Male Sexual Impotence (erectile dysfunction)

Male sexual impotence is also defined as "erectile dysfunction". It is a common problem that affects many men at least once in their lifetime. According to the most current studies, the disease affects 7% to 8% of men aged 20 to 39 years and about 55% to 60% of men aged over 70 years.

It is estimated that, in Brazil, about 10 million men suffer from the chronic form of the disease and that about 20 million men face the less severe form. Although sexual impotence in the past was exclusively related to physical causes, today we know that 70% of cases are associated with organic causes, such as diabetes, vascular problems or side effects of drugs and medicines.

Impotence can also translate as occasional sexual dysfunction due to psychological, emotional or traumatic causes. Fear, anger, frustration and yearning for performance are the most frequent reasons. Erectile dysfunction can seriously affect self-esteem, worsening the difficulty when the physical problem is mixed with psychological issues. It may start abruptly, usually after a major psychological trauma, or it may set in gradually as a result of depression, anxiety and chronic stress. In addition, in many mental disorders, sexual libido and potency are also affected.

There is a very common situation, which affects all adult men at least once, particularly those involved in casual sex, the so-called "performance anxiety" or fear of failure. Many societies expect an aggressive sexual role from men and consider that failure to perform sexually is shameful.

Occasional failures also occur in many other situations. They can be, for example, a simple lack of dialogue with the sexual partner, a marital friction (eg after a fight), the presence of disturbing elements in the environment, such as noise or light, a temporary decrease in sexual libido , due to fatigue or worries, or fear of being caught in illicit relationships.

An important question asked by doctors to determine the cause of impotence is whether the patient often wakes up with an erection. "Morning" erections are psychological and are related to the mechanisms of blood supply during sleep and not to sexual arousal. The presence of these erections generally means that the main cause may not be organic.

Psychological factors are also present when the cause of impotence is purely organic. The inability to achieve an erection in these cases increases anxiety and the fear of not being able to have an erection.

There are many physical causes for temporary or chronic impotence, which can range from the most curable or even the most severe causes, which cannot be cured without invasive or radical measures, such as surgery.

The following causes are well known and studied:

1. Problems with the blood supply of the penis;
2. Side effects of drugs and medication;
3. Disorders of the nervous system;
4. Hormonal disorders;
5. Structural damage to the penis;
6. Other diseases, complex and multisystemic;

Peripheral vascular disease

This is the most common cause of erectile dysfunction, because it is correlated with many systemic diseases that affect blood vessels in the genital region, directly or indirectly. Chronic diseases, such as diabetes mellitus, high cholesterol and others, lead to the destruction of the contractile walls of the veins, or cause hardening, narrowing or blockage of the arteries that reach the penis. The erection of the penis happens when the blood, carried by the arteries of the penis, makes the erectile bodies made of spongy tissue swell. Any failure in this filling mechanism, such as narrowing of atherosclerotic arteries and plaques, can lead to erectile failure. The erection is maintained by a physiological trapping of the accumulated blood flow in the penis, via blood vessels. Any failure in this mechanism (relaxation of the vascular system of the penis) results in less rigid erections or an inability to maintain them long enough to complete intercourse.

Vascular failure is perhaps the cause that most correlates with age. Generally, impotence caused by vascular factors seems to increase slowly over the months or years, causing a decrease in the firmness of the erections, to finally become the predominant factor.

The diagnostic approach to vascular disease is to investigate it with ultrasound, using a method called cavernosonogram Doppler, which is able to show the color image of blood flow in the penis.

Medications and drugs

More than 200 prescription drugs are known to affect erectile function in men. In fact, there are so many, and for so many conditions, that this must be one of the main causes of organic impotence. Some of these drugs promote impotence by acting on the Central Nervous System. Others affect the intensity of the blood supply to the penis or promote blood vessel loosening. Among them are:

1. Medicines used to treat high blood pressure (high blood pressure), such as spironolactone and thiazide-based diuretics, as well as beta-blockers;
2. Medicines used to treat depression (antidepressants) and anxiety (anxiolytics), such as phenothiazine;
3. Medicines used to treat neurological disorders, such as Parkinson's disease and others;
4. Medicines used to treat gastrointestinal problems, such as cimetidine;
5. Medicines used to treat allergies.

In addition, substance abuse such as alcohol, tobacco, cocaine and other drugs is also a major cause of impotence these days. It is ironic that these substances of abuse are considered aphrodisiacs by their users, when taken in small quantities, but produce dependence when used systematically. A goblet of wine, during a romantic encounter, can "release" inhibitions and decrease performance anxiety or other psychological inhibiting factors. A mild anxiolytic can have the same effect. Some smokers are calmer by slowly enjoying a cigarette, pipe, or cigar. For some people, the powerful sense of well-being that accompanies ingesting cocaine, methamphetamine and other drugs can act as a sexual arousal. However, chronic abuse and high doses of these substances have the opposite effect.

