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Impotency & Infertility

pcaw.org has compiled information on the issue of impotency and infertility. Remember, November is National Impotency Month.

Take This Quiz First
Impotence: Causes and Solutions

Impotency and Viagra

What is Viagra used for?

What Lifestyle Changes May Help Prevent or Treat Impotence?

Older patients often "left in the dark" about treatment options
Older Lovers Are Less Desirable Fathers
If He Can't Perform in Bed, Don't Get Mad, Get Him a Doctor
Impotency and Cholesterol
The Marlboro Man may be impotent
Infertile men at greater risk of testicular cancer
Remedies for Impotence. Who Said?
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Related issues:
Prostate Cancer

What Lifestyle Changes May Help Prevent or Treat Impotence?


Maintaining General Health

Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease. Such good habits include a diet rich in fresh fruits and vegetables, whole grains, and fiber and low in saturated fats and sodium. Men who drink alcohol should do so in moderation. A regular exercise program is extremely important. Quitting smoking is essential.

Frequent Erections

Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.

Kegel Exercises

The Kegel exercise is a simple exercise commonly used by people who have urinary incontinence and by pregnant women. It may also be helpful for men whose erectile dysfunction is caused by impaired blood circulation. The basic technique consists of tightening and releasing the pelvic muscle that controls urination. Since the muscle is internal and is sometimes difficult to isolate, doctors often recommend practicing while urinating on the toilet. The patient tries to contract the muscle until the flow of urine is slowed or stopped and then releases it. People should perform 5 to 15 contractions, attempting to hold each contraction for 10 seconds, three to five times daily.

Changing or Reducing Medications Causing Impotence

If medications are causing the problem, the patient and the physician should discuss alternatives or reduced dosages. In treating high blood pressure, for instance, ACE inhibitors are less likely to cause sexual dysfunction than many other medications.

Psychotherapy and Behavioral Therapy

Some form of psychological, behavioral, sexual, or combination therapy is often recommended for individuals suffering from impotence, regardless of cause. In such cases, it is beneficial to have the partner involved in this process whether sexual therapy is part of the treatment or not. The value of sex therapy itself is questionable. In one study 12 out of 20 of men whose dysfunction had a psychological basis and who were advised to enter a sex clinic resisted sex therapy out of embarrassment or because they felt it wouldn't help. Of the eight who entered therapy only one actually achieved satisfactory sex. Some kind of interpersonal, supportive, or behavioral therapy, however, can be of help to a patient during all phases of the decision-making process with regard to possible methods of treatment. Therapy may also ease the adjustment period after the initiation or completion of treatment.

Copyright 1999 Nidus Information Services, Inc. Well-Connected Report: Impotence (Erectile Dysfunction). June 1999. www.well-connected.com

In a totally unrelated development (unrelated to aging, that is), National Institute of Aging supported scientists from the University of South Carolina have found yet another compelling reason to avoid cholesterol. Men with lower blood cholesterol or higher amounts of the beneficial high-density lipoprotein (HDL) cholesterol may be less likely to develop erectile dysfunction or impotence.

Older patients often "left in the dark" about treatment options


Treatment of male impotence has gained heightened priority in medical treatment. However, doctors are sometimes inclined to hand out the oral pill "like candy", even for older patients who may have special medical problems and need other types of treatment. This warning was recently voiced by US and European medical experts at an international meeting in Paris, France, July, 99.

At the same time the world patient population is rapidly expanding. The number of males suffering from moderate to severe erectile dysfunction (ED) now tops 170 million globally.

"The increasing need for better treatments will have important implications for healthcare providers, insurance companies, governments and academia", said leading specialists, sponsored by scientific organizations from around the world, including the International Society for Impotence Research (ISIR) and the American and European Associations of Urology, and co-sponsored by the World Health Organization.

Fifty to sixty percent of oral treatments, such as sildenafil (Viagra, Pfizer), are likely to have the largest share of the market, particularly in the US. However, the demand for Viagra is slowing, and injection therapy with alprostadil (Caverject, Pharmacia & Upjohn, or Edex, Schwarz Pharma), either alone or in combination with other compounds, will still account for 30-40% of treatments, due to greater safety and efficacy, urologists suggested at the meeting.

