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Impotence

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder, and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Impotence can also be a total inability to achieve erection, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult.

Impotence usually has a physical cause such as disease, injury, or drug side effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. However, it is not an inevitable part of aging.

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Is it treatable?

Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence - especially complications of impotence.

Since an erection requires a sequence of events, impotence can occur when any of these events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases, including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease - account for about 70 percent of cases of impotence.

Between 35 and 50 percent of men with diabetes experience impotence.

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Can certain types of surgery affect impotence?

Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

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Can certain medicines or drugs affect impotence?

Many common medicines can produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug). 

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What about psychological factors?

Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.

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What about other causes?

Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

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Medical history

Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire.  A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.

Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behaviour modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).

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Drug Therapy

Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day.

Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs, including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone, but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use might be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.

Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.

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Treatment of Impotence with Acupuncture

Impotence refers to the inability to have an erection or maintain an erection until ejaculation, which is often seen in sexual neurastenia and some chronic diseases.

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Etiology and pathogenesis

Impotence is usually caused by the decline of fire from the gate of life and exhaustion of essence and blood as a result of early marriage, indulgence in sexual activity or frequent masturbation, damage to the kidney by fright, damage to the heart and spleen and further the Stomach Meridian of Foot-Yangming and Chong Meridian by worries. There are also some cases caused by the downward flow of dampness-heat.

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Syndrome differentiation

Failure to have an erection or inability to maintain a satisfactory erection, premature ejaculation. The accompanying symptoms are dizziness, blurred vision, tinnitus, insomnia, pale complexion, lassitude, soreness and weakness in the loin and knees, thready and weak pulse.

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Treatment

Principles: To invigorate kidney qi and benefit the heart and spleen. Methods: Select acupoints on the Kidney Meridian of Foot-Shaoyin and the Stomach Meridian of Foot-Yangming and a back-shu point to apply acupuncture treatment, using the reinforcing manipulation. Moxibustion can also be used if necessary.

Acupoints: Shenshu (BL 23), Zusanli (ST 36) and Neiguan (PC 6).
Notes: Since the disease is chiefly due to the deficiency of kidney qi, Shenshu is used to invigorate kidney qi and improve the function of the Kidney Meridian. Zusanli, the he point of the Stomach Meridian of Foot-Yangming, helps relieve stagnation, calm the mind and invigorate the heart and spleen when used together with Neiguan.

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Other Remedies

1. Pricking therapy: Acupoints: Shenshu (BL 23), Mingmen (DU 4), Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Sanjiaoshu (BL 22), Guanyuanshu (BL 26), Baihui (DU 20), Dazhui (DU 14), Dazhu (BL 11) and Changqiang (DU l). Methods: Select one to two points each time. Prompt prick and sway the needle for 5- 10 minutes. Use a fine needle to prick the tendons if the patient is of weak constitution, and moxibustion treatment can be used at the same time. The treatment is given every two days, and a complete course includes five times treatment.

2. Electric acupuncture: Apply an electro-acupuncture device to Qugu (RN 2., Rangu (KI 2), and four pairs of points Shangliao (BL 3l), Zhongliao (BL 33), Ciliao (BL 32) and Xialiao (BL 34) on both sides of the body, using low-frequency pulse circuit. The treatment lasts three to five minutes each time. When puncturing at Qugu, it's better to conduct the needling sensation towards the external genitalia.

3. Ear acupuncture Points: Auricular points for uterus (seminal vesicle, external genitalia, testis (ovary) and internal tragic apex. Methods: Select two to four points each time, and keep the needle in the skin for 10-20 minutes. If needle embedment therapy is used, it should last three to five days.

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Notes

Tonics which benefit qi and strengthen the kidney yang can be taken during the acupuncture treatment to achieve a better result.

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Further Reading

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Chinalife Remedies

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Please note that although we are confident that our treatments will help the majority of our patients, we cannot absolutely guarantee a cure as the needs and difficulties of each patient can differ greatly