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Patient
History
Medical
and sexual histories help define the degree and
nature of impotence. A medical history can disclose diseases that lead
to
impotence. A simple recounting of sexual activity might distinguish
between
problems with erection, ejaculation, orgasm, or sexual desire.
A history
of using certain prescription drugs or illegal
drugs can suggest a chemical cause. Drug effects account for 25 percent
of
cases of impotence. Cutting back on or substituting certain medications
often
can alleviate the problem.
Physical
Examination
A physical
examination can give clues for systemic problems.
For example, if the penis does not respond as expected to certain
touching, a
problem in the nervous system may be a cause. Abnormal secondary sex
characteristics, such as hair pattern, can point to hormonal problems,
which
would mean the endocrine system is involved. A circulatory problem
might be
indicated by, for example, an aneurysm in the abdomen. And unusual
characteristics of the penis itself could suggest the root of the
impotence--for example, bending of the penis during erection could be
the
result of Peyronie's disease.
Laboratory
Tests
Several
laboratory tests can help diagnose impotence. Tests
for systemic diseases include blood counts, urinalysis, lipid profile,
and
measurements of creatinine and liver enzymes. For cases of low sexual
desire,
measurement of testosterone in the blood can yield information about
problems
with the endocrine system.
Other
Tests
Monitoring
erections that occur during sleep (nocturnal
penile tumescence) can help rule out certain psychological causes of
impotence.
Healthy men have involuntary erections during sleep. If nocturnal
erections do
not occur, then the cause of impotence is likely to be physical rather
than
psychological. Tests of nocturnal erections are not completely
reliable,
however. Scientists have not standardized such tests and have not
determined
when they should be applied for best results.
Psychosocial
Examination
A
psychosocial examination, using an interview and
questionnaire, reveals psychological factors. The man's sexual partner
also may
be interviewed to determine expectations and perceptions encountered
during
sexual intercourse.
Since an erection
requires a sequence of events, impotence
can occur when any of the events is disrupted. The sequence includes
nerve
impulses in the brain, spinal column, and area of the penis, and
response in
muscles, fibrous tissues, veins, and arteries in and near the corpora
cavernosa.
Damage to
arteries, smooth muscles, and fibrous tissues,
often as a result of disease, is the most common cause of impotence.
Diseases--including diabetes, kidney disease, chronic alcoholism,
multiple
sclerosis, atherosclerosis, and vascular disease--account for about 70
percent
of cases of impotence. Between 35 and 50 percent of men with diabetes
experience impotence.
Surgery
(for example, prostate surgery) can injure nerves
and arteries near the penis, causing impotence. Injury to the penis,
spinal
cord, prostate, bladder, and pelvis can lead to impotence by harming
nerves,
smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.
Also, many
common medicines produce impotence as a side
effect. These include high blood pressure drugs, antihistamines,
antidepressants, tranquilizers, appetite suppressants, and cimetidine
(an ulcer
drug).
Experts
believe that psychological factors cause 10 to 20
percent of cases of impotence. These factors include stress, anxiety,
guilt,
depression, low self-esteem, and fear of sexual failure. Such factors
are
broadly associated with more than 80 percent of cases of impotence,
usually as
secondary reactions to underlying physical causes.
Other
possible causes of impotence are smoking, which
affects blood flow in veins and arteries, and hormonal abnormalities,
such as
insufficient testosterone.
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