However, several of the experts complained that the hype for the oral pill has pushed other and perhaps better treatments into the background. "In one group of 1,000 patients attending my clinic, up to 40% of men and their partners said they preferred alprostadil because it provides a more rigid and more predictable erection", said Dr. Hartmut Porst, an international specialist in male impotence from Hamburg, Germany. "It is also easy and safe to use, even for patients who have a health problem. But, presently they are not getting enough information about such therapies".

One very large target group for injection therapy includes men who have become impotent after radical prostatectomy, and those who have suffered a pelvic or perineal trauma.

"Only 8-10% of these patients will respond to oral treatment, whereas up to 70% can be treated successfully with injection therapy. The same considerations apply to the large number of patients who have erectile dysfunction as a consequence of diabetes. Less than 40% will respond to the pill, compared to 70-80% with self-injection", Dr. Porst commented.

Results from a world survey covering nearly 300 medical centers and about 100,000 patients, were reported by Dr. Ronald Virag of Paris, France. The overall assessment was that injection therapy would remain an important treatment option. It continued to be widely used in many countries, and in over 50% of the centers, alprostadil was the preferred drug. In addition, combination of injection therapies and other medications often increase the success rate in certain patients.

In 62% of cases, patients preferred to give the injection manually, while about 30% used an auto injector. In some situations, the patient would begin with the auto injector, and go on to the manual method. In 7-10% of cases, patients used both methods. Many centers also gave patients the option of using the pill and injection therapy either alternately or in combination.

Dr. Virag emphasized the importance of a proper initial patient consultation, including a careful diagnostic and medical check-up, and regular follow up. "Doctors should not just hand out the pill like candy", he commented. Where there was good follow -up, drop out rates were much lower, averaging about 20%. Switching patients from injection therapy to the pill was occurring at a rate of 18% in some parts of the world to 60% in others. However, there were also many patients who experimented with oral therapy, and then returned to self-injection.

"We notice a big difference between patients who have only had oral therapy, and those who have also had injection therapy, in regard to their sense of satisfaction about their sex lives. That difference is something every patient has a right to experience", said Dr.Virag.

In terms of success rates for the different types of therapy, injection therapy was assessed at about 90% according to the global data. This compared with 50% for the oral pill, and 25-35% for topical therapy, Dr. Virag also reported.

"Meanwhile, there is a growing number of drugs in the research pipeline" noted, Dr. Robert Kramer of Boston University, and former president of the International Society of Impotence Research. He was chairman of a committee of leading scientists and researchers who reviewed the field of pharmacological therapy in a report to the meeting.

He mentioned two upcoming new oral medications:

Other upcoming drugs include:

Summing up, Dr. Kramer cited, " researchers are now actively exploring new molecular targets." He added, "for example, that the enzyme PDE5, on which sildenafil acts, is only one of a group of at least 12 enzymes, and more may be discovered." New combinations are also being tested, such as apomorphine, sildenafil and phentolamine, and apomorphine and phentolamine. Margaret Pearson, MPH MARGPEAR@aol.com

If He Can't Perform in Bed, Don't Get Mad, Get Him a Doctor


Approximately 50% of American men over 40 have experienced problems with impotence to varying degrees, according to a study by the New England Research Institute. The ability to have an erection declines with age. A recent study suggests that 19 million men from age 40 to 70 in the U.S., out of a total of more than 37 million, either may be impotent or may have experienced the problem.

