes and postmenopausal conditions deserve to be the object of somatic treatment. Perhaps other, psychological interpretations might have been developed to understand their sexual problems. Mark might have been passive aggressive in not treating his erectile dysfunction sooner. Esther, as a consequence of her sense of rejection, might have refused hormone replacement treatment as a way of withholding herself as a potential sexual partner. And there certainly may have been numerous nonsexual marital tensions or differences that could serve as the focus of lengthy marital therapy. But Mark had diabetes and Esther had atrophic vaginal walls.
The disease perspective says that the clinician should first examine all the somatic conditions and diseases that might play a causal role before rushing on to a more psychological understanding of the sexual dysfunction. For the physician, this is professionally instinctive; for the nonphysician with a treatment quiver filled with psychological approaches and interpretations, ruling out diseases and somatic conditions is usually a skill deliberately learned. Nonphysician mental health providers must develop a level of knowledge about the diseases affecting sexual function that is superior to that of the educated layperson. They must also have a good working relationship with primary care physicians, urologists, and gynecologists, both for their own continuing education and for mutual patient referrals.
The Past Is Prologue
In the somatic treatment of sexual dysfunction, it is important to observe the limits posed by premorbid sexual function. “Past is prologue” in the sense that the baseline level of sexual function for the years preceding the onset of the disease is probably going to be the optimum level of functioning possible with the most successful of somatic treatments. A common medical phrase is “return to baseline”: the patient returns to the level of function (e.g., cardiac, pulmonary) that he or she had before a disease or critical event.
Mark and Esther will in all probability never have more interest in sex or more frequent sex than they did before the onset of Mark’s diabetes. While the “finding again” of each other sexually will undoubtedly enrich their marriage, after their second honeymoon their sexual life will probably settle into the baseline value they placed on sex twelve years ago. This is realistic, not pessimistic. It is a realism that is aided by the disease perspective, with its sensitivity to somatic limits posed by illnesses and injuries even though much of the baseline of sexual life is determined by factors other than somatic.
These nonsomatic factors make the return to baseline not merely a realistic compromise between ideals and reality but also a goal to strive for. After many decades, aging bodies and the ebbing of all novelty demand that the physiological drive for sex be supplemented by motivations of caring, sensuality, and need for intimacy. Helping couples to recall their baseline level of sexual life gives them a joint goal to aim for. Memory and imagination can be employed to picture the type of sexual life the future may hold for them. The clinician’s role is—to use the saying usually applied to parents—to give their patients both ground and wings: the ground of accepting the limitations imposed by somatic conditions; the wings of imagining new meanings and ways of coming together sexually.
The most remarkable change in the treatment of sexual disorders in the past two decades has been the emergence of somatic treatments. In ear lier years, the only somatic interventions had been surgeries and topical applications. The surgeries included procedures such as insertion of a penile prosthesis and reconstruction of vulvar and vaginal tissue. Topical aids were vaginal lubricants and attempts, usually unsuccessful, to apply an anesthetic to the penis to retard premature ejaculation. In the past twenty years, however, the primary somatic treatment of male sexual dysfunction has been the use of oral medications such as Viagra, intracavernosal injections, and penile vacuum devices. The goal of the treatment is, obviously, to produce an erection capable of penetration. It is an organ- specific goal; there is no claim that the presence of an erection will make the man want to use it sexually—let alone that his partner will want to.
For women, the goal of somatic treatment is likewise directed toward improving the genital environment so that it can contain the penis and respond with pleasurable sensations rather than pain. Vaginal lubricants are sold over the counter and are widely used successfully. For women with hormone deficiencies due to surgery or for postmenopausal women, estradiol vaginal tablets improve lubrication and make the vaginal epithelium thicker. Exogenous androgen is also employed for androgen-deficient women (e.g., those who have had their ovaries removed) to increase sexual desire, but this remains a controversial treatment. A product called EROS-CTD serves as a suction device on the clitoris, improving clitoral engorgement and presumably the potential for vaginal lubrication, subjective arousal, and orgasm. At present, research is being conducted on vasoactive medications for sexual arousal in women, comparable to the Viagra-assisted arousal in men.
