Male Impotence - Vascular Surgery - Male Impotence

Written by HealthyPlace.com Staff Writer

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Vascular Surgery

If there is a physical blockage to penile blood inflow, it is possible to have an arterial by-pass graft operation in which the blockage is by-passed using a length of vein, or synthetic tubing. In some cases, a single stricture can be dilated with a special balloon inserted into the artery under X-ray control.

Another successful approach is to hook up another artery, which normally delivers blood to the lower abdominal muscles, to the penis. This is joined to one of the penile arteries using microsurgical techniques; the procedure instantly increases the blood flow to the penis. The lower abdominal muscles do not suffer either, as several other arteries also supply them with blood. Some of the penile-draining veins are usually tied off at the same time to increase the effect: this combines a better blood flow coming in with

a weaker blood flow draining out. Success rates are as high as 70 per cent.

Arterial by-pass surgery involves a fairly large incision extending up the lower abdomen, and requires a stay of several days in hospital.

If impotence is due solely to a slow venous leak, this is simply corrected by tying off the major veins draining the penis. This procedure is known as venous ligation, and is successful in 50 per cent of cases. Occasionally, new veins open up after the operation and venous leaking may recur after a few years.

Surgical Implants

Prostheses are devices that can be surgically implanted into the penis to produce erection. There are two main types:

semi-rigid rods giving the patient half an erection all of the time
complicated, inflatable devices with small pumps implanted in the scrotum and a fluid reservoir bag implanted in the abdomen or pelvis. These devices are activated by squeezing the pump or activating a trigger button in the scrotum. Deflation is brought about by pressing another button.

Some semi-rigid implants have an embedded silver wire to make them bendable. The penis can then be bent and 'parked' when not in use. Newer designs consist of implanted, interlocking discs made of plastic. These can be rotated in one direction to lock and become rigid, then, after intercourse, rotated the other way to become flaccid when not required.

Insertion of an implant takes from one to three hours, depending on the type selected. The procedure is done under a local anesthetic, or under a spinal epidural (the body is numbed from the waist down).

It takes around two weeks for the discomfort and swelling of the operation to settle down, especially under the scrotum where the base of the penis is situated. Intercourse can be resumed from four to six weeks after the operation, depending on the procedure used. The main risk with penile implantation is post-operative infection, but this seems to be relatively rare. Ninety per cent of men with an implant are entirely happy with its performance. Most implants are invisible, although the semi-rigid rods can make the penis stick out a little bit at all times. This does not look abnormal, however.

Psychological Causes of Impotence

Psychological problems account for 60 per cent of cases of impotence. Counseling and psychotherapy are helpful and often result in dramatic improvement.

Psychological problems are usually based on fear, guilt or feelings of inadequacy. The more a man worries about not getting an erection, the more the erection is likely to fail. It becomes a self-fulfilling prophecy. Relaxation training and professional psychosexual counseling are vital.

Psychosexual counseling often involves a temporary ban on penetrative sex. Sufferers are taught to relax with their partner while exploring each other's bodies afresh. Usually, it is agreed in advance that even if an erection is achieved, sexual penetration will not be attempted.

After several weeks of abstinence, couples are then allowed to try having sex with the partner on top. This is known as the Mistress position. The so-called 'Missionary position' (man on top) is not good for men with semi-rigid erections.

A caring and sympathetic partner is important. He or she is an invaluable support during the investigation and treatment of the partner's impotence. A partner who mocks or ridicules (or even feels overly sorry for) a man's performance is making the problem worse and may even have contributed to it in the first place.

Premature Ejaculation

Premature ejaculation is the most common male sexual dysfunction. There are three different ways of defining it:

if the man comes before he wants to or before his partner wants him to
if ejaculation occurs before the penis penetrates the vagina
if the man cannot stop himself ejaculating for at least one minute after penetrating his partner.

Most men experience premature ejaculation several times during their lives most commonly when losing their virginity. It also occurs in over 50 per cent of males when making love to a new partner for the first time. Premature ejaculation is particularly common among teenagers and tends to become less of a problem for men in their twenties and thirties and beyond.