Impotence

What is impotence?

Impotence is an inability to achieve or sustain an erection. This condition is also called erectile dysfunction.

What causes impotence?

There are many possible causes of impotence:

• Age - as men grow older, the ability to sustain an erection lessens
• Medications - antidepressants, heart medication, pain medication
• Anxiety and depression
• Smoking and alcohol use
• Vascular problems - blood flow is vital to achieving an erection, so those men with a vascular difficulties may experience impotence
• Other health problems - men with diabetes can experience impotence because of nerve, blood vessel, and muscle impairment

For cancer patients, the cause of impotence is often cancer treatments, including:

• Chemotherapy (damages testes and reduces testosterone production; some drugs, such as Platinol^® (cisplatin) and Oncovin^® (vincristine) may interfere with nerves that control erection)
• Surgery or radiation for prostate cancer (may damage nerves)
• Radiation therapy to the pelvic region (may damage testes)
• Hormonal therapy for prostate cancer (reduces testosterone levels in the body)

The cancer itself may also damage nerves involved in having an erection.

What is the treatment for impotence?

Talk to your doctor about options for treating impotence. Depending on your circumstances, your doctor may recommend hormone replacement, medication, or exercises.

Hormone replacement therapy (HRT) - HRT may be an option if your cancer is not hormone-related, such as prostate cancer. Your doctor may refer you to an endocrinologist who can administer hormone patches and/or testosterone replacement.

Drug therapy - In recent years, several drugs have been developed that inhibit an enzyme to help you maintain an erection. These include Viagra^® (sildenafil), Cialis^® (tadalafil), and Levitra^® (vardenafil).

Exercises - The Kegel exercise focuses on improving circulation and strengthening muscles that are used for intercourse. This exercise involves contracting the muscles that control urination and attempting to hold each contraction for at least 10 seconds, then releasing. Do these exercises as directed by your doctor, or 3 to 5 times per day, 5 to 10 contractions each time.

Vacuum constriction device - A pump is placed over the penis, creating a vacuum that forces blood into the penile shaft.

Penile injections - Painless self-injections of a medication (usually Caverject® [prostaglandin E1] or Regitine® [papaverine and phentolamine]) are made directly into the penis. These drugs relax smooth muscles, enhancing blood flow and producing an erection.

Penile prosthesis - The most common implant is the IPP: inflatable penile prosthesis. A small pump moves fluid into the implant, making it firm and creating an erection. When you finish having sex, a release valve deflates the implant.