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The inability to achieve penile erection or to maintain an erection until ejaculation. Also called impotence. The incidence of Impotence or Erectile Dysfunction often correlates with a man's age, some 67% of men by the age of 70 years old have some difficulties achieving an erection. Stress also as a significant impact on man's ability to perform. Over the last decade we have seen a considerable rise in the incidence of impotence in men in their mid thirties and even younger. Stress has been noted as an important cause of impotence in this age group. Impotence impacts more than a man's sexual activity. The emotions and uncertainties that coincide with this condition often have a significant effect on a man's self-esteem, as well as, his relationship with his partner. Although the incidence of Impotence increases with age, it is not an inevitable result of aging. Impotence is a secondary condition linked to many medical conditions. Fortunately, there are now very effective methods to treat impotence. For a detailed description of the most recommended impotence treatment options by Urologist (doctors that specialize in this type of medicine) please visit the following webpage:
The first step in treating Impotence is that the individual understands the psychology, physiology and anatomy responsible for the ability to achieve and maintain an erection. If we can comprehend these events than we can better understand the factors that are responsible for Impotence and address the questions concerning treatment. Normal Erectile Function For something that appears so natural, an erection is a rather complicated process involving the coordination of the psychological, neurological and cardiovascular systems. The penis becomes erect following a series of events. First, the nerves are stimulated, a sensation known as arousal. No matter what the nature of the stimulus, visual, mental or physical the brain coordinates the following series of events:
Causes of Impotence Historically, when an individual consulted his physician
concerning Impotence he was usually informed there were no known
physiological answers concerning his condition. Today, a generation
of research has resulted in significant advances in both the diagnosis
and treatment of Impotence. Physicians now understand that approximately
85% of Impotence is attributable to physical/organic conditions
while only 15% is due to psychological or mixed origin (both psychological
and organic). Some important causes of physiological Impotence are
as follows: Vascular Disease
Diabetes is another common cause of Impotence. Approximately 50% of men with insulin dependent diabetes experience some degree of ED after 55 years old. Diabetes results in poor circulation and/or peripheral neuropathy. When the nerves are involved, sexual stimuli are not transmitted appropriately to or from the brain and Impotence develops. Neurological diseases such as multiple sclerosis, Parkinson's disease, spinal cord injuries and long term effects of diabetes can also result in the disruption of the normal sequence of events necessary for an erection to occur. Endocrine System
Prescription medications often cause Impotence as a side effect. Some two hundred known medications fall into this category including: Antihypertensives medications specifically:
Antidepressant/Antipsychotic medications -of almost any label can also result in Erectile Dysfunction e.g. Prozac®, Elavil®, Zoloft®, Thorazine® and Haldol®. Note: Many other medications in a variety of classes can periodically cause Impotence. If you take a prescription medication or an over-the-counter medication, regularly, please consult with your physician. However, never alter a dosage or discontinue a medication without the advice of your physician.
Smoking and Impotence Smoking as been linked to Impotence in numerous clinical studies. The most common causes of the organic component in erectile dysfunction or impotence are vascular abnormalities associated with atherosclerosis and diabetes mellitus. Atherosclerosis causes 40% of cases of erectile dysfunction, and in cases of diabetes mellitus the prevalence of erectile dysfunction is 50%. Smoking is significantly associated with the development of both atherosclerosis and diabetes mellitus. The Epidemiology and Pathophysiology of Impotence.
Aside from impotence, smoking as also been linked to the following negative effect concerning male sexual health:
LH-RH Analogs/Antiandrogen medications and Impotence are medications are used in the treatment of prostate cancer. They function by decreasing the production of testosterone in the testes and adrenal glands, which decrease in testosterone often results in Erectile Dysfunction. Chemotherapy/Radiation and Impotence therapy is also a significant contributors to Impotence. These drugs/treatments are used in the treatment of cancer. Substance Abuse and Impotence can also negatively effect male potency. The chronic use of cocaine, marijuana, alcohol, steroids etc. often results in Erectile Dysfunction, as well as a decrease in desire. Excessive tobacco use can also attribute to Impotence by accentuating the effects of other risk factor such as vascular disease or hypertension. Radical Pelvic Surgery and Impotence also result in Erectile Dysfunction. Surgical procedures involving the prostate gland, bladder or colon may interfere with the nerves involved in the erectile response. Radiation therapy for cancer may also effect the erectile process. Psychological Impotence is usually diagnosed when no physical causes can be defined. Pure psychological Impotence usually occurs suddenly without warning as opposed to physical ED that may gradually develop over the years. Some common causes of psychological Impotence are as follows:
Anatomical Deviation of the Penis and Impotence
Impotence Treatment Options Until recently, individuals who sought medical treatment for Impotence were told "It's all in your head". Physicians labeled these individuals with a psychological disorder and they were referred to counseling. Today, there are many treatment options available. The treatment option you choose should be specific and responsive to your needs and expectations as well as your partners. Medication Information -currently there
are several oral medications for the treatment of impotence
including
Viagra,
Cialis,
Levitra
and
Uprima.
