Male Impotence - Slow Leaks - Male Impotence

Written by HealthyPlace.com Staff Writer

Slow Leaks

In some males, erection starts off rigidly and then slowly sags due to a slow leak of blood out of the corpora cavernosa and corpus spongiosum (see Chapter 1). This is due to a weakness in the mechanisms that constrict outlet veins and prevent pooling blood from draining away during erection. This problem can be detected by special tests using dyes that show up on X-ray (cavernosometry). Venous leaks are a common cause of impotence in older men. Some men suffer from both poor blood supply and a venous leak.

Fibrosiss

If the blood supply is normal, fibrosis or a build-up of scar tissue (e.g. Peyronie's Disease) can make the penis rigid on one side, rather than expansile. This stops the penis inflating fully, or makes it curve dramatically and painfully to one side. This can cause partial or total impotence. Surgical treatment to remove the scar tissue, or to take a tuck in the opposite side so erections become straight again, can help

Hormonal Imbalances

Occasionally, an hormonal imbalance may be the cause of impotence, especially if testosterone hormone levels are too low or prolactin hormone levels too high. If you suffer from impotence you will have blood tests to screen for hormonal problems. If an imbalance is found, this is usually easily treated once its cause is sorted out.

Diabetes

Diabetes causes impotence for two main reasons: it encourages furring up of the arteries (atherosclerosis) and, if not well controlled, can lead to permanent nerve damage from the high levels of circulating sugar.

Nerve Damage

Diseases or injuries that affect the nerves can cause impotence. This includes men who suffer from severe multiple sclerosis, or who have sustained a spinal cord injury as a result, for example, of breaking their back. Sometimes reflex erections occur but ejaculation is not normally possible without electrical stimulation.

The Treatment of Physical Impotence

The treatment of physical impotence is now sophisticated. Several options are available after full investigations have suggested the likely cause.

Oral Drugs

International trials of an oral drug treatment for impotence are currently under way. The drug, a derivative of yohimbine hydrochloride, is derived from the African Pausinystalis yohimbe tree. Results of the trials are expected soon but it will be a few years before it becomes widely available on the market.

Topical GTN

Glyceryl trinitrate (GTN) is a drug normally used to treat heart angina pains. GTN dilates blood vessels and increases blood flow. Research has found that GTN patches applied to the penis for one to two hours before intercourse can help to overcome impotence. Of 10 males aged 4571 who had suffered impotence for an average of five years, four achieved an erection with intercourse and ejaculation a success rate of 40 per cent.

The use of GTN patches has an advantage over GTN creams, as the latter are absorbed by vaginal tissues and cause the side-effect of headaches in any female partners.

Vacuum Erections

For a vacuum erection the penis is placed in a plastic cylinder from which air is extracted via a pump. The resultant partial vacuum makes the penis fill with blood and triggers an erection. A tight ring is then placed around the base of the penile shaft to trap the blood and maintain rigidity. The penis then remains erect once the vacuum cylinder is removed. Obviously, as it acts rather like a tourniquet, the penis looks a little blue, and the ring can only be left in place for a short while (otherwise the blood supply of the penis may be compromised). Another problem is that the elastic band prevents semen coming out of the tip of the penis during ejaculation. Semen may seep out later, or may wash into the bladder to be urinated away. This is not harmful but does affect fertility.

P.I.P.E.

Some patients are taught to give themselves an injection into the shaft of the penis. This is known as P.I.P.E. Pharmacologically Induced Penile Erection. The injections are given via a very fine needle inserted into the corpora cavernosa. The shaft of the penis is not very pain-sensitive and the injections are described as no more painful than a mosquito bite. After withdrawing the needle, the injection site is pressed firmly for 30 seconds so that no bleeding occurs. After 510 minutes, an erection starts to form as the arteries supplying blood to the penis dilate and draining veins constrict.

The commonly used drug, papaverine, can induce prolonged erections and priapism, however. Priapism is a surgical emergency the penis needs to be drained of trapped blood to restore the circulation. Papaverine can also cause internal scarring and curvature (Peyronie's disease) in a few males. In the majority of cases, nevertheless, P.I.P.E. is very successful and has transformed the lives of many impotent males.

Another drug, prostaglandin E1, is prescribed instead of papaverine by some doctors as it has a lower risk of side-effects.

A new development is a self-injection system known as Caverject (alprostadil). This works in a similar manner to prostaglandin E1 and can be prescribed by doctors. Some men find it more painful than other drug treatments, however.