There are several different types of impotence:
Arteriogenic: This form of impotence is when the arteries that supply the penis with blood can’t deliver sufficient blood to cause or sustain an erection. This can occur because of a narrowing of the arteries such as occurs in the elderly, diabetics and those with high blood pressure or because of injury to the genital region which causes a block in the artery to the penis. The latter description is more frequent among younger patients. Injuries that can cause problems may stem from major incidents, such as fracture of the pelvis or pubic bone, or stem from minor injuries, such as bicycle riding that may crease a clot, or thrombus, within the artery leading to the penis. Clots such as these are capable of continuing to grow until they block the penis’ blood supply altogether.
Today, it has been established that erectile dysfunction (ED) is a marker, a warning sign, for future cardiovascular diseases like heart attacks and strokes. It’s been noted that arterial diseases can often affect smaller arteries, such as within the penis, before affecting much larger arteries, such as within the heart or brain. This makes a very strong case for the early diagnosis and management of ED, and this, in turn, will allow the early detection of diseases like diabetes, high blood pressure, high cholesterol, high lipids, etc..
In a case study, College student S.V.S., 23, became totally impotent following a vehicular accident in which he sustained a fracture of the pelvis and a rupture of the urethra. The patient was admitted to hospital for almost four weeks and underwent an operation. Prior to the accident, the patient reported a normal sex life with his fiance. When the patient returned to speak to the doctors who treated the original injurty, he was informed that the problem was likely psychological and that it would be all right in a few months on its own. After a year with no improvement, the patient was seeking to end his engagement. After reading a magazine article, he was prompted to see an andrologist. A phalloarteriogram study showed that the main artery to the penis was blocked. The patient was finally cured with a microsurgical bypass operation – a penile revascularization procedure.
Impotence as a result from arteriogenic injuries is more common than many doctors suspect, but they are often unaware of the conditions that may cause this. It’s common for patients to be wrongfully admitted to orthopedic or urology wards in an attempt to treat problems. Unfortunately the impotence problem is often not discovered until after the more noticeable wounds or injuries have recovered. In these cases, the patient learns of the resulting impotence first, and not the doctor.
Venogenic: Where the veins of the penis leak blood and prevent the development of a rigid erection. In a male without this condition, veins within the penis shut down so that almost no blood can flow back out from the penis. This allows blood to accumulate in the sinusoids of the penis, thus raising pressure and allowing for the development of rigidity or hardness.
Venogenic impotence is extremely common. It’s thought that between 30-70% of impotence problems stem from this condition. Primary venogenic impotence afflicts men from the time they’re born. Such men have never had a rigid erection all their lives. Yet there are some men who may develop secondary venogenic impotence suddenly later in life.
Neurogenic: The nerve supply to the penis is very complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. These nerves trigger the surrounding arteries and veins that will change and sustain the blood flow.
The nerve supply to the penis can be affected by a large number of things. Injuries to the back, especially if they involve the vertebral column and the spinal cord can cause impotence.
So also can injury to other nerves supplying the penis such as occurs after pelvic or perineal trauma. There are cases where surgical procedures conducted on other conditions may cause injury to the nerves to the penis, which can lead to impotence. These include operations on the rectum, prostate, urethra, spine, retroperitoneum, urinary bladder etc.
Of course, disorders of the nervous system such as multiple sclerosis, myelitis, tumour etc. are wont to cause impotence if they involve the nerve supply to the penis.
Another disease affecting the nerves to the penis is diabetes mellitus. Impotence is extremely common among diabetics. It’s believed that up to 50% of diabetics suffer from impotence. Impotence in diabetics is almost always organic in origin. The usual therapy given to diabetics to treat their diabetes won’t restore the damaged erectile function as the actual diabetes can’t be reversed. Only the blood sugar levels and the complications of diabetes are controlled. Modern andrology, however, can offer a cure to nearly all patients with diabetes-related impotence. This is another fact that is, unfortunately, not known to most people. There simply aren’t many diabetologists that will work on treating erectile dysfunction as part of their treatements.
Some drugs may also be responsible for causing neurogenic impotence as they damage or otherwise affect the nerve endings. Among the most predominant of these are anti-hypertensives used to treat high blood pressure and psychotropics. The list is very large. Most doctors will remain completely oblivious to the fact that the drugs being prescribed to treat various ailments could be the culprit for causing impotence as a side effect.
Endocrinologic (or hormonal): This occurs when there is an imbalance or insufficiency of sex hormones in the blood stream. It accounts for about 5 to 10 per cent of all organic impotence. However, hormonal changes usually affect the libido instead of the ability to achieve and maintain an erection. There are many diseases that may cause changes in hormonal levels.
Mixed: Often, there may be multiple factors that can affect a patient. These patients are often diagnosed with systemic disease. The systemic diseases usually responsible include renal (kidney) failure, liver failure and diabetes.
Another section of patients with mixed factors for impotence is where the erectile dysfunction itself may lead to other ailments and disorders, such as depression. While the underlying cause of the impotence might be organic, if it’s been untreated or undiagnosed it can take a toll on the patient’s mind, in most cases because the patient has been told the problem is all within his mind.
Psychogenic: When there is no organic factor and the problem lies purely in the mind, it is labeled a case of psychogenic impotence. However, prior to giving a patient this particular label, it’s important to have an andrologist investigate for any potential organic or bodily causes that could be creating the problem first.
Only then can treatment proceed in a scientific and systematic manner.
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