The Truth About Impotence - Not Having Normal Erections During Sexual Activity

Written by Krista

DR. GOLDSTEIN: That's an excellent question. Since age 18, a man who is now 23, has noted not only problems with ejaculation but problems with erection. His evaluation has focused pretty much exclusively on hormonal status. What I would encourage this individual to do is to either return to this doctor or see another doctor and have the focus shifted from the primarily hormonal based evaluation to an evaluation that's based on blood flow delivery to the penis. The strongest reasons for 23-year-old people having diminished quality erections are due to blood flow changes, again probably from some accident or injury than they are related to hormonal changes.

KEN BADER: Here's an excellent practical question from a 66-year-old gentleman in North Carolina. He asks, "What all is involved for a man to do in order to receive a prescription for Viagra? Can I just go to the doctor and ask for it, and he'll give me a prescription? I'm a 66-year-old male with no medical problems."

DR. GOLDSTEIN: An individual who believes he meets the definition of impotence or in the medical world, we use erectile dysfunction, here is what you would have to have to meet the definition. A consistent, for a period of usually around six months, problem with erection quality, usually obtaining and maintaining the erection that effects satisfactory sexual intercourse, or satisfactory sexual activity. So if you meet that definition of a consistent problem with the quality of erection that affects satisfaction during sexual activity, please see a local doctor. You need to see an internist or a primary care doctor. If you'd like you could see a urologist. You would undergo a history, a physical examination and some

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laboratory tests and most likely after education and attempts to modify your lifestyle, end up with a prescription for Viagra.

KEN BADER: This question follows right out of that answer. It's from a 58-year-old male listener in Florida. He says, "How do you find a competent urologist?" Listen to this. "In the last three years I have gone to two, both asked questions and neither gave me any physical exam. The first was part of an impotence clinic. He suggested I masturbate. The second gave me a pill made of some African tree bark. I've since read it doesn't work. And then suggested having his nurse show me how to inject myself. Right or wrong I didn't go back to learn how to do this. The doctors on the show all seemed to look at a possible physical cause before prescribing any treatment. Thank you."

DR. GOLDSTEIN: Well, I appreciate your call, and I apologize for your unfortunate experience with my colleagues. The only thing I can say to you, I guess, is that your evaluation happened prior to the Viagra era. Now were you to go to either a competent urologist or internist or primary care doctors you would be managed, not with the oral pill from tree bark, which again, has never been shown to work, but now with a drug, which has been shown to be safe and effective for the treatment of impotence, and that is, of course, Viagra. Should Viagra fail you would then be considered for second line therapies, which would be injections or vacuum devices or pellets, and third line therapies would be penile implant devices. First line therapies now are the oral pill, Viagra, potentially psychologic therapy, and you should be able to find many physicians to help you with this management.

KEN BADER: Here's an interesting situation from a female listener. She's 67 years old and she lives in Georgia. She writes, "My husband had a penile prosthesis inserted a few months ago, and has experienced some disappointment. He had been experiencing gradually increasing impotence for several years and was more than anxious to have this done. Is it possible that because of his dysfunction we both sort of put sex out of our minds, or does it just take a long time to adjust to this method? He has coronary heart disease and takes a great deal of medication. He is 65 and although he has problems, is very active."

DR. GOLDSTEIN: I need to know much more information. Penile implants have a excellent success rate, about 80 percent in men who have impotence. We've been using penile implants since the early 1970s and considering it's now the late 1990s, it's almost 25 years of experience. The design of the devices have improved greatly and there is usually in four to five people great satisfaction, as was seen on the show. I need to know a little bit more of why your partner has this disappointment. Maybe there's something that could be done that's simple that can enhance that disappointment so that there's satisfaction. We're now even using Viagra in men with penile implants to enhance their satisfaction. So we need more information.

KEN BADER: A 47-year-old gentleman from North Carolina writes, "When I have an erection only the left half of the penis seems to inflate. I am able to achieve orgasm, but there is discomfort in the penis on the side that is inflated, similar to too much pressure. Is there a reason and a solution?"

DR. GOLDSTEIN: Without seeing you, the left half inflates and the right side doesn't. The one thing that comes to my mind is a condition called Peyronie's Disease, and I'm surprised despite all these questions we've had today, I haven't heard from one patient who has had Peyronie's Disease. This condition involves thickening of the wall of the erection chamber. And of course, things that inflate and increase in volume require elastic or elastic properties of the wall. So if the wall is scarred and can't inflate then that would be a condition called Peyronie's Disease. Peyronie's Disease is also associated with pain and you described this pain. Peyronie's Disease is a condition which occurs generally from trauma during intercourse, primarily from partner superior intercourse. And one would need to see a doctor and discuss this with him for appropriate management.

KEN BADER: From North Carolina comes this gentleman's question. He says, "I'm a 35-year-old man who has visited a vascular specialist to determine if I had any vascular reason I have problems obtaining an erection. The specialist determined I had no vascular problem. He did not suggest anything to help me have an erection." He asks, "How normal is this, and do you think Viagra would help since I suspect my problem is more mental?" He adds, "My wife wants me to see another doctor."