Download Treatments for Impotence

Graedons’ Guide to
Treatments for Impotence
People have been searching for sexual enhancers for centuries. Artichokes, asparagus, truffles,
oysters, ginseng, garlic, ground-up rhinoceros tusk and crocodile kidneys are just a few of the agents
that have been used to pique desire or improve performance. There is little evidence that any of these
exotic ingredients has any measurable effect on human sexuality.
Prunes, sometimes referred to as the “funny fruit,” were once considered so sexually stimulating
by Shakespeare’s contemporaries that “owners of brothels distributed them free to clients so that the
customers’ performance would match their passion.”
Ginseng has been touted to increase stamina and counteract impotence for at least 2,000 years.
Current claims for its ability to promote sexual potency are only semi-substantiated by animal
research. Some studies report that ginseng facilitates mating behavior in rats, increases gonadal
weight, accelerates ovulation in frogs, and stimulates egg-laying in hens. But whether enhanced egglaying or faster frog ovulation has any relevance for human sexuality is yet to be established.
The problem is that when it comes to sex, researchers have been surprisingly reticent. There is still
a lot we don’t know about both male and female sexuality. Erections, for example, are extremely
complex events, involving the brain and nervous system, hormones and blood vessels. If any one of
these systems fails, it can have negative consequences.
For example, a man who is under emotional stress may find it difficult to become aroused. A variety
of medications can also lower libido or interfere with the ability to achieve an erection. Nerve damage
or blockage of blood vessels leading to the penis can also impair erectile functioning. Once a problem
occurs, it can create a vicious cycle. Performance anxiety may make it hard for a man even to initiate
lovemaking.
It is estimated that up to 30 million American men are affected by erection difficulties. Before
considering any specific treatment program it is essential to have a proper medical workup and
diagnosis. Smoking, excessive alcohol consumption, diabetes and high blood pressure can all
contribute. So can a wide range of drugs.
In recent years, Prozac (fluoxetine) and related antidepressants (Effexor, Luvox, Paxil, Serzone,
Zoloft) have been found to affect sexuality in a variety of ways. Such drugs may diminish desire, make
it difficult to achieve an erection or interfere with the ability to achieve orgasm. The popularity of
these medications has created a virtual epidemic of sexual dysfunction for both men and women.
You will find a list of common culprits in the accompanying Guide to Drugs That Affect Sexuality.
A book by Theresa Crenshaw, M.D., titled Sexual Pharmacology (Norton), explores this issue in
depth. Of course, no one should ever stop any prescription drug without careful medical supervision.
Discontinuing a blood pressure medicine suddenly could lead to rebound hypertension or even a
heart attack. A caring and patient physician should be willing to try to find medications that are less
likely to interfere with a satisfying sex life.
It is extremely important to discuss any aspect of sexual dysfunction with a knowledgeable and
sympathetic physician. Urologists can be very helpful in this regard. Once a proper diagnosis is made,
a variety of treatment options is available. Selecting the best one will require frank communication
among both partners and the doctor.
© 1998 Graedon Enterprises, Inc.
Yohimbine: For ages, West African healers
have used the bark of the yohimb tree to restore
sexual vigor. Studies have shown that yohimbine
may indeed be beneficial for 30 to 40 percent of
men with either psychological or physiological
problems with erections. Yohimbine is available
by prescription (Erex, Yocon, Yohimex, etc.)
and should only be used under medical supervision.
Side effects may include elevated blood
pressure, heart palpitations, increased pulse,
nausea, headache, nervousness, dizziness,
flushing, tremors and sweating. People with
diabetes, blood pressure problems, heart, liver or
kidney disease should avoid this drug unless a
physician deems it appropriate.
Erection Medications: For years, urologists
have been prescribing medications that can be
injected directly into the penis to cause an erection that lasts for up to an hour. The usual selfinjectable drug is Caverject (alprostadil), a form
of prostaglandin. It has been demonstrated effective about 90 percent of the time, whether impotence is due to vascular, psychological or nervous
system problems.
Side effects are generally tolerable, but about
half the men in one study reported that the
injections occasionally caused penile pain. Other
complications included bruising; erections prolonged beyond two hours (this requires emergency treatment); and the development of fibrous tissue in the penis which can lead to
Peyronie’s disease (curvature of the penis).
For men who do not wish to inject themselves,
there is now an identical prescription medicine,
MUSE (alprostadil). This is a tiny pellet inserted into the urethra with a special device.
Erection occurs quickly for most men. Approximately one third may experience pain in the
penis, while 12 to 13 percent report pain in the
urethra. Muse is not appropriate for men with
sickle cell disease, multiple myeloma or leukemia. A pregnant woman should not be exposed
to either MUSE or Caverject.
Viagra (sildenafil) is an eagerly awaited pill for
impotence. Originally developed for high blood
pressure, it blocks an enzyme that interferes with
erection and helps 40 to 80 percent of men with
severe erectile problems. Viagra is taken 30
minutes to an hour before sexual activity. Side
effects are reportedly mild, but may include headache, digestive upset, visual disturbances or
muscle aches.
Vacuum Devices: These machines consist of a
cylinder that fits over the penis, a pump and a
ring to fit around the base of the penis. Once the
cylinder has been placed over the penis, the
pump pulls air out of the cylinder. This creates a
vacuum which pulls blood in. Once the penis is
erect, the ring goes around the base to help hold
the erection, and the cylinder is removed. The
ring may stay in place for up to half an hour.
Most men are able to master the use of this
equipment with little difficulty. Patient education improves the success rate, and many couples
report satisfaction with the device. A vacuum
device may be inappropriate for men with blood
clotting problems, sickle cell disease, leukemia
or pelvic infections.
Hormone Replacement: For a few men, sexual
difficulties are related to a hormonal imbalance.
Correcting the imbalance may solve the problem. There is now a testosterone patch (Testoderm) designed to be applied daily to the scrotum. In most men, this drug delivery system can
raise blood levels of the male hormone to normal
within three to four weeks of steady use. Periodic
blood testing is needed to assess dose.
Surgery: When impotence is due to a blocked
artery or a leaky vein in the penis, vascular
surgery may be helpful. Doctors use techniques
developed for working on the heart--but in miniature, since genital blood vessels are much smaller
than their cardiac counterparts. If you are a
candidate, get all the information you need about
risks, recovery time and effectiveness rates. It’s
best to seek a surgeon with lots of experience in
this specialized field.
Implants: Several types of penile prostheses
are available for the man who does not respond
to other treatment. Such a device, surgically
implanted in the penis, allows an erection because it is either semirigid, the simplest type, or
inflatable. Questions about the incidence of postsurgical infections and silicone reactions have
been raised but remain to be resolved.