IMPOTENCE

Erectile failure or impotence is a common problem and most of the time related to anxiety, depression or as a complication of diabetes mellitus.

CAUSES OF IMPOTENCE

With reduced libido

• Depression

• Hypogonadism

• Hyperthyroidism

Acromegaly

Addison’s disease.

With intact libido

• Anxiety

• Vascular insufficiency

• Neuropathic e.g. diabetes, alcohol excess, multiple sclerosis.

• Drugs: beta-blockers, thiazide diuretics, antihistamines, metoclopramide, sedatives, tricyclic anti-depressants, antihypertensives.

Investigations

Blood glucose

Serum testosterone

FSH, LH

Serum prolactin.

Management

Testosterone if there is hypogonadism.

In diabetic neuropathy oral sildenafil (Viagra); a phosphodiesterase inhibitor is first-line therapy. Nitrates are contraindicated with Viagra because of the risk of severe hypotension.

Injection of prostaglandin El by the patient himself.

Vacuum constriction device

Penile prostheses