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Personal Health;With more
help available for impotence,
few men seek it.
ASTONISHING progress has been made in the last decade
both in understanding the myriad causes of impotence and in
correcting or circumventing them. Today a way can be found to
help nearly every man who is interested in having his
sexual potency restored. Yet
only about 5 million of the more than 30 million men with
serious erectile problems have sought professional help.
Few men are willing to discuss problems of impotence even with
their sexual partners. To reduce the perceived stigma and
embarrassment of impotence and encourage more men to seek
treatment, urologists now refer to the condition as erectile
dysfunction.
The problem is far more common than most men realize. According
to the findings of one recent study among 1,290 men in
Massachusetts, the incidence of complete impotence ranges from 5
percent among 40-year-olds to 15 percent among 70-year-olds.
And, if those reporting moderate degrees of impotence are
included, the numbers rise to 22 percent and 49 percent,
respectively. Yet, experts have found that if nothing interferes
with the erectile response, men can remain potent and capable of
enjoying sexual intercourse into their 90's. New Knowledge
Perhaps the most important development in the treatment of
erectile dysfunction has been the nearly complete reversal of
the long-held belief that in 80 percent of cases the problem was
due to psychological factors. It is now recognized that about 70
to 80 percent of cases have a physical cause, like blood vessel
disease, and that emotional factors like anxiety about sexual
performance, undue stress or guilt, are common causes of
impotence only among the relatively few young men with erectile
dysfunction. Among men 20 to 60 years old, physical causes
account for about 55 percent of cases; for men over 60, physical
factors are the primary cause about 90 percent of the time. But
even when a physical cause is found, emotional factors,
including depression, repressed anger and marital discord may
compound the problem.
Another assumption that has been strongly challenged is that an
inability to achieve a full erection or maintain it long enough
to complete sexual intercourse is a natural consequence of
advancing age. It is now known that the increase in erectile
dysfunction with age is due not to aging itself but to health
problems that are more common among older men, ranging from
cardiovascular disease, diabetes and surgery for prostate cancer
to the side effects of medications and hormonal aberrations that
often go undiagnosed.
It has recently been recognized that the sooner erectile
problems are properly diagnosed and treated, the more likely the
treatment will be successful. According to Dr. Irwin Goldstein,
urologist at Boston University School of Medicine, an erection
brings the oxygen-rich blood needed to maintain the
healthfulness of the penile blood vessels and nerves that make
erection possible. This means that the longer a man goes without
an erection, whether during sleep or sexual excitement, the
greater the damage to the lining of blood vessels, an effect
that can eventually make erection impossible. The Right
Diagnosis
Proper diagnosis of the cause of erectile problems is critical
to proper treatment. The diagnosis is best determined by a
board-certified urologist with special training and experience
in treating erectile dysfunction. The problem may be correctable
when the underlying cause is treated. Even when a correctable
physical cause is found, emotional factors must not be
overlooked.
Accordingly, at the Center for Male Sexual Dysfunction at
Montefiore Medical Center in the Bronx, the man and his partner
are interviewed separately. The Montefiore team has found that
sexual partners seldom tell the same story of their sex lives
together and that in many cases the information obtained from
the partner alters diagnosis and treatment. In addition, all
patients should be fully evaluated for contributing
psychological factors.
At the Montefiore center, the man's response to visual sexual
stimulation is also examined. If a normal erection occurs,
chances are the man's impotence with his partner is emotionally
caused. But if there is no response, a physical cause may be
blocking the man's natural reaction to erotic stimuli. An
at-home test using a device called a Rigiscan is done to check
for the occurrence of erections during sleep, which typically
occur four or five times a night in men with a physically normal
erection response. This is a more convenient and far less costly
approach than former evaluations that required the man to spend
one or more nights in a sleep laboratory.
The most common cause of erectile dysfunction in men over 60 is
interference with blood flow by atherosclerotic plaques in the
penile and/ or pelvic arteries. In fact, experts urge that every
older man who complains of erectile problems undergo a complete
cardiovascular workup, since he may be at high risk of suffering
a heart attack or stroke. Diabetes is another common cause; not
only does it hasten the development of atherosclerosis, it can
also damage nerves involved in an erection.
Critical nerves can be irreversibly damaged during surgery to
remove a prostate cancer; although surgeons try to spare the
nerves, the location of the cancer may prevent that. Other
nerve-damaging conditions that can lead to erectile dysfunction
include multiple sclerosis, Parkinson's disease and injuries to
the spinal cord or pelvis.
Hormonal abnormalities are a relatively uncommon cause. A
testosterone deficiency more commonly results in a loss of
libido and only sometimes in erectile dysfunction. An elevated
level of prolactin, a pituitary hormone that may be overproduced
when this gland develops microtumors, is a sometimes overlooked
cause of dysfunction. Either an under active thyroid or
overproduction of thyroid hormone can also contribute to an
erectile problem.
More than 200 different prescription drugs can interfere with
the erectile response, including some of the popular medications
used to combat high blood pressure, psychosis and depression.
Men needing treatment for such other problems who wish to retain
their full sexual abilities should discuss the possibility of
alternative medications with the prescribing physician.
Men's long-standing habits can also contribute to erectile
problems, especially smoking, excessive alcohol intake and the
use of cocaine, which foster atherosclerosis and nerve damage.
WHEN a man has difficulty achieving or maintaining an erection,
his partner, particularly if she is a woman, is often at a loss
as to what to say and do. Caught between not wanting to make her
man feel inadequate and wanting to maintain an active sex life,
she may end up pretending that the physical act of intercourse
is not important to her. Such pretense can ultimately become a
wedge between loving partners, especially when both avoid
physical demonstrations of affection lest the gestures be
misinterpreted as an invitation to or request for more intimate
contact.
In a very helpful booklet, "Male Impotence: A Woman's
Perspective" prepared for the Geddings Osbon Foundation of
Augusta, Ga., Nancy Hanks, a registered nurse, counsels women:
"If having intercourse is important to you, admit it to yourself
and to your partner. Don't pretend it doesn't matter."
She also urges women to learn about the physical and
psychological causes of impotence and to examine relationship
issues that could be contributing to the problem. Even when a
correctable or treatable cause is found, couple counseling or
sex therapy may be needed to rekindle long-buried sexual
excitement and romance.
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