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1. In 1974, Kaplan coined the term ‘Erectile Dysfunction’ (ED) which according to a National Institutes of Health (NIH) consensus panel convened in 1993 stated that ED is defined as the inability to achieve and/or maintain an erection sufficiently for satisfactory sexual activity.
2. "A naughty thought" was all that was required to lift the penis and if it did not “rise to the occasion” it was claimed to be due to a state of the mind.
The first study that demonstrated reliable data on the prevalence of ED in a large population sample was conducted by Kinsey in 1948. This study evaluated 15,781 men in the general population who were classified by age, education, occupation and residence. ED was found to be an age dependent disorder with a prevalence ranging from 0.1% at 20 years of age to 75% at 80 years Types of Erectile Dysfunction Organic (Physical) –
1. Vasculogenic (arterial and/or venous),
2. Neurologic,
3. Hormonal
4. Cavernosal abnormalities or lesions. Psychogenic – due to central inhibition of the erectile mechanism without a physical insult.
Mixed – due to a combination of organic and psychogenic factors.
Organic factors : with or without psychogenic factors, are present in an average of 78% of men with ED. This finding clearly implicates the myth that in most cases ED is psychogenic. Aging:
1. Aging, which has the strongest association with ED probably exerts its effects mainly through impaired vasodilatory and veno-occulusive mechanisms.
2. Atheroma of the internal iliac arteries and their pudendal branches and age related degeneration of intracorporeal smooth muscle resulting in venous leakage are important factors related to age. Diabetes Mellitus
1. ED is one of the most common complications of diabetes, its prevalence ranging from 35% to 75% of diabetic men.
2. Damage to small blood vessels is the main etiology and, therefore, ED often occurs in associations with diabetic retinopathy. Diabetic peripheral autonomic neuropathy is a further contributory factor. Cardiovascular Disease
1. The association of impotence with vascular disease in the literature is strong.
2. Heart disease and two associated risk factors, hypertension and low serum high-density lipoprotein, were significantly correlated with impotence. Hyperlipidemia
1. The probability of impotence varied inversely with high-density lipoprotein cholesterol.
2. Billups and Friedrich, suggest that erectile dysfunction may be one of the earliest indications of vascular disease. Smoking
1. Cigarette smoking has been shown to be an independent risk factor for vasculogenic impotence.
2. This is because of its deleterious effects on blood vessels and its action leading to an increase in platelet stickiness. ALCOHOLISM
1. Chronic Alcohol patients also suffer from Erectile Dysfunction.
2. After withdrawal of Alcohol they improve.
3. Drug Therapy
4. The role of some drug classes such as estrogens (used in the treatment of prostatic cancer), antihypertensives, and cardiac-active drugs.
5. Chronic Renal Failure
6. Impaired Erectile Dysfunction is frequent in men with chronic renal failure, and the prevalence of ED has been reported to be as high as 45%.
7. Peyrone’s disease
8. Fibrosis developing in the corpora albuginea may result in permanent scarring and consequent deformity of erection. Depression
1. Reactive or endogenous depression is strongly associated with ED. Nearly 90% of severely depressed men report complete impotence.
2. Endocrinological causes
3. Testosterone secreted from the Leydig cells of the testis under the influence of luteinizing hormone (LH) is necessary for normal male sexuality and sexual function.
4. Lower circulating testosterone, result in loss of libido and ED.
5. Patients who are hypogonadal as a result of pituitary or testicular dysfunction frequently suffer from ED, which responds to treatment with exogenous androgens i.e. testosterone.
6. Progressive decrease in free testosterone levels with age. In some men, the lack of testosterone may be associated with a loss of libido and erectile dysfunction.
7. Prolactin
8. is release from the pituitary gland, acts as an inhibitory factor in male sexual function.
9. Hyperprolactinemia, either idiopathic or, less commonly, the result of a tumor such as a pituitary prolactinemia, is associated with ED.
10. Correction of the raised prolactin levels using bromocriptine may sometimes restore potency in such patients.
Neurogenic Causes
1. Besides central nervous system causes like cerebrovascular accidents, Parkinson’s disease and multiple sclerosis, damage or degeneration of peripheral nerves supplying the corpora also results in ED. Example includes diabetic neuropathy, cauda equina lesions.
Psychogenic causes
1. Psychogenic ED typically occurs in younger men, and is variable and often associated with performance anxiety.
2. The treatment of functional sexual impotence is by counseling, behavioural training, sex education and drugs.
3. Results are usually uncertain. Sulbutiamine has been shown to be effective in improving sexual symptoms when compared to placebo.
Conclusion
My clinical experience with the patients who are coming to me with the problem of impotence were performed the following tests-
1. First of all I used to exclude psychological impotence mainly by history taking. If the patients seems to be of orgainic impotence then we perform following tests :
1. Testosterone, Prolactin & PSA estimation.
2. Penile Test.
3. Management og Organic Erectile Disfunction.
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