¿WHAT IS THE IMPOTENCE?

¿WHAT IS THE IMPOTENCE?

The impotence -whose medical term is that of “erectile dysfunction (DE)” – is the incapacity to achieve or to maintain a sufficient erection for a satisfactory sexual activity.

That of it is a very frequent situation; has been calculated that affects in greater or smaller degree halfway of the men between the 40 and the 70 years.  But is not a theme that treat openly.  Myths and cultural expectations of the male sexuality have impeded many men to seek aid for an inconvenience that is able, in most cases, to be benefited of a medical processing.

Although it can be told with security that every man experiences an erectile dysfunction occasionally, the impotence is defined in medical terms as the incapacity to maintain a sufficient erection for the intercourse in al less 25% of the intents.

HOW A NORMAL ERECTION OCCURS?

When there is not sexual stimulation, the flow of blood inside the penis is very low, what maintains it in flabby or not erect state.  When a man is stimulated sexually, the arteries of the penis relax and they dilate, and the blood flow toward the penis enlarges a lot.  To the extent that the penis is expanded, the veins of the penis -that would have that to return the blood of the penis toward the circulation of return- they are compressed, and the blood cannot leave.  With more blood flow entering and very little leaving, the penis returns each harder and greater time.

You CAUSE DE THE DYSFUNCTION ERECTIL “DE”

Most cases of DE (70-80%) are associates with not psychological and physical alterations.  That of alteration of one can be produces by or several of the three mechanisms responsible for the erection: blockade of the arteries; incapacity of the blood vessels inside the penis to store the blood; or damage in the nerves of the penis or of the area pelviana.  Also they can be responsible for one of other physiological, as low dysfunctions levels of male hormone (testosterone).

Thus, the situations that more often produce impotence are:

* Illnesses that affect to the blood vessels and they restrict the blood flow toward the penis, like the diabetes, the hypertension (high arterial tension), the excess of cholesterol or the heart illnesses.  * “Situations that interrupt the connection between the nervous system and the penis, like the surgery of prostate or wounds traumáticas in the zone.  * “Many medicines (some of them employees to treat the hypertension and the depressions), that produce DE as secondary effect done not desire.  * Nervous Breakdown.  * Habits of risk for DE:  Smoking, alcohol, drugs, stress.

An indicator of the physical impotence, in comparison with the psychological one, is the incapacity to experience or to maintain an erection al to be awoke in the morning.  The impotence that persists more than 3 months and that be not due to an evident stressful event, to drugs, to alcohol or to transitory medical affections that cause DE, indicates the need to receive medical attention by a urologist.

DE and aging:  Many misunderstandings in this theme exist.  As a consequence of the process of aging, is used to there to be a period refractario greater -necessary time for a new erection after an orgasm-.  The age also seems to affect the necessary time to be excited and for the erection and the ejaculation.  All this completely normal changes are considered.  Nevertheless, the sexuality does not have date of expiration.  If that of it is given more in older people, is only because is more probable than they suffering associated illnesses to DE and that use more medicaciones than they altering the erectile function.

DIAGNOSIS DE THE “DE”

1.  Medical history.  It interests to collect present medical problems and prior, medicines that are being taken and antecedents of psychological problems (stress, anxiety, depression).  The doctor will also require sexual antecedents -start of that of, frequency, quality and duration of any erection, etc.- and he will investigate the motivation for the processing and the expectations of the patient.  That of it is logically thing of two, and can be appropriated to interview to the sexual couple

2.  Physical exam.  It includes an exploration of the genital area and a rectal touch (exam of the straight one with a finger put on gloves).  They should be sought evidences of other illnesses -hypertension, diabetes, ateroesclerosis, nervous damage…-

3.  You test of laboratory.  They will be done analysis of blood to measure the levels of testosterone and, if is necessary, those of prolactina for determine if there are problems of the endocrine system.  They can be necessary diverse specific exams to detect that of, like tests of erectile answer after injection of medicines that dilate the blood vessels of the penis, or detection of by means of diverse nocturnal erections devices.

4.  Techniques of radiología diagnostic.  The cavernosometría and cavernosografía of dynamic infusion (DICC) is a test in which an erection with medicines is induced, the capacity of storage of the penis is measured, an ultrasound of the arteries of the penis is done (to measure the arterial pressure of these arteries), and a x-ray of the erect penis is carried out for obtain precise anatomical data.  Only is necessary in some cases of DE.

PROCESSING FOR THE IMPOTENCE

Less than the 10% of the men that suffer from they seek helps medical.  Al to confront that of, is frequent to be demoralized, or to seek miraculous processing.  Innumerable popular remedies exist that should be considered with every caution and skepticism.  At present many very sure and efficient processing exist, although in no magical case.

The modality of the processing comes dictated by the specific problem that causes the impotence.  The first step is to define the cause, if is possible, and then to try the simplest solution and less risked.  In synthesis, the different therapeutic alternatives include an or several of the following.

1) to Change the habits of life that affect to the health of the arteries and veins:  Smoke not, to moderate the consumption of alcohol and of greases, to do something of exercise and to learn to be relaxed.

2) to Change or to reduce the medicines that cause impotence, like some antidepressants, diuretic and betabloqueantes…

3) Psicoterapia and therapy conductual.  Independently of the cause of that of, is recommended for all the psychological therapy form any patients, conductual, sexual or of combination, generally attended by its couple.

4) Therapy transuretral and of injection.  It consists of being injected medicines in the erectile weaving, to relax the smooth muscles of the penis and to permit that can take place the erection.  It is indicated in some cases of DE.  The medicines injected are used to being associations of papaverina-fentolamina, or well alprostadil (prostaglandina E1).  The adverse reactions are generally smaller, but they are able incluír erections prolonged and painful (priapismo).  An alternative to the injections is a device of plastic to apply these medicines through the urethra.  Although surer and less costly than the surgical processing, these therapies have a high rate of abandonments, since the loss of spontaneity causes loses interest in the procedure.