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Impotence or erectile dysfunction is either prolonged inability to obtain a valid erection or not being able to keep an erection hard enough for penetration during sexual intercourse. When it is in a lack of sexual desire in either men or women, it is then a question of aphanisis which is treated by psychologically. Impotence is a very common disease affecting about 18 million men in the U.S.

Sexual stimulation causes the release of nitric oxide which is a key mediator to cause a normal erection. This release starts from the endothelial cells of the cavernous bodies (a body of erectile tissue with large interspaces which may be distended with blood, as in the penis or clitoris) and non- cholinergic non- adrenergic neurons. Under control of specific receptors (the P2Y receptors), and within the muscle, this nitrogen monoxide activates a known receptor for the nitric oxide called guanylate cyclase which has the effect of causing a transformation leading to a relaxation of the smooth muscles of the penile arteries and intra- cavernous tissue, as well as engorgement of the penis and, ultimately, to the erection. 


Impotence Treatment 


Impotence can be treated with medications or non-drug therapy 


Non-drug treatments 

The management of psychogenic dysfunction may involve individual or couple psychotherapy but there is no real evaluation of the effectiveness of this type of treatment.  The change in lifestyle can bring beneficial effects, stops using tabaco or consuming alcohol is recommended.  

Phosphodiesterase-5 Inhibitors (PDE-5 Inhibitors) - The phosphodiesterase 5 include sildenafil, tadalafil or vardenafil. They have tangible results on treating impotence and are available everywhere. Udenafil, le mirodenafil, l'avanafil and lodenanafil are also used to treat impotence. These products do not play on libido; they work for most men. Sildenafil in men without erectile dysfunction can prolong erection with ejaculation, without playing on the refractory period (the time between two successive erections). 

Other treatments of Impotence -  

Taking testosterone may have some efficacy in case the patient has low blood levels of this hormone.
The injection of different medical products in the cavernous body shortly before the sexual act provides a rapid erection. Common drugs used include alprostadil (or Prostaglandin E1), papaverine, phentolamine and vasoactive intestinal peptide (known as the vasoactive intestinal polypeptide or VIP). This technique requires a learning process and possibly the cooperation of the partner.  

The vacuum pump (also called erector vacuum or vacuum) can be used in conjunction with a constriction ring:  


First the blood is drawn into the penis through the vacuum tube and held in order to maintain the erection. The patient drags a constriction ring to the base of the penis to maintain the erection. The results are comparable to the intra -cavernous injection but it offers several advantages in terms of cost, tolerance and acceptation. 

Finally, the establishment of a penile prosthesis may be recommended if the other alternatives do not work. It can be rigid (and therefore sometimes difficult to hide) or inflatable with a pump in the scrotum. Patient and physicians will talk to determine the best option for the patient.