Vascular issues are among the most well-known causes of impotence. Simultaneously, the penile pulses are palpated; the examiner should feel for plaques in the corpora cavernosa, which would indicate Pyronine’s disease. Neurologic impotence is suggested by the absence of sensation in the sacral dermatomes when tested by pinprick or neurologic abnormalities elsewhere. The prevalence of complete impotence tripled from 5 to 15% between subjects ages 40 and 70 years.
Organic impotence refers to the inability to obtain an erection firm enough for vaginal penetration, or the inability to sustain the erection until completion of intercourse. In high-level cases, LaRoche’s syndrome of aortoiliac occlusion are proposed by bilateral thigh or calf claudication, loss of muscle mass in the buttocks and legs, and impotence. Subject age was the variable most strongly associated with impotence. Certain drugs, alcohol included, can lead to impotence as a result of endocrine disturbances.
Patients with psychogenic impotence may have a entire erectile malfunction with one companion but not another, or be unable during sexual intercourse but not throughout self–stimulation. A self-administered sexual exercise survey was used to identify erectile vigor. The combined predominance of least, moderate, and complete impotence was 52%. Subjects with low testosterone levels needed additional endocrine evaluations to be depicted.
Endocrine problems, though uncommon, should be counted in cases presenting including impotence. In some cases, impotence can be a symptom of progression towards cardiovascular disease. If the latter is considered more likely, it is perfectly reasonable to refer the patient directly for sexual therapy, with the option of reconsidering the diagnosis if, after appropriate therapy, there is no improvement. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. A careful drug history is important in the evaluation of impotence. Thus, because of its derogatory implication in lay method and because of uncertainty on its meaning, the word impotence has been eliminated from the technical vocabulary in favor of the term “erectile dysfunction.”
In advanced cases, Lehriche’s syndrome of aortoiliac occlusion will be proposed by bilateral thigh or calf claudication, loss of muscle mass in the buttocks and legs, and impotence. By contrast, psychogenic impotence typically is abrupt in onset, often in relation to psychological trauma, and may wax and wane. For instance, observing the patient for a few weeks off offending medication may be all that is necessary to establish the cause of impotence.
After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality.
Direct palpation of the dorsal artery of the penis may be informative if pulsation is absent. At first, the patient will have partial erections or seemingly firm erections that become flaccid during intercourse. Impotent patients should be questioned about decreased genital sensation, which would suggest diabetic, alcoholic, or other forms of neuropathy; weakness, which may accompany multiple sclerosis or spinal cord tumors; and back pain, bowel, and bladder symptoms, which raise concern for cauda equina syndrome. Testicles less than 4 cm in length or a prostate gland that is smaller than expected may be the only clues on physical examination to a pituitary tumor with secondary hypogonadism.
NOTE: Ten to 20% of middle-aged men and a much higher percentage of elderly men are impotent. Aside from its importance as a common and distressing sexual problem, organic impotence may herald important medical problems.
Organic impotence is constant and nonselective, meaning it is not better or worse with any specific partner or any type of stimulation. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject’s home. When organic impotence is likely, a serum testosterone level is the initial screening test for hypogonadism and should be obtained prior to urologic referral. While an occasional patient with organic impotence will be misrouted, many more with psychogenic impotence will be spared an unnecessary and costly evaluation for organic causes.
Hypothalamic–pituitary problems, which include tumors, are the most common endocrine disorders causing impotence, followed by primary gonadal failure from one of many causes. Poorly controlled diabetes with polyuria and polydypsia is an important reversible cause of impotence, as is hyperthyroidism. Certain drugs, alcohol included, can lead to impotence as a result of endocrine disturbances.
Finally, the history may suggest one of several mechanical causes of impotence such as Pyronine’s disease and congenital or acquired abnormalities of the penis. Again, without testing it is not completely certain why one is impotent.
REFERENCES:
Erectile Organic Dysfunction. https://microd.org/organic-erectile-dysfunction/
Common Causes of Impotence – News-Medical.net. https://www.news-medical.net/health/Common-Causes-of-Impotence.aspx
Impotence | sexual dysfunction | Britannica. https://www.britannica.com/science/impotence
Impotence and Its Medical and Psychosocial Correlates …. https://www.sciencedirect.com/science/article/abs/pii/S0022534717348711
How Science Can Help Fix America’s Testosterone Crisis …. https://principia-scientific.com/how-science-can-help-fix-americas-testosterone-crisis/
The Taco Cat Talk 