Also known as erectile dysfunction (ED), impotence is defined as the repeated inability to achieve or maintain an erection. Although ED alone is not a cause of infertility, it certainly presents a challenge for couples trying to achieve pregnancy. According to which study you’re looking at, ED currently affects anywhere between 15 and 30 million men across the United States. This significant variation in statistics is likely due to the fact that many men are still reluctant to seek treatment for their ED, due to cultural stigmas surrounding male infertility.
What Causes ED?
Attaining and maintaining an erection are achieved through a complex sequence of events, involving different chemical messengers in the brain that send blood to the muscles of the penis, causing it to fill with blood and expand; a separate penile gland is involved in keeping the blood in the penis to maintain the erection.
Therefore, if any of these organs or tissues is for whatever reason malfunctioning, the entire process is affected. There are many possible reasons as to why a man might develop ED.
About 10 to 20% of all cases are attributed to psychological factors such as depression, guilt or stress, while nearly 70% are caused by disease, such as multiple sclerosis, alcoholism, kidney disease or diabetes, all of which can prevent blood flow to the penis. In fact, some 30 to 50% of diabetic men experience ED.
Certain illegal and prescription drugs (such as antidepressants and blood pressure medication), as well as certain lifestyle choices such as being overweight and smoking, have also been linked to impotence. Spinal cord or brain injuries can also impair a man’s ability to achieve an erection due to damaged nervous impulses that inhibit communication between the brain and the penis.
Before ED can be diagnosed, the doctor must first find out what’s causing the problem. He will most likely conduct a physical and psychological examination as well as do a background check on the patient’s medical and sexual history to get an idea of his overall state of mental and physical health. There are also several laboratory tests such as hormonal blood tests that may be performed.
Normally, to determine if the ED is psychological or physical the doctor may ask the patient to stay overnight in a supervised environment so he can monitor the patient’s nocturnal erections. Healthy men will have an involuntary erection during the night; therefore if the patient doesn’t have an erection, it is likely the ED is being caused by a physical problem.
ED can be treated in a variety of ways. If, for example, a prescription medication was determined to be the cause of infertility, the medication will likely be changed. Doctors are also looking into new ways to perform certain operations so as to avoid post-surgery impotence.
For men whose ED is caused by psychological factors, some form of talk-therapy will likely be recommended, sometimes in combination with other medications. Sex therapy is an increasingly recommended form of this type of treatment. If the patient is involved in a relationship it is likely that his partner will be encouraged to participate in therapy so that open communication can be established.
Impotence caused by physical problems like disease may be treated with certain medications. Viagra has no doubt made oral contraceptives a more popular option, although direct injections into the penis are generally believed to be more effective since they allow for automatic erections. Negative side effects may include persistent erection and scarring, although research is still underway as to whether there are any possible long-term effects.
There are three main types of surgeries performed on men with ED:
- Penile implantation to cause erections (the most common type of surgery);
- Reconstruction of the arteries to increase blood flow to the penis;
- Reconstruction of the arteries to block off veins that cause blood to leak from penile tissues
For men seeking a less invasive or simply a more natural way to treat their ED, one popular option is the vacuum method, whereby a tubular plastic device is placed over the penis, sealed off and then using a hand pump the man draws blood into the penis to achieve erection. A rubber ring is then placed at the base of the penis to prevent blood from leaking to maintain the erection. The entire process usually takes only a few minutes.