Male Erectile Disorder
Erectile dysfunction (or impotence) refers to the inability of a man to attain or maintain penile erection long enough to complete intercourse. Erectile dysfunction is characterized as primary or secondary. The patient with primary impotence has never achieved sufficient erection. Secondary impotence, which is more common and less serious than the primary form, implies that, despite the current inability, the patient has succeeded in completing intercourse in the past. Transient periods of impotence aren't considered dysfunctional and probably occur in 50% of men.
Three types of secondary erectile disorder occur:
Erectile disorder affects all age-groups but increases in frequency with age. The prognosis depends on the severity and duration of impotence and on the underlying cause.
Psychogenic factors are responsible for 50% to 60% of cases of erectile disorder; the rest can be attributed to organic factors. In some patients, psychogenic and organic factors coexist, making isolation of the primary cause difficult.
Psychogenic causes may be intrapersonal, reflecting personal sexual anxieties, or interpersonal, reflecting a disturbed sexual relationship. Intrapersonal factors include guilt, fear, depression, and feelings of inadequacy resulting from a previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, abnormal mother-son intimacy, or homosexual experiences or fantasies.
Interpersonal factors may stem from differences in sexual preferences between partners, lack of communication, insufficient knowledge of sexual function, or nonsexual personal conflicts.
Situational impotence, a temporary condition, may develop in response to stress. Organic causes include chronic diseases, such as cardiopulmonary disease, diabetes mellitus, multiple sclerosis, and renal failure; spinal cord trauma; complications of surgery; drug or alcohol-induced dysfunction; and, rarely, genital anomalies or central nervous system defects.
Sex therapy, which is designed to reduce performance anxiety, may effectively cure psychogenic impotence. To be most effective, such therapy should include both partners.
The course and content of sex therapy for male erectile disorder depend on the specific cause of the disorder and the nature of the male-female relationship. Treatment usually includes sensate focus therapy, which restricts the couple's sexual activity and encourages them to become more attuned to the physical sensations of touching. Other measures include improving verbal communication skills, eliminating unreasonable guilt, and re-evaluating attitudes toward sex and sexual roles.
Treatment of organic impotence focuses on eliminating the cause, if possible. If the cause can't be eliminated, psychological counseling may help the couple deal realistically with their situation and explore alternatives for sexual expression. Some patients with organic impotence may benefit from a surgically inserted inflatable or semirigid penile prosthesis. Others may be treated with medication such as sildenafil (Viagra).
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