More than 80% of alcoholics suffer from chronic sexual impotence. Scientific studies have shown that chronic smokers have significant damage to their genital blood supply system.

Neurological damage

Nervous diseases or damage to the nerves that control the erection process are also among the most common causes of impotence.

The great increase in the incidence of hyperplasia and prostate cancer in recent decades is one of the most responsible. Prostate surgery damages the nerves in more than 80% of cases. Some of these patients recover their sexual function, completely or partially, after a year or more, but most remain impotent for life. Radiation therapy for prostate cancer, although less traumatic, also has an effect on sexual potency. Other pelvic surgeries can have a deleterious effect on the erection.

Another cause of impotence is trauma to the groin. This is more common than we think, particularly in some sports. Recently, a group of researchers discovered that riding a bicycle can be the biggest cause of impotence, because strong strokes of the perineum (the triangle between the anus and the base of the scrotum) against the front bar of the bicycle are very harmful. It remains to be seen whether the constant, low-intensity trauma caused by rubbing the perineum against the seat could also be responsible for erectile dysfunction.

Some nervous diseases strongly affect the ability to achieve erection, because they act on brain structures that are responsible for the central control of the sexual impulse and its performance. They are: Parkinson's disease and other diseases of the motor system, stroke, multiple sclerosis, some tumors of the brain and pituitary gland, and epilepsy. Affections in the spinal cord or nerves that come or go to the genital area, such as compression of the vertebral discs or traumatic affections such as paraplegia and quadriplegia, or in regional paralysis, can affect sexual performance, causing partial or total impotence.

Structural damage to the penis

There are less common diseases (for example, fibrosis of the penis tissue) caused by organic diseases, Peyronie's disease (it causes an abnormal curvature of the penis) and cysts and tumors.

Hormonal disorders

Approximately 5 to 10% of the male population suffers from some type of hormonal disorder. The most common, also related to age, is the constant decrease in levels of testosterone, the main sex hormone in men. It probably has something to do with the decreased ability of testicular cells to synthesize the hormone. This phenomenon has led some experts to state that there is a type of "menopause" for men, not as drastic as for women, called andropause. Although this is controversial, the fact is that many metabolic precursors to testosterone (substances used by the body in the synthesis process) such as DHEA (dehydroxyiepiandrosterone), decrease significantly with age.

The decrease in testosterone has been associated with a decrease in sexual libido and performance, because brain circuits and penis tissues are dependent on these hormone levels. However, a significant percentage of men with low testosterone levels remain sexually unchanged. When low testosterone levels affect primary and secondary sexual characteristics (for example, when beard growth is considerably slow, or there is hair loss on the chest or pelvis, or even atrophy of the testicles and penis, and an increase in the region) of the breasts called gynecomastia), it is said that a condition called hypogonadism (of gonads, or sex gland) occurs. There are two types of hypogonadism:

1. Primary hypogonadism, caused by a disease in the testosterone-producing cells;
2. Secondary hypogonadism, caused by a disease or dysfunction in the systems that control testosterone production, such as the pituitary gland. The most common form of secondary hypogonadism is called Hypogonadotropic Hypogonadism, because there is a demonstrable decrease in the levels of FSH (Follicle Stimulating Hormone), or gonadotrophic hormone, which is produced by the pituitary gland. Primary hypogonadism, in contrast, has normal or even increased levels of FSH.

Another condition that can often lead to sexual impotence is called hyperprolactinemia, which is an abnormal increase in another hormone produced by the pituitary gland, called prolactin. In women, prolactin is responsible for stimulating the mammary glands to produce milk. Men usually have low levels of prolactin, but in some diseases they may be increased, such as in a type of benign tumor called prolactinoma.

In diagnostic tests done to diagnose the causes of sexual impotence, the doctor usually orders laboratory tests designed to measure the level of testosterone, FSH and prolactin. Simultaneously, low levels of testosterone and FSH signify a diagnosis of Hypogonadotrophic Hypogonadism. Hyperprolactinemia is also often associated with this condition.

In the work developed at Comunna Metamorfose, therapists research the body's potential to readapt to stimuli that provoke a re-reading of the body's pleasure potential. Our research shows that the human body reacts to pleasure stimuli by seeking adaptive resources, since the main memory related to orgasm is linked to one of the most important aspects of the human being: the ability to reproduce and eternalize.

Based on human instinct and the species' ability to adapt, we realize that the human body reorganizes the sensory synapses that take information to the brain, reactivating the conditions conducive to orgasm and pleasure.

There are numerous other orgasm possibilities, such as dry orgasm, which can benefit men who have undergone radical prostate removal through surgery.

Each man needs to go through a set of therapeutic situations that will reproduce the stimuli necessary to live new experiences of orgasm and pleasure. We recommend those who are experiencing this condition of impotence and want to try our therapeutic processes, to contact the accredited therapists, so that they receive the proper guidance on how to get started.