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◆ IMPOTENCE - diseaseconditions



◆ IMPOTENCE
o0-----------------0o
ERECTILE DYSFUNCTION
o0-----------------0o


=>GENERAL INFO:
--------------------

Impotence or erectile dysfunction affects 10-15 percent of all males and can be emotionally and psychologically disabling for men and their partners. In 80% of erectile dysfunction cases, physical factors such as drugs, blood flow abnormalities, nerve impulse abnormalities or hormonal abnormalities are the major causes. Psychological factors account for the remaining cases and may be attributed to stress, performance anxiety and misinformation about sexuality.


=>DEFINITION:
----------------

Impotence or erectile dysfunction, is the inability to achieve an erection, and/or dissatisfaction with the size, rigidity, and/or duration of erections. Erectile dysfunction affects millions of men.

Although in the past it was commonly believed to be due to psychological problems, it is now known that 80 to 90 percent of impotence is caused by physical problems, usually related to the blood supply of the penis.


=>RISK FACTORS:
------------------

According to the National Institutes of Health, erectile dysfunction is also a symptom in many disorders and diseases.

FOLLOWING ARE THE RISK FACTORS:

-> Type 2 diabetes
-> Hypertension
-> Prostate Problems
-> Depression
-> Alcohol ingestion
-> Lack of sexual knowledge
-> Poor sexual techniques
-> Inadequate interpersonal
relationships
-> High levels of blood cholesterol
> Smoking
-> Hypogonadism in association with
a number of endocrinological
conditions
-> Vascular disease and vascular
surgery
-> Low levels of HDL
-> Drugs
-> Neurogenic Disorders
-> Peyronie's Disease (distortion or
curvature of the penis)
-> Priapism (inflammation of the
penis)
-> Many chronic diseases, especially
renal failure and dialysis.


Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.
It is estimated that nearly 5 percent of men become impotent by the age of 40, and 15 to 25 percent by the age of 65. Accurate risk factor identification and characterization are essential for prevention or treatment of erectile dysfunction.


=>TYPES OF ED:
------------------

FOLLOWING ARE SOME DIFFERENT TYPES OF IMPOTENCE:

1=> PREMATURE EJACULATION (PE):

Premature ejaculation is the inability to maintain an erection long enough for mutual satisfaction. Premature ejaculation is divided into primary and secondary forms:

(A). PRIMARY PREMATURE EJACULATION:

Primary premature ejaculation is a learned behavior that begins when a male first become sexually active. Like any learned behaviors, it can be unlearned. This form of Primary Ejaculation is psychogenic (as opposed to organic or physical) impotence. (Congenital venous leak is a subset of primary PE and is caused by a congenital venous leak in which the venous drainage system in the penis does not shut down properly.)

(B). SECONDARY PREMATURE EJACULATION:

Secondary premature ejaculation occurs when, after years of normal ejaculation, the duration of intercourse grows progressively shorter. Secondary PE is due to physical causes, usually involving the penile arteries, veins, or both.


2=> PERFORMANCE ANXIETY:

Performance anxiety is a form of psychogenic impotence - usually caused by stress or anxiety.

3=> DEPRESSION:

Depression is another cause of psychogenic impotence. Some antidepressant medications cause erectile failure.

4=> ORGANIC IMPOTENCE

Organic impotence involves the penile arteries, veins, or both, and is the most common cause of impotence, especially in older men. When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause. The controllable risk factors for arteriosclerosis - being overweight, lack of exercise, high cholesterol, high blood pressure, and cigarette smoking - can cause erectile failure often before progressing to affect the heart. Many experts believe that when veins are the cause, a venous leak or "cavernosal failure" is the most common vascular problem.

5=> DRUG-INDUCED IMPOTENCE

A great variety of prescription drugs, such as blood pressure medications, anti-anxiety and antidepressant medications, glaucoma eye drops, and cancer chemotherapy agents are just some of the many medications associated with impotence.

6=> HORMONE-INDUCED IMPOTENCE

Hormonal abnormalities such as increased prolactin (a hormone produced by the anterior pituitary gland), steroid abuse by body-builders, too much or too little thyroid hormone, and hormones administered for prostate cancer may cause impotence. Rarely is low testosterone responsible for impotence.



=>DIAGNOSIS:
----------------

To determine whether the cause of the erection problem is physical or psychological, the urologist may prescribe a change in medication, hormone replacement, antidepressant therapy, devices, or self injection to promote erections. In some cases, the patient may opt for a surgical alternative, such as insertion of a penile implant.

1). MEDICAL/SEXUAL HISTORY:

It may reveal conditions or diseases that lead to impotence and helps distinguish among problems with erection, ejaculation, orgasm, or sexual desire.

2). PHYSICAL EXAMINATION:

To look for evidence of systemic problems, such as the following:
-> A problem in the nervous system may be involved if the penis does not respond as expected to certain touching.
-> Secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involves the endocrine system.
-> Circulatory problems could be indicated by an aneurysm.
-> Unusual characteristics of the penis itself could suggest the basis of the impotence.

3). LABORATORY TEST:

To help diagnose impotence include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. When low sexual desire is a symptom, measurement of testosterone in the blood can yield information about problems with the endocrine system.

4). PSYCHOSOCIAL EXAMINATON:

To help reveal psychological factors. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.


=>TREATMENT:
----------------

THE TREATMENT BASED UPON:

-> Age, overall health, and medical history
-> Extent of the disease
-> Tolerance for specific medications, procedures, or therapies
-> Expectations for the course of the disease
-> Individul opinion or preference

SOME AVAILABLE TREATMENT:

(1). SILDENAFIL SITRATE:
(ViagraTM)

ViagraTM is the first approved non-surgical treatment for erectile dysfunction that does not have to be either injected or inserted directly into the penis to achieve and maintain erection. It was approved by the US Food and Drug Administration (FDA) for prescription sale at the end of March, 1998.
Viagra does not directly cause penile erection, but affects the response to sexual stimulation.

The FDA recommends that men follow these general precautions before taking Viagra:
A). If you are taking medications that contain nitrates, such as nitroglycerin, you should not use Viagra. The two taken together can lower blood pressure too much.

B). Women or children should not use Viagra.

C). Have a complete medical history and physical examination to determine your cause of erectile dysfunction.

D). Men with medical conditions that may cause a sustained erection such as sickle cell anemia, leukemia or multiple myeloma, or a man who has an abnormally shaped penis May not be able to take Viagra.

E). Tell your physician about all the medications you are taking - including over-the-counter ones - because there are medications known to interact with Viagra.

F). Viagra's use in combination with other ED treatments has not been studied, therefore, its use in combination with other treatments is not recommended.

(2). HORMONE REPLACEMENT:

Testosterone replacement therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects. Testosterone replacement therapy is available in an oral form and as a skin patch.


(3). PENILE IMPLANTS:

There are three types of implants used to treat ED, including the following:

A). HYDRAULIC PUMP:

A pump and two cylinders are placed within the erection chambers of the penis which causes an erection by releasing a saline solution; it can also remove the solution to deflate the penis.

B). PROSTHESIS:

Two semi-rigid but bendable rods are placed within the erection chambers of the penis which allows manipulation into an erect or non-erect position.

C). SOFT PLASTIC BLOCKS:

These are placed within the erection chambers of the penis and can be inflated or deflated using a cable that passes through them.
Infection is the most common cause of penile implant failure and is treatable with antibiotics. In some cases, the infected implant must be replaced by a new implant. Implants are usually not considered until other methods of treatment have been tried.

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