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The truth about impotence

The Truth About Impotence

November 16, 2019

As many as 30 million American men suffer from erectile dysfunction, or what is commonly known as “impotence.” The good news is that in the majority of cases, the condition can be successfully treated. The bad news is that only a small percentage of men with the problem ever seek treatment.

“Erectile dysfunction (ED) is not just an embarrassing and highly sensitive barrier to sexual relations. It may also be a very subtle but significant indicator of a more serious medical problem, such as coronary artery disease or diabetes,” says Benjamin N. Hendin, MD, a urologist at Kelsey-Seybold Clinic who specializes in erectile dysfunction, vasectomy reversals, and male fertility.

“There are a number of myths surrounding erectile dysfunction,” notes Dr. Hendin. “One of the most common is that it is all in a man’s head.” While psychological factors may play a role, there are often underlying physical or physiological causes that result in the inability to attain or maintain an erection, such as reduced blood flow to the penis.

ED Won’t Just Go Away

Another myth is that ED is part of the normal aging process and that there’s nothing men can do about it. “The incidence of erectile dysfunction does increase as men age,” Dr. Hendin explains, but it’s not just a normal process of aging. “In the majority of cases, it can be successfully treated. We have effective treatments that can be tailored to the couple’s lifestyle and needs. This is not a ‘problem’ that will go away, and it should not be brushed off.” ED can be a symptom or a sign of an underlying disease.

One of the greatest treatment barriers is getting men to seek help. “We’re embarrassed. We may think we’re ‘less masculine,’ or we may not feel comfortable discussing such a delicate or sensitive area of our health,” the doctor notes. “Men have all sorts of reasons for not seeking help. Many fear the doctor will find something serious, while others may wait because they don’t think we can help them. Some men think it’s not important in their lives – maybe they’re divorced or not involved in a relationship,” Dr. Hendin explains.

Partners Should Be Involved

Dr. Hendin has found that it helps if the patient’s partner is involved in the discussion of treatment options. “If my patient is agreeable, I try to involve the partner in the treatment process,” he says. “We have very successful treatments, but performance fears and anxiety can reverse the function we’ve restored. A number of things have to work in harmony, which is why I like to stress the importance of discussing the problem as a couple.”

Medical treatment of ED ranges from simple lifestyle modifications to oral prescription drugs and penile implants. The treatment chosen depends on the cause of the problem.

The diagnostic evaluation involves a thorough medical, social, and sexual history on the patient, in addition to a thorough physical exam. Lab tests on blood and urine help to identify underlying medical issues that may need treatment.

Common Causes

Reduced blood flow to the penis and nerve damage are two of the most common causes of erectile dysfunction. Hardening and narrowing of the arteries (atherosclerosis) can reduce blood flow throughout the body and lead to impotence. High levels of blood sugar associated with diabetes may damage small blood vessels and nerves throughout the body, which can impede blood flow or nerve signals necessary for erection.

There are also potential lifestyle factors, such as smoking or long-term use of alcohol, drugs, or steroids. Trauma to the pelvic region or spinal cord can damage veins and nerves needed for erection. Cancer surgery for the prostate, colon, or bladder may also result in impotence.

In some instances, there may be abnormal penile curvature due to scarring of the sheath surrounding the erectile chambers, a condition called Peyronie’s disease.

Psychological factors are often secondary to the physical causes. However, anxiety about performance may make the problem worse.

What About Viagra?

According to Dr. Hendin, “Viagra” (the brand name) or “sildenafil” (the chemical name) is an effective and proven therapy for ED. Currently, sildenafil is the only FDA-approved agent in its class. “It is the most effective oral agent we have,” says Dr. Hendin.

Other Treatment Options

Diabetes or other significant underlying conditions may contribute to the cause of ED. As a result, a thorough medical evaluation is necessary. Also, it’s vital that the doctor be informed of any medicines or nutritional supplements that the patient may be taking.

“The least invasive option we have is lifestyle modifications,” says Dr. Hendin. “A man may see some improvement simply by reducing the intake of alcohol and exercising more.

Oral medications, such as Viagra, are the next line of therapy. These medications enhance the quality of the male erection and increase response to sexual stimulation. Two other treatment options include Muse suppositories and injection therapy directly into the penis. The suppositories are administered in the penis. “In general, they tend to be less effective than Viagra,” notes Dr. Hendin. “The injections are much more effective but require application with a tiny needle.”

Nonsurgical Pump

An option for some men is a vacuum device in which the man achieves an erection by applying a hand-held device referred to as a pump. “The results are not as ‘natural’ as the erection produced with Viagra, and the application may be a bit cumbersome, but there are no chemicals or surgery involved,” explains Dr. Hendin.

Surgical Penile Implants

Another treatment option is surgical therapy using a penile implant. “This is not our first line of therapy, since it involves surgery,” notes Dr. Hendin. “It is highly effective, however, and results in high patient satisfaction.”

Hormone Replacement Therapy

A small number of men may have a hormonal imbalance related to lack of sufficient male hormone (testosterone). “Hormone replacement therapy or other forms of hormonal treatment can be indicated for both treatment of erectile dysfunction as well as the prevention of osteoporosis, which can occur with extremely low levels of testosterone,” says Dr. Hendin. “Anabolic steroid abuse can also be associated with hormonal imbalances, and the management in these cases tends to be more complex.”

See Your Primary Care Physician

What advice does Dr. Hendin offer a man who’s suffering from ED? “See your primary care physician. Don’t just go in for a checkup or your yearly prostate screening. If you’re having problems, tell the doctor, who can prescribe oral medications. If your situation is complex, if you’re seeking a second opinion, or you don’t feel comfortable talking about the condition with your regular doctor, see a specialist,” urges Dr. Hendin.

He also has some advice for the partners of men who have a problem. “Encourage your significant other to talk about his condition and seek help. Again, it could be a subtle sign of an underlying medical condition. If the man in your life won’t schedule a regular exam, including a yearly prostate screening, then ask if you can schedule it for him,” says Dr. Hendin. “Get involved in the discussion and solution.”

Headshot of Benjamin Hendin, MD, urologist at Kelsey-Seybold Clinic.

About the Author

Dr. Benjamin Hendin is a urologist at Kelsey-Seybold's Main Campus and Fort Bend Medical and Diagnostic Center. His clinical interests include erectile dysfunction (impotence) penile prosthesis, Peyronie’s disease, male fertility/infertility, microsurgery and vasectomy reversal.

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