While it used to be thought that impotence was primarily a psychological problem, doctors now tell us that physical causes predominate. Among the most common: atherosclerotic disease (vascular disease), which usually starts affecting men as they age... in the 50s, 60s, and especially in the 70s; diabetes; alcoholism; neurogenic problems, such as MS (multiple sclerosis); spinal cord injuries; hormonal deficiencies; certain medications, such as those used to treat high blood pressure, tranquilizers, sedatives, and amphetamines. Joel R. Cooper, The Medical Reporter, jcooper@medreport.com

Older Lovers Are Less Desirable Fathers


From a study of European noble families, it seems that daughters of older fathers have a shortened life span. Using data from 700 families with 2,159 daughters and 4,942 sons, the study looked only at children who survived past age 30 in order to discount the effect of childhood diseases. It was found that daughters born to young fathers (in their 30s) lived to age 74.5. Daughters of older fathers (in their 50s) averaged 72.4 years. Correcting data for maternal age, parental longevity, and historical fluctuations in life expectancies increased the difference in these two groups of daughters from 2 years to 3 years.

It was suggested that this effect was due to the accumulation of genetic mutations during cell division which is more likely to be seen in sperm cells which are manufactured through adulthood rather than eggs which are produced during fetal development. Daughters would receive an X chromosome from an older father with more mutations in it than would daughters from young fathers

Impotency and Cholesterol


In a totally unrelated development (unrelated to aging, that is), National Institute of Aging supported scientists from the University of South Carolina have found yet another compelling reason to avoid cholesterol. Men with lower blood cholesterol or higher amounts of the beneficial high-density lipoprotein (HDL) cholesterol may be less likely to develop erectile dysfunction or impotence.

According to the researchers, atherosclerosis (hardening of the arteries), which may impede blood flow to and from the penis, is one primary cause of impotence. While a positive link between blood cholesterol and atherosclerosis, the association between cholesterol and impotence has only been suggested until now. The South Carolina scientists conducted a study of more than 3,200 generally healthy men between the ages of 25 and 83. Data indicated that the men with total cholesterol over 240 milligrams per deciliter (mg/dl) of blood had nearly double the risk of penile dysfunction as men with readings of 180 mg/dl. A similar pattern held true in patients with significant amounts of HDL cholesterol. Those with HDL readings of 60 mg/dl or greater were one-third less likely to develop dysfunction than were men with less than 30 mg/dl HDL.

The Marlboro Man may be impotent


According to Denver urologist Lawrence Karsh, M.D., smoking is one of the worst things a young man can do to his body. We already know about smoking's link to lung cancer and heart disease. But smoking, over many years' time, can also damage and block the blood vessels inside the penis, resulting in a failure to sustain a normal erection. In most cases, the damage won't be seen until it's too late - - sometimes not for 20 - 30 years or longer.

Infertile men at greater risk of testicular cancer


Men in couples with fertility problems are more likely to develop testicular cancer than other men. A study of over 32,000 Danish men has found that these men are 1.6 times more likely to develop this cancer, suggesting that both conditions have a common cause. One popular theory is that key testicular cells are damaged while males are still in their mother’s womb by environmental pollutants that increase their exposure to oestrogen. On the positive side, testicular cancer is still a relatively rare condition – on average, a man has just a one in 450 chance of developing it – and can almost always be effectively treated if caught early. Nevertheless, men with fertility problems should make sure they examine their testicles regularly for lumps and swellings.

Remedies for Impotence. Who Said?


Just another piece of evidence that it is important to choose your parents carefully! Back in 1919, Drs. Wood and Ruddock wrote that the common cause of impotence is a lack of power in the erectile organ. This may arise from sexual abuse, excessive venery, nervousness, or disease of the nervous system and debility of nerve force; it may be general or local. They recommended the following remedies:

The Doctors also recommend a "new" remedy: Damiana, and suggest you ingest one-half to one teaspoonful of the fluid extract or 3 to 6 grains of the solid extract. If you can find the sugar-coated pills, you could try 1 to 2 of them. Another recommendation is "unicorn root." Take one-half cupful of the infusion 2 to 3 times a day. Once the organs are healthy again, you can try boiling one-half ounce of the powdered bean with one pint of water and then taking that in doses of 2-3 tablespoons, 3 times a day. 

Disclaimer


Information is designed for educational purposes only and is not engaged in rendering medical advice or professional services. Any medical decisions should be made in conjunction with your physician. We will not be liable for any complications, injuries or other medical accidents arising from or in connection with, the use of or reliance upon any information on the web.

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