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A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.
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A medical examination may indicate neurological, vascular, or hormonal disease, or Peyronie's disease. History of illness, smoking, drug use, and hypertension can be ascertained with a thorough examination of health history. Laboratory tests are performed to identify the underlying cause.
About Erectile Dysfunction
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Measurements are compared to those taken when the penis is flaccid.
Carmine Gazzaruso, MD; Stefano Giordanetti, MD; Emanuela De Amici, MD; Gianandrea Bertone, MD; Colomba Falcone, MD; Diego Geroldi, MD; Pietro Fratino, MD; Sebastiano B. Solerte, MD; Adriana Garzaniti, MD
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Let your partner know that he's not alone. Remind him that ED is a fairly common and very treatable medical condition. ED is not a reflection on his masculinity or a lack of attraction or desire for you. You should also support your partner in any efforts to change his lifestyle (such as encouraging a proper diet, quitting smoking or use of any recreational drugs, etc.) to deal with ED.
The potential effects of prolonged PDE-5 inhibition on spermatogenesis were evaluated by Hellstrom and colleagues55 in a large cohort of men given daily doses of 10 and 20 mg of tadalafil who were followed up for 6 months. They found no significant effect of the drug on reproductive hormones or sperm parameters.
Erectile Dysfunction (ED)
A penile implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve or improve naturally or with other medical treatments. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie's disease).
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Other adverse events associated with oral PDE-5 inhibitor therapy appear to be few (Table 4). In clinical trials the rates of discontinuation of the drug because of adverse events was low (< 5%) for all of 3 drugs, with few or no cases of priapism.37,53,55,56 Extra caution should be taken for patients who are expected to have reduced clearance of the drug. This group includes men who have severe hepatic or renal insufficiency, men over 65 years old and men taking drugs that inhibit the cytochrome P450 3A4 enzyme (e.g., cimetidine, erythromycin and ketoconazole).57 For these patients it is prudent to start with smaller doses of medication and build up gradually. For sildenafil, it is our experience that a starting dose of 50 mg is safe and effective for all men.
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