A full review of the somatic treatments of sexual dysfunctions and disorders is not the purpose here and is available elsewhere. Instead, I offer some comments on somatic treatments from the disease perspective in the context of a typical case.
■ Mark and Esther had been married for thirty-nine years. During the last ten years they had not had intercourse, because of Mark’s erectile dysfunction brought on by diabetes. The diabetes was well controlled in recent years, and Mark had felt guilty about not being able to have intercourse with Esther. In preparation for their fortieth wedding anniversary, Mark obtained a prescription for Viagra from his primary care doctor. He tested it privately and, with some manual simulation, obtained a full erection such as he had not experienced in years. He could not wait for their anniversary to surprise Esther. As might have been predicted by even a casual observer, the anniversary bedroom scene was not a happy one. Having taken the Viagra an hour before retiring, and with some minimal self-stimulation, Mark had a full erection. Esther had reconciled herself years ago to a marriage that was sensual but not sexual. She had not taken hormone replacement after menopause, because she had some medical concerns and, in any case, they weren’t having intercourse. Now here they were: forty years of marriage, ten years without intercourse, Mark with a full erection—and Esther with no psychological or physiological preparation for intercourse. Following some conversation, during which Mark lost the erection, they decided to try intercourse. After some time and stimulation, Mark was able to get an erection. It was difficult to penetrate Esther, and when he finally did it was quite painful for her. He withdrew immediately, with orgasm for neither. It was about two months before they felt able to seek help, so hurt and embarrassed were they about the failure of communication and the physical pain Mark had caused Esther. The work of the sexual therapy was to assist them to gradually integrate the use of Viagra into their sexual life. It necessitated a switch of focus from his penis to her arousal, both emotional and in terms of vaginal lubrication. After discussing the pros and cons with her internist, Esther began hormone replacement therapy, which made her “generally feel better.” Gradually, over a period of four months, the couple progressed in sensate focus therapy, from sensual rapprochement to sexual engagement to successful intercourse about every three weeks.
Integration
The somatic treatments, as briefly described above, offer women and men an opportunity to restore sexual function in situations where disease, surgery, aging, or even psychological factors have made it impossible. These treatments are widely prescribed by primary care physicians and by specialty physicians such as urologists and gynecologists, and many of the somatic treatments are available over the counter. Millions of people will try them; the challenge is whether or not the somatic treatments will be integrated into the sexual lives of those who use them. The case of Mark and Esther is patently a situation of non-integration in the introduction of Mark’s use of Viagra. Mark’s attention was too selffocused on the presence of an erection. He forgot that coming together sexually, for two people who care for and are committed to each other, entails more than an erect penis. He was probably totally ignorant of the possible condition of his wife’s postmenopausal vagina in the absence of hormone replacement.
Integration of somatic treatments of sexual dysfunction recognizes that the treatments are directed to the genital organs. Their effect is to make the genitals capable of responding sexually. The work of integration is to harmonize improvements in physiological functioning of the genitals with an emotional desire and readiness for the sexual activity. This integration does not require professional assistance for most couples— most can incorporate the somatic treatments into their sexual life through open communication with each other. But other couples, such as Mark and Esther, find themselves unable to use the somatic advances without professional assistance in the work of integration. The art of sexual therapy with such a couple is to provide assistance while being as unobtrusive and noninvasive of their sexual and intimate life as possible. Sexual therapy entails assisting couples to do the work of emotional, sensual, and sexual integration.
Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).
Psychotherapy
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient’s partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.
Drug Therapy
Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day.
Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs–including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone–but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient’s believing that an improvement will occur.
Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels.
These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis.
A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.
The most common side effects of the preparation are:
- aching in the penis, testicles, and area between the penis and rectum;
- warmth or burning sensation in the urethra;
- redness of the penis due to increased blood flow;
- minor urethral bleeding or spotting.
Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.
Vacuum Devices
Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure).
One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.
Surgery
Surgery usually has one of three goals:
- To implant a device that can cause the penis to become erect,
- To reconstruct arteries to increase flow of blood to the penis,
- To block off veins that allow blood to leak from the penile tissues.
Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.
Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.
Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.
With an inliatable implant, erection Is produced by squeezing a small pump (a) implanted in the scrotum. The pump causes fluid to flow Irom a reservoir (b) residing in Ihe lower pelvis to two cylinders (c) residing in the penis. The cylinders expand to create ihe erection.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage.
Surgery to veins that allow blood to leave the penis usually involves an opposite procedure–intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure’s long-term effectiveness.
In patients who only have partial erections or who either do not respond to other treatments or prefer not to use them, a vacuum device maybe useful. The device consists of a plastic cylinder connected to a pump and a constriction ring. A vacuum pump uses either manual or battery power to create suction around the penis and bring blood into it; a constriction device is then released around the base of the penis to keep blood in the penis and maintain the erection. A vacuum device can be used safely for up to 30 minutes, which is when the constriction device should be removed. The advantage of such a device is it is relatively inexpensive, easy to use and avoids drug interactions and side effects. Side effects may include temporary penile numbness, trapping the ejaculate and some bruising.
Penile prosthesis
For men with erectile dysfunction who have failed or cannot tolerate other treatments, a penile prosthesis offers an effective, but more invasive alternative. Prostheses come in either a semi-rigid form or as an inflatable device. Most men prefer the placement of the inflatable penile prosthesis.
The placement of the prosthesis within the penis requires the use of an anesthetic. A skin incision is made either at the junction of the penis and scrotum, or just above the penis, depending on which prosthesis and technique is used. The spongy tissue of the penis is exposed and dilated; the prosthesis is then sized and the proper device is then placed. The inflatable device — a pump that contains the inflation and deflation mechanism — is placed in the scrotum. The patient can control his erection at will by pushing a button under the skin. Although placement of the prosthesis requires a surgical procedure, patient and partner satisfaction rates are as high as 85 percent. Full penile length might not be restored to the patient’s natural erect status. Rare side effects include infection, pain and device malfunction or failure. As the nerves that control sensation are not injured, the penile sensation and the ability to have an orgasm should be maintained.
Psychological Causes of Impotence
Common causes of psychogenic impotence include depression and performance anxiety. Depression is associated with decreased energy, interest and decreased libido or desire. Performance anxiety, work stress or strained personal relationships can affect erectile function in both conscious and subconscious ways.
Neurogenic Impotence
Penile erection depends on an intact nervous system so any injury to the nervous system involved in erections may cause impotence. Diseases such as Parkinson’s disease, Alzheimer’s disease, stroke or head injury can lead to impotence by affecting the libido, or by preventing the initiation of the nerve impulses responsible for erections. Patients with spinal cord injuries will have decreased erections related to the extent of the injury. Patients who have undergone pelvic surgery such as radical prostatectomy, cystectomy or colectomy may have injury to the cavernous nerves that control erection. Long-standing diabetes may affect some nerves as well as causing impotence.
Hormonal Causes of Impotence
Diseases and conditions that decrease circulating testosterone in the body, such as castration or hormonal therapy used to treat prostate cancer, will decrease libido and impair erections.
Vascular Causes of Impotence
Diseases such as high blood pressure, high triglyceride and cholesterol levels in the blood, cigarette smoking and diabetes mellitus, and treatments such as pelvic irradiation to treat prostate, bladder and rectal cancers, may damage blood vessels to the penis over time. There is strong epidemiological association between heart disease, hypertension, low levels of high-density lipoproteins (HDL) and impotence. Patients with Peyronnie’s disease which causes curvature of the penis, trauma, diabetes or old age may have damage to the spongy tissue of the penis, causing the veins to be more “leaky,” which can lead to impotence.
