Erectile disorder
Erectile disorder: Excerpt from Professional Guide to Diseases (Eighth Edition)
Erectile disorder, or impotence, refers to a male’s inability to attain or maintain penile erection sufficient to complete intercourse. The patient with primary impotence has never achieved a sufficient erection; secondary impotence, which is more common and less serious than the primary form, implies that, despite present inability, the patient has succeeded in completing intercourse in the past.
Transient periods of impotence aren’t considered dysfunction and probably occur in half of adult males. Erectile disorder affects all age-groups but increases in frequency with age. The prognosis depends on the severity and duration of impotence and the underlying cause.
Causes and incidence
Statistics indicate an organic basis for erectile dysfunction in 20% to 50% of men who have this disorder. 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 generally involve guilt, fear, depression, or feelings of inadequacy resulting from previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, abnormal mother-son intimacy, or homosexual experiences. 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, as in performance anxiety.
Organic causes may include chronic diseases, such as cardiopulmonary disease, diabetes, multiple sclerosis, or renal failure; spinal cord trauma; complications of surgery; drug- or alcohol-induced dysfunction; and, rarely, genital anomalies or central nervous system defects.
Erection problems are common in adult men, with almost all men experiencing occasional difficulty getting or maintaining an erection.
Signs and symptoms
Secondary erectile disorder is classified as follows:
❑ Partial — The patient is unable to achieve a full erection.
❑ Intermittent — The patient is sometimes potent with the same partner.
❑ Selective — The patient is potent only with certain females.
Some men lose erectile function suddenly; others lose it gradually. If the cause isn’t organic, erection may still be achieved through masturbation.
Patients with psychogenic impotence may appear anxious, with sweating and palpitations, or may lose interest in sexual activity. Patients with psychogenic or drug-induced impotence may suffer severe depression, which may cause the impotence or result from it.
Diagnosis
A detailed sexual history helps differentiate between organic and psychogenic factors and between primary and secondary impotence. Questions should include: Does the patient have intermittent, selective, nocturnal, or early-morning erections? Can he achieve erections through other sexual activity? When did his dysfunction begin, and what was his life situation at that time? Did erectile problems occur suddenly or gradually? Is he taking large quantities of prescription or nonprescription drugs?
Diagnosis must rule out chronic diseases, such as diabetes and other vascular, neurologic, or urogenital problems.
When the disorder causes marked distress or interpersonal difficulty, it may fulfill diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Procedures used to differentiate between organic and nonorganic causes of erectile disorder include noninvasive tests, such as monitoring nocturnal penile tumescence, blood pressure measurements in the penis with a Doppler ultrasound, and measuring pudendal nerve latency. Laboratory tests include glucose tolerance tests, plasma hormone assays, liver and thyroid function tests, and prolactin and follicle stimulating hormone levels. Invasive diagnostic studies include penile arteriography and dynamic infusion cavernosonography.
Treatment
Sex therapy, which should include both partners, may effectively cure psychogenic impotence. The course and content of such therapy depend on the specific cause of the dysfunction and the nature of the male-female relationship. Usually, therapy includes sensate focus exercises, which restrict the couple’s sexual activity and encourage them to become more attuned to the physical sensations of touching. Sex therapy also includes improving verbal communication skills, eliminating unreasonable guilt, and reevaluating attitudes toward sex and sexual roles.
Treatment of organic impotence focuses on reversing the cause if possible. If not, psychological counseling may help the couple deal realistically with their situation and explore alternatives for sexual expression. Certain patients suffering from organic impotence may benefit from surgically inserted inflatable or noninflatable penile implants. Sildenafil, a recent drug treatment for erectile dysfunction, is also effective and is an alternative to surgery in many male patients.
Special considerations
❑ When you identify a patient with impotence or with a condition that may cause impotence, help him feel comfortable about discussing his sexuality. Assess his sexual health during your initial nursing history. When appropriate, refer him for further evaluation or treatment.
❑ After penile implant surgery, instruct the patient to avoid intercourse until the incision heals, usually in 6 weeks.
To help prevent impotence:
❑ Promote establishment of responsible health and sex education programs at primary, secondary, and college levels.
❑ Provide information about resuming sexual activity as part of discharge instructions for patients with conditions that require modification of daily activities. Such patients include those with cardiac disease, diabetes, hypertension, and chronic obstructive pulmonary disease and all postoperative patients.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Impotence
More Medical Textbooks Online about Impotence
Review other book chapters online related to Impotence:
Medical Books Excerpts
- IMPOTENCE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- IMPOTENCE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Impotence
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Impotence
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Impotence
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Impotence
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Impotence
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- IMPOTENCE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Impotence (Professional Guide to Signs & Symptoms (Fifth Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
