Men's sexual impotence is also defined as “erectile dysfunction”. It’s a common problem that affects many men at least once in their lives. According to recent studies the disease affects between 7% and 8% of men with ages ranging between 20 and 39, and 55% to 60% of men over 70.
It is estimated that in Brazil, next to 10 million men suffer this disease chronically, and that 20 million have a less severe form. While in the past sexual impotence was related exclusively to physical causes, nowadays we know that 70% of cases are associated to organic causes, like diabetes, vascular problems or side effects of drugs and medicines.
Impotence can also be interpreted as an occasional sexual dysfunction with origins of a psychological, emotional or traumatic nature. Fear, rage, frustration and eagerness for the performance are the most common reasons. Erectile dysfunction can severely affect self-esteem, worsening the matter when mixed with psychological reasons. It can start abruptly, generally after a great psychological trauma, or settle itself gradually as the result of depression, anxiety or chronic stress. Besides, in many mental problems, sexual libido and potency are also affected.
This is a very common situation that affects at least once every grown man, particularly those involved in casual sexual relationships, the so called “performance anxiety” or fear of failing. Many societies expect men to have an aggressive sexual role and consider that a flaw in the sexual performance is shameful.
Occasional flaws are also common and occur in many situations. They can be, for example, a simple miscommunication with the sexual partner, a couple’s quarrel (for example, after a fight), the presence of disturbing elements in the environment, such as noise or light, the temporary decrease of sexual libido due to fatigue or worries, or the fear of being caught in illicit intercourse.
An important question made by doctors to determine the cause of the impotence is if the patient frequently wakes up with an erection. “Morning wood” is psychological and it’s related to the blood flow mechanism during sleep and not to sexual excitement. Psychological factors are also present when the cause for impotence is purely organic. The inability to reach an erection in these cases raises anxiety and fear of not being able to achieve an erection.
There are many physical causes for chronic or temporary impotence, from which can be extended from the most curable to the most severe causes where it cannot be cured without invasive or radical measures, such as surgery.
The following causes are well known and studied:
- Problems with the blood flow in the penis;
- Collateral effects from drugs and medicines;
- Nervous system disorders;
- Hormonal disorders;
- Structural damage of the penis;
- Other diseases, complex and multi-systemic;
Peripheral Vascular Disease
This is the most common cause of erectile dysfunction, because it’s correlated to many other systemic diseases that affect the blood vessels in the genital area, direct or indirectly. Chronic diseases like diabetes mellitus, high cholesterol and others, lead to the destruction of the contractive walls of the veins, or provoke hardening, narrowing or blockage of the arteries that go to the penis. The penis’ erection happens when the blood, carried by the arteries of the penis, dilates the erectile bodies made of spongy tissues. Any flaw in this mechanism (relaxation of the vascular system of the penis) results in less stiff erections or inability in maintaining them during the whole coitus.
Vascular failure may be the cause that further correlates with age. Generally impotence caused by vascular factors seems to slowly increase as months or years pass by, causing a decrease in the firmness of the erections to finally become the preponderant factor. The diagnostic approach to vascular disease is to investigate it with ultrasound, through a method called Doppler cavernosonogram, which is able to show a colourful image of the blood flux in the penis.
Medication and drugs
Over 200 medicines in doctor’s prescription list are known to affect men’s erectile function. In fact, there are so many, and to so many conditions, that this must be one of the main causes of organic impotence. Some of these drugs promote impotence by acting in the Central Nervous System. Others affect the intensity of the blood supply in the penis or promote relaxation of the blood vessels. Between them there is:
- Medicine used to treat arterial hypertension (high blood pressure), such as spironolactone and thiazide based diuretics, as well as beta-blockers; Medicine used to treat depression (antidepressants) and anxiety (anxiolytics), such as
- Medicine used to treat neurologic disorders, such as Parkinson’s disease and others;
- Medicine used to treat gastrointestinal disorders, such as cimetidine;
- Medicine used to treat allergies.
Furthermore abuse of substances like alcohol, tobacco, cocaine, and other drugs is also a very important cause of impotence nowadays. It’s ironic that these abusive substances are described as aphrodisiacs by its users, when taken in small quantities, but produce dependence when used systematically. A wine glass during a romantic dinner can “release” inhibitions and reduce the anxiety of performance, or other inhibiting psychological factors. A light anxiolytic can cause the same effect. Some smokers can calm themselves by enjoying slowly a cigarette, smoking pipe or cigar. To some people the powerful sensation of wellbeing that follows the consumption of cocaine, meth and other drugs can act as sexual excitement. However the chronic abuse and high doses of these substances have the opposite effect. Over 80% of alcoholics suffer from chronic sexual impotence. Scientific studies have shown that chronic smokers have significant damage to their genital blood supply.
