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

Treatment depends on controlling symptoms and treating the cause

Testosterone if there is hypogonadism.

In diabetic neuropathy oral sildenafil (Viagra)