Drugs and Impotence
Certain anti-depressants or anti-psychotics have been associated with impotence, especially those drugs that regulate serotonin, noradrenaline and dopamine. These include Prozac, Zoloft and Paxil. Beta-blockers and thiazide agents used to treat hypertension are associated with impotence. Cimetidine, a drug to treat acid reflux disease; chronic alcoholism; estrogens and drugs with anti-androgen action such as ketoconazole, and spironolactone can cause impotence, decreased libido and male breast enlargement. Even moderate alcohol intake may have an effect.
Aging and diseases which cause impotence
Aging, even in healthy men causes a progressive decline in sexual function. Medical studies have discovered that as men age, there is a decrease in turgidity, or “stiffness,” of erections as well as a decrease in the force and volume of ejaculation. Also, with normal aging, there is an increase in the length of time required between erections after orgasm, called the refractory period. Further, the sensitivity to touch decreases over time as do serum testosterone levels, with an associated decrease in desire. Studies indicate that half of all men with diabetes will eventually develop impotence. In addition, those with liver cirrhosis, chronic renal failure or coronary artery disease have a high incidence of impotence.
Drugs (medically prescribed, alcohol, nicotine, caffeine, illicit drugs) are consumed to cure, to calm, to stimulate, or to avoid physical and psychological pain. The body affected by drugs is a body with altered sexual responsiveness. Therefore, ingested drugs must be recognized as possible causes of sexual dysfunctions and disorders.
Some drugs are alleged to be prosexual in that they are thought to promote sexual activity. Alcohol, cocaine, and hallucinogens, including amphetamines, fall into this grouping.
– Alcohol is popularly thought to decrease inhibitions about sexual activity. In fact, several researchers over the decades have generally concluded that alcohol has negative physiological effects on arousal and orgasm, to say nothing of the severe health effects that can result from sustained alcohol abuse. But the expectations of both women and men are such that they report increased sexual functioning, even when responding to an alcohol placebo. Thus, the frequent clinical situation is that patients generally believe that alcohol helps them to function sexually, while in fact both its short-term and long-term effects on healthy sexual functioning may be the opposite.
– Cocaine is a drug of abuse that is often linked with sexual behavior. As is often the case with alcohol intoxication, cocaine impairs judgment and often leads to sexual activity that puts individuals at risk for sexually transmitted diseases. Cocaine’s dopaminergic effect increases sexual desire in both men and women but also inhibits orgasm and, given a sufficient dosage, causes erectile dysfunction. Individuals with a cocaine habit will find themselves with increased sexual desire, with little inhibition about the sexual activity, and eventually unable to become aroused.
– Hallucinogens such as LSD, Ecstasy, mushrooms, and amphetamines are commonly perceived to be aphrodisiac in their effect on sexual function. This might be expected given the CNS effects caused by these substances. As Crenshaw and Goldberg noted, “The intoxicated states (however mystical) that occur with hallucinogens involve severe alterations in dopamine, serotonin and excitatory amino acid activity. Phencyclidine (PCP, angel dust), for example, incites potent activity at glutamate receptors, apparently inducing psychoses by altering excitatory amino acids. Given the strong impact of these neurotransmitters on sexual function, both extremely positive and negative sexual effects may be expected to occur.” Relying on intoxication for sexual experience has obvious detrimental long-term consequences.
– Other drugs are decidedly negative in their effects on sexual functioning. Excessive alcohol, chronic nicotine use that has caused cardiovascular disease, some antihypertensives, and many antidepressants—all have been implicated in interfering with sexual function. Table lists some of the more commonly prescribed drugs and their effects on sexual function. This not an exhaustive list, but it provides examples of the reported sexual dysfunctions associated with the drugs.
Given the various effects that drugs can have on the physiological basis of sexual function, the clinician needs to know what drugs the individual with a sexual problem is taking. A complete review of a patient’s use of prescribed, over-the-counter, and possible illegal drugs is essential. Once known, the drugs should be examined for their possible contributory role in the sexual problem.