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
Impotence can be
treated with medications or non-drug therapy
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
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
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.