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Erectile disorder
Erectile disorder, or impotence, refers to a male’s inability to attain or maintain penile erection sufficient to complete intercourse. There are two forms of erectile disorder: the patient with the primary form has never achieved a sufficient erection; the patient with the acquired form, which is more common and less serious than the primary form, implies that, despite present inability, the patient has succeeded in completing intercourse in the past. Transient periods of erectile dysfunction aren’t considered pathological and probably occur in half of adult males. Erectile disorder affects all age-groups but increases in frequency with age. The prognosis depends on the severity and duration of impotence and the underlying cause.
CAUSES AND INCIDENCE
In about 50% to 80% of men who have erectile disorder, statistics point to an organic basis; psychological causes account for the remainder. In many patients, organic and psychogenic factors may coexist, making isolation of the primary cause difficult. It’s estimated that 30 million men are affected by erectile disorder.
Organic causes may include cardiovascular occlusive disease, diabetes, anemia, multiple sclerosis, renal failure, neurologic disease, complications from surgery, alcohol or substance abuse, genital anomalies, incompetent penile venous valves, nicotine abuse, or hormonal disorders. Many drugs prescribed to treat other conditions also have side effects that may affect sexual functioning.
PREVENTIONSome drugs known to cause erectile disorder include antihypertensives, antihistamines, tranquilizers, appetite suppressants, some antidepressants, and cimetidine (Tagamet), an H2 receptor antagonist.
Psychogenic causes may be intrapersonal, reflecting personal sexual anxieties, or interpersonal, reflecting a disturbed sexual relationship. Intrapersonal factors generally involve guilt, fear, depression, or feelings of inadequacy resulting from previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, or abnormal mother-son intimacy. Interpersonal factors may stem from differences in sexual preferences between partners, lack of communication, insufficient knowledge of sexual function, or nonsexual personal conflicts.
Situational impotence, a temporary condition, may develop in response to stress, as in performance anxiety. Erectile disorder is commonly reported by patients who also have eating and personality disorders.
Situational impotence, a temporary condition, may develop in response to stress, as in performance anxiety. Erectile disorder is commonly reported by patients who also have eating and personality disorders.
SIGNS AND SYMPTOMS
Secondary erectile disorder is classified as follows:
• Partial—The patient is unable to achieve a full erection.
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