Impotence can be of several types:
Arteriogenic: This form of impotence is when the arteries that supply the penis with blood can’t deliver sufficient blood to cause or sustain an erection. This can occur because of a narrowing of the arteries such as occurs in the elderly, diabetics and those with high blood pressure or because of injury to the genital region which causes a block in the artery to the penis. Problems due to genital injuries are more predominant in younger patients. The injury can be major and sudden as after a vehicular accident causing a fracture of the pelvis or pubic bones, or low grade and gradual, as in bicycle and other riders, and occurs because sustained friction in that region causes a clot-like substance (thrombus) to develop in the artery to the penis. This clot gradually grows and ultimately blocks the blood supply to the penis completely.
Recently, it’s been recognized that signs of erectile dysfunction in men can serve as a warning for future cardiovascular diseases, such as heart attack or stroke. Diseases of arteries affect the smaller arteries (penis) before they affect the larger ones (coronaries of the heart and carotids of the brain). This should be a strong argument for the benefit of having erectile dysfunction diagnosed and treated early, as medical specialists can then help to detect any early warning signs of other problems developing, such as diabetes, high blood pressure and others.
In a case study, College student S.V.S., 23, became totally impotent following a vehicular accident in which he sustained a fracture of the pelvis and a rupture of the urethra. The patient was hospitalized for almost a month after a surgical operation. The patient reported that his sex life with his fiance was completely normal prior to the accident. Upon returning to the doctor who treated the original injury, the patient was told that his erectile problem was psychological and that it should resolve in a couple of months. 12 months later and the patient noticed no improvement at all, forcing him to consider breaking his engagement. It was only after reading a magazine article that prompted him to visit an andrologist. Using a phalloarteriogram, it was discovered that the artery to the penis was obstructed. The patient underwent a penile revascularization procedure using microsurgery and was cured.
Arteriogenic impotence resulting from injuries is very common but often unsuspected because of ignorance of the causative conditions. Many such patients are to be found in orthopedic and urology wards. It’s often only after the original wounds or fractures are healed that any impotence problems are discovered. Ironically, it is most often discovered by the patient himself and not by the doctor.
Venogenic: Where the veins of the penis leak blood and prevent the development of a rigid erection. In an unaffected male with an erection the veins will shut off blood flow almost totally so that no blood can escape back out of the penis. When everything is working normally, blood accumulates within the penis, which raises pressure that makes the penis hard.
Venogenic erectile dysfunction is very common. It’s thought that between 30-70% of impotence problems stem from this condition. Primary venogenic impotence afflicts men from the time they’re born. Such men have never had a rigid erection all their lives. Yet secondary venogenic impotence may develop suddenly even after years of a regular sex life.
Neurogenic: The nerve supply to the penis is very complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. These nerves trigger the surrounding arteries and veins that will change and sustain the blood flow.
The nerve supply to the penis can be affected by a large number of things. Impotence can be caused by injuries to the back and particularly injuries to the spinal column.
There are other nerves that can be affected by other injuries, such as pelvic or perineal trauma. A wide variety of operations performed for other conditions can cause incidental injury to the nerves of the penis and cause impotence. These include procedures on the rectum, prostate, urethra, spine, retroperitoneum, urinary bladder and others.
There are also some disorders of the nervous system that can affect the nerves to the penis, causing impotence, like multiple sclerosis, myelitis, tumour and others.
Another disease affecting the nerves to the penis is diabetes mellitus. Impotence is extremely common among diabetics. In fact, as many as 50 per cent of all diabetics are impotent. The cause of impotence in diabetics is mostly organic. Appropriate therapy for diabetes can never restore erectile function because the basic diabetic process can never be reversed. Unfortunately, diabetic treatments tend to only control the blood sugar levels and little else. Modern andrology, however, can offer a cure to nearly all patients with diabetes-related impotence. Once again, this fact remains little-known among many people. Very few diabetologists offer their patients a way to treat the resulting erectile dysfunction their diabetes could be causing.
Some drugs are also capable of damaging the nerve endings, which can cause neurogenic impotence. Among the most predominant of these are anti-hypertensives used to treat high blood pressure and psychotropics. Yet the number of drugs in this category is extensive. Most doctors will remain completely oblivious to the fact that the drugs being prescribed to treat various ailments could be the culprit for causing impotence as a side effect.
Endocrinologic (or hormonal): This occurs when there is an imbalance or insufficiency of sex hormones in the blood stream. It is believed between 5-10% of organic impotence cases come under this category. Usually, changes in hormonal levels can affect the sex drive instead of the hardness of an erection. There are many diseases that may cause changes in hormonal levels.
Mixed: Sometimes, more than one factor can be operative in the same patient. These patients are often diagnosed with systemic disease. Notable examples are diabetes, kidney failure and liver failure.
Another group where mixed factors operate is where long standing impotence has led to secondary psychiatric disorders such as depression etc.. Even though the underlying cause of the erectile dysfunction is organic, it may have been misdiagnosed or even treated incorrectly, so the patient is led to believe that the reason for his impotence is all in his mind.
Psychogenic: When there is no organic factor and the problem lies purely in the mind, it is labeled a case of psychogenic impotence. However before such a label is given to a patient, it is absolutely necessary to have an andrologist investigate into any possible organic or bodily causes.
Once this has been done, treatment can commence specifically to treat the problem found.
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