Impotence

Male impotence is much more common that is generally supposed.It may be constant or occasional and it seen in varying degrees.Some men find themselves impotent with one woman and not with another.Most impotent men have good spermatogenesis and are potentially fertile.
Clinical types:
-absence of sexual desire and consequently of erection
-failure to obtain an erection
-weak and fleeting erection which subsides before penetration is complete
-normal erection and penetration but failure to emit semen.This condition of partial impotence is difficult to diagnose and the couple are ofthen unaware of it themselves.
Causes:
Ofthe there is more then one factor operating and in nearly all cases a vicious cicle is quickly established.
Impotence resuts in loss of self-esteem and this in turn causes impotence.The more a man fails the more likely he is to fail.
Impotence slightly low levels of testosterone in the plasma.The administartion of testosterone in this case never restores potency so is just a theory.There is little evidence to support this or the idea that a hormone deficiency plays any part in impotence which is not caused by an endocrine disorder.
Impotence is physiological before puberty and with advancing years.Too-frequent coitus at any age temporarily diminishes desire and capacity.Sexual capacity in the male is usually quite strong up to the age of 50 years but thereafter slowly weakens.But a man of 80 years and more can be surprisingly potent.
Some men have minimal sex drive and some may even be completely unresponsive sexually.A man with minimal or no sex drive is not necessarily timis and undersized,he is often physically well built and handsome.
From overexcitement or anxiety coitus may fail.The stress on any problem creates inhibition which prevent ejaculation despite normal penetration or erection loss.
Organic causes:
These account for only 5% of cases of male impotence:
-general ill health,debility.physical and mental exhaustion
-castration(even this does not always cause impotence)
-hypoplasia of the testes
-complete testicular failure
-an endocrine disease(for exemple diabetes)
-depression
-generalized vascular disease.

Drugs which sometimes destroy libido and encourage impotence include certain hypotensive agents and narcotics,depressants and tranquillizers.

Treatment:
This must be proceded by diagnosis and this means clinic hystory,examination and investigation to exclude an organic cause.If nocturnal erection occur an organic cause is excluded.If is not an organic problem than the man need psychiatric treatment and support.
An hormone therapy is used too.Androgens by mouth,by injection or by implant are indicated only when there is clear evidence of hormone deficiency and sometimes are useful in agening men.