What are the physical causes of impotence?
IPhysical impotence develops gradually and is characterized by any of these three basic functional problems:
Failure to initiate results from impaired release of the chemical messages sent by the nervous system. The inability to develop an erection is common in cases of hormonal insufficiency, spinal cord injury, radical pelvic surgery, multiple sclerosis and Parkinson's disease.
Failure to fill results from poor blood flow into the penis. The inability to develop an erection rigid enough for intercourse is caused by blockage in the arteries, common in cases of pelvic trauma, hypertension, smoking, diabetes and high cholesterol.
Failure to store results from venous leakage when blood escapes too quickly from the penis, leaking back into the body. This inability to maintain an erection rigid enough for intercourse is common in cases of hypertension, smoking, diabetes, high cholesterol and pelvic trauma.
Physical impotence occurs when there is a problem with any of the systems needed to get or maintain an erection. The good news is that potency can usually be restored when a man is treated for underlying medical conditions, when medications are adjusted or when lifestyle habits are changed.
Here are some of the top causes of impotence:
Cardiovascular diseases. Hardening of the arteries can affect the artery leading to the penis so that it cannot dilate enough to deliver all the blood necessary for an erection. Impotence can also occur if the nerves that control blood flow to the penis are damaged. Atherosclerosis typically affects arteries throughout the body and is aggravated by hypertension, high blood cholesterol levels, cigarette smoking, and diabetes mellitus. When coronary arteries (arteries that supply blood to the heart muscle) are narrowed by atherosclerosis, heart attacks and angina occur. When cerebral arteries (arteries that supply blood to the brain) are narrowed by atherosclerosis, strokes occur. Similarly, when arteries to the penis and the pelvic organs are narrowed by atherosclerosis, insufficient blood is delivered to the penis to achieve an erection. There is a close correlation between the severity of atherosclerosis in the coronary arteries and erectile dysfunction. For example, men with more severe coronary artery atherosclerosis also tend to have more erectile dysfunction than men with mild or no coronary artery atherosclerosis. Some doctors suggest that men with new onset erectile dysfunction should be evaluated for silent coronary artery diseases (advanced coronary artery atherosclerosis that has not yet caused angina or heart attacks).
Diabetes mellitus. One out of every four impotent men has diabetes, which can cause nerve deterioration (diabetic neuropathy). Impotence may result if nerves or blood vessels that control the flow of blood to the penis are affected. In some cases, keeping the diet and blood sugar under control can decrease impotence. But permanent nerve damage can result in a chronic problem. Erectile dysfunction tends to develop 10-15 years earlier in diabetic men than among nondiabetic men. In a population study of men with type I diabetes for more than 10 years, erectile dysfunction was reported by 55% of men between the ages of 50 to 60 years. The increased risk of erectile dysfunction among men with diabetes mellitus may be due to the earlier onset and greater severity of atherosclerosis that narrows the arteries and thereby reduces the delivery of blood to the penis. When insufficient blood is delivered to the penis, it is not possible to achieve an erection. Diabetes mellitus also causes erectile dysfunction by damaging both sensory and autonomic nerves, a condition called diabetic neuropathy. Smoking cigarettes, obesity, poor control of blood glucose levels, and having diabetes mellitus for a long time further increases the risk of erectile dysfunction in diabetes. In addition to atherosclerosis and/or neuropathy causing erectile dysfunction in diabetes, many diabetic men develop a myopathy (muscle disease) as their cause of erectile dysfunction in which the compliance of the muscle in the corpora cavernosa is decreased and clinically this presents as an inability to maintain the erection.
Disease of the Nervous System. Some conditions, such as multiple sclerosis, Parkinson's disease and spinal cord injuries, can affect or cause impotence. Damage to the spinal cord and nerves in the pelvis can cause erectile dysfunction. Nerve damage can be due to disease, trauma, or surgical procedures. Examples include injury to the spinal cord from automobile accidents, injury to the pelvic nerves from prostate surgery, multiple sclerosis (a neurological disease with the potential to cause widespread damage to nerves), and long-term diabetes mellitus.
Aging. There are two reasons why older men are more likely to experience erectile dysfunction than younger men. First, older men are more likely to develop diseases (such as heart attacks, angina, strokes, diabetes mellitus, and high blood pressure) that are associated with erectile dysfunction. Second, the aging process alone can cause erectile dysfunction in some men; primarily by decreasing the compliance of the tissues in the corpora cavernosa, although it has been suggested, but not proven, that there is also decreased production of nitric oxide in the nerves that innervate the corporal smooth muscle within the penis.
Cancer Surgery. Surgery to remove cancer from the prostate, bladder, colon or rectal area can cause impotence if the nerves and blood vessels that control erections are damaged in the process of removing cancerous tissue.
Medications. Some prescription medications for high blood pressure, depression, spinal cord injury, diabetes and other conditions can cause temporary impotence by interfering with the nerve impulses or blood flow to the penis. Many common medicines produce erectile dysfunction as a side effect. Medicines that can cause erectile dysfunction include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants. Examples of common medicines that can cause erectile dysfunction include beta-blockers such as propranolol (Inderal), hydrochlorothiazide, digoxin (Lanoxin), amitriptyline (Elavil), famotidine (Pepcid), cimetidine (Tagamet), metoclopramide (Reglan), indomethacin (Indocin), lithium (Eskalith; Lithobid), verapamil (Calan, Verelan, Isoptin), phenytoin (Dilantin), and gemfibrozil (Lopid).
Smoking. A recent study at the New England Research Institute in Watertown, Massachusetts, found that impotence was equally common among smokers and non-smokers in general. However, among men with certain health problems, those who smoked were much more likely to have potency problems. For example, 56 percent of smokers with heart disease were completely impotent compared with only 21 percent of non-smokers with the disease.
Alcoholism. Excessive alcohol consumption disrupts hormone levels and can lead to nerve damage. This type of impotence may be reversible or permanent depending on the severity of the nerve damage. Some clinical studies suggest about 25 percent of all alcoholics become impotent--even after they stop drinking.
Hormone Imbalance. Abnormal testosterone levels are rare, but they can cause impotence. In addition, other illnesses, such as kidney failure and liver disease, can disrupt the balance of hormones.