Nervous diseases or damage to the nerves that control the process of erection are also in between the most common causes of impotence..
The big increase in the incidence of hyperplasia and prostate cancer in the last decades are some of the biggest culprits. Prostate surgery damages the nerves in more of 80% of the cases. Some of these patients recover the sexual function, completely or partially, after a year or more, but most of them remain impotent for the rest of their lives. The radiation therapy of the prostate cancer, even if less traumatic, also has an effect over sexual potency. Other pelvic surgeries may have a poisonous effect over the erection.
Other cause of impotence is crotch trauma. This is more common than we might imagine, particularly in some sports. Recently a group of researchers discovered that riding a bike can be the biggest cause for impotence, because strong blows to the perineum (the triangle between the anus and the base of the scrotum) against the frontal bar of the bike are very harmful. It is yet to be proven if constant trauma, of low intensity caused by the friction of the perineum against the seat could also be responsible for erectile dysfunction.
responsible for erectile dysfunction. Some nervous diseases affect strongly the capacity to achieve erection, because they act over the cerebral structures that are responsible for the central control for sexual impulse and the performance. They are: Parkinson’s disease and other diseases that affect the motor system, stroke, multiple sclerosis, some tumours in the brain, hypophysis gland, and epilepsy. Affectation in the spinal cord, or in the nerves that come and go to the genital area, such as the compression of vertebral discs of traumatic affectations like paraplegia and tetraplegia, can affect sexual performance, causing partial or total impotence.
Structural damage of the penis
There are less common diseases (for example, fibrosis in the penis’ tissue) caused by organic diseases, the Peyronie disease (it causes an abnormal bend in the penis), cysts and tumours.
Approximately 5 to 10% of the male population suffers some kind of hormonal disturbance. The most common one, also related to age, it’s the constant decrease in the testosterone levels, men’s main sexual hormone. It probably has something to do with the decrease in the cell’s ability to synthesize the hormone. This phenomenon took some experts to say that there exists a kind of “menopause” for men, not as drastic as the female one, denominated as andropause. While this is controversial, the fact is that many metabolic precursors of the testosterone (substances used by the body in the synthesis process) such as DHEA (dihydroxiepiandrosterone), decrease significantly with age.
The decrease of testosterone is associated with the decrease in sexual libido and performance, because the brain circuits and the penis tissues are dependant of these levels of hormones. However, a significant percentage of men with low testosterone levels remain with an unaltered performance. When the low levels of testosterone affect the primary and secondary sexual characteristics (for example, when beard growth is considerably slow, or there is a loss of hair in the chest or the pelvic region, or even the atrophy of the testicles and penis, and an increase of the chest area called gynecomastia), it’s said that occurs a condition called hypogonadism (the gonads, or sexual gland). There are two types of hypogonadism:
- Primary hypogonadism, caused by a disease in the cells that produce testosterone;
- Secondary hypogonadism, caused by a disease or dysfunction in the systems that control the production of testosterone, like the hypophysis. The most common form of secondary hypogonadism is called Hypogonadism Hypogonadotropic, because there is a clear decrease in the FSH (Follicle-stimulating hormone) levels, or gonadotropic hormone which is produced by the hypophysis gland. The primary hypogonadism in contrast has normal or high levels of FSH.
In the works developed by Centre Metamorphosis, the therapists research the potential of the body to readapt to the stimuli which will provoke a rereading on the potential pleasure of the body. Our research demonstrates that the human body answers to stimuli of pleasure by searching for adapters means, since the principal memory related to the orgasm is connected to one of the most important aspects of the human being: the capacity of reproducing and perpetuating. Based on the human instinct and on the ability to adapt of the species, we understand that the human body reorganises the sensorial synapses that take information to the brain, reactivating the favourable conditions to the orgasm and the pleasure.
There are numerous other possibilities of orgasm, like the dry orgasm, that can benefit the men that suffered the radical removal of the prostate through surgery.
Each man needs to go through a set of therapeutic situations which will reproduce the necessary stimuli to experience new situations of orgasm and pleasure.
We recommend to the ones that are presenting this condition of impotence and want to experience our therapeutic procedures, contact with the accredited therapists, so you can receive the right orientation of how to start.