IMPOTENCE

How Does an Erection Occurs?

The two chambers that run the length of the penis are called corpora cavernosa. This tissue is spongy inside these compartments. Tunica albuginea is the membrane that envelops these corpora cavernosa. Vases, arteries, spaces, fibrous tissue, and smooth muscles are all present in the spongy tissue. Encircling the base of the corpora cavernosa lies the Urethra, a frequent conduit for semen and urine.

Mental and sensory stimulation precedes erection. The smooth muscles of the corpora cavernosa relax in response to brain and local nerve impulses, allowing blood to enter and fill the empty gaps. Consequently, the corpora cavernosa experiences pressure from the blood, causing the penis to become turgid.

An erection can be sustained thanks to the tunica albuginea’s role in retaining blood in the corpora cavernosa. When the penile muscles contract, the blood flow is stopped and outflow channels are opened, reversing the erection.

How is Impotency Caused?

A sequence of events is required to cause an erection and if at any stage, any break occurs, impotence results. The sequence of events is like – first of all nerve impulses generate in the brain, via spinal cord passes down around the penis and as a result produces response in muscles, fibrous tissues, veins and arteries in and around the corpora cavernosa.

The commonest cause of impotence is because of any damage to the fibrous tissues, veins, arteries smooth muscles etc. The diseases which affect these structures are diabetes, chronic smoking or tobacco, chronic alcoholism, kidney diseases, multiple sclerosis, atherosclerosis and vascular diseases generally responsible for about 65 – 70% of cases of impotence. Almost 35 – 50% of men suffering from diabetes, develop impotence.

Injury to the spinal cord, bladder, prostate, pelvis or penis can cause impotence by damage to the nerves, smooth muscle arteries and fibrous tissues of the corpora cavernosa. Also the surgery in pelvic area can damage nerves or blood vessels, results in impotence.

Long term use of many commonly used drugs like drugs for high blood pressure, antidepressants, tranquilizers, appetite suppressants, antacids and antihistaminics etc. can cause impotence as side effects.

About 30 – 35% of the cases of impotence are because of psychological reasons. These includes depression, anxiety, stress, guilt, fear of being caught, fear of failure, lack of correct sex knowledge, myths and misconceptions regarding sex. These factors are generally associated with more than 80% of the cases of Impotence.

Causes of Impotency

Performance Anxiety

This is a psychogenic problem. Erection is not possible for a man who is anxious and or depressed. Stressful conditions cause liberation of Catecholamines such as (Adrenaline and nor-adrenaline) which stops erection.

Depression

This is an important cause of impotence. But unfortunately, most of the antidepressant medicines cause erectile failure. Thus reducing the patients depression by intensive counselling is the first line of treatment.

Organic Impotence

The most common cause of organic impotence is problems in Penile Arteries or Veins or both . In arterial cause, Arteriosclerosis or hardening of the arteries is the main cause. A Venous leak is the most common vascular cause. In a normal man, arterial inflow increases to 5 to 10 times during sexual excitement. As a result the Venous drainage get compressed temporarily, thus sustaining erection. When this drainage system becomes weak and cannot hold the blood back, the penis becomes soft and flaccid. This is the result of Venous leak.

Associated factors like overweight, lack of exercise, tobacco, smoking, hyperlipidaemia, high blood pressure etc. all will leads to early erectile failure often before progressing to affect the heart. The Penile arteries are about 1/3rd the size in diameter of the Coronaries arteries and therefore the Penile arteries gets chocked sooner. Remember , if the person changes his life style well in time, these changes are reversible.

Diabetes and Impotence

Impotence is most common in diabetics. It is estimated that about 50% of the diabetics are impotent and the rest will become impotent with time. This is usually due to premature hardening of the arteries. Peripheral Neuropathy with involvement of nerves controlling erection is common in diabetics.

Neurological causes of Impotence

There are many reasons for the neurological causes of impotence. Chronic alcoholism, diabetes, multiple sclerosis, heavy metal poisoning, spinal cord injuries and injuries to nerves by Pelvic trauma, injuries of surgery, all can lead to erectile dysfunction.

Drugs and Impotence

Commonly used drugs like antidepressant, antihypertensive, antianxiety, glucoma eye drops and chemotherapy agents are few of the many drugs which can lead to impotency. Therefore the drugs should be taken under strict medical supervision.

Hormone Induced Impotence

Increased Prolactin(produced by anterior Pitutory), steroid abuse by body-builders, more or less levels of thyroid and hormonal drugs administered for prostatic cancer may cause impotence. Rarely low level of testosterone can cause impotence.

Anatomical defects

Sometimes Cogenital or acquired abnormalities of the penis may prevent erection. For eg – Peyronies Disease or Chordaee etc.

Cogenital Venous Leak

In this condition, closure of Venous Valve do not occur, which is a must for the engorgement and rigidity of the penis. Therefore such men cannot get a rigid erection and penile axial pressure is low and results in Impotence.