Mechanism of Action of the Various Impotence Medications:
The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum during sexual stimulation. NO then activates the enzyme guanylate cyclase, which results in increased levels of cyclic guanosine monophosphate (cGMP), producing smooth muscle relaxation in the corpus cavernosum and allowing inflow of blood. Some Medication Information enhance the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is responsible for degradation of cGMP in the corpus cavernosum. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum. Some impotence medications stimulate dopamine receptors in the hypothalamus and mid brain regions. Subsequently, once sexual stimulation as occurred an excitatory signal is transmitted via the spinal cord to stimulate parasympathetic activity in the pelvic region that results in smooth muscle relaxation in the walls of the arteries supplying the penis. The relaxation of walls of these arteries allows the arteries to expand so more blood can flow to the region, hence, improved erections. Other impotence medications exert their action by effecting two enzymes, Cyclic guanosine monophosphate (cGMP) and phosphodiesterase type 5 (PDE5) that play important roles in erectile function. Sexual stimulation triggers the local release of nitric oxide (NO) from nerves and endothelial cells in the penis. NO stimulates an enzyme that catalyzes formation of cGMP from the nucleotide guanosine 5-triphospate (GTP) in the penile blood vessels and corpus cavernosum walls. The cGMP causes vasodilation of arteries, allowing the influx of blood into the corpus cavernosum. Increased blood flow into the penis causes the erectile tissue to expand. When the erectile tissue has expanded sufficiently, the veins draining the corpus cavernosum become compressed. This decreases the outflow of blood from the penis, and the blood remains in the corpus cavernosum to keep the penis erect. The enzyme PDE5 eventually causes degradation of the cGMP, and the erection ends.
Additional Impotence Treatment Options
Final Notes, Impotence Treatment Options
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Impotence Information
Vascular
Disease is the leading cause of Impotence. Vascular disorders include
arteriosclerosis (hardening of the arteries), hypertension, hyper-cholestremia
and other conditions which interfere with the blood flow to the
penis. Additionally, "venous leakage", a condition occurring
when the penile veins are unable to constrict efficiently during
an erection, also contributes to poor erections. When these veins
"leak", blood escapes to the periphery resulting in a
poor erection. 
Anatomical Deviation of the Penis, known as Peyronie's Disease,
may also cause impotence. This condition usually develops from an
inflammatory process and results in fibrous scaring of the penis.
The cause of this process is not yet understood; however, when an
erection does occur, there is a bending of the penis secondary to
the scar tissue. This curvature may interfere with erectile capacity
and/or ejaculation. 
Herbal
Approaches for the treatment of impotence have become very
popular as an initial treatment for Impotence. Herbal supplements
for the treatment erectile dysfunction should contain a combination
of the following ingredients: Yohimbe (bark), Maca (root), Horny
Goat Weed (leaf), Saw Palmetto (berry), Schizandra (berry), Guarana
(seed) Tribulus Terrestris (aerial part), Ashwagandha (root), Asparagus
Racemosus (aerial part), Ginger (root) Cayenne Pepper (berry), L
Tyrosine, and L Histidine. Physicians' Select Male Enhancement
capsules provide the most complete ingredients for the herbal
treatment of erectile dysfunction.
Penile
Injection Therapy: treatment of impotence uses a hypodermic
needle to inject medication that is a mixture of papaverine, phentolamine
and prostoglandin into the side of the penis. The medication relaxes
the smooth muscle tissue of the penis allowing for an erection.
These injections can be painful, result in scare tissue formation
at the injection site and cause priapism, the prolonged and painful
engorgement of the penis). 
Urethral
Inserts: treatment of impotence consists of a disposable
applicator, small enough to fit into the urethra. The applicator
is inserted into the urethra approximately one inch and the prostaglandin
E-1 medication is released. As a result, an erection occurs lasting
30-60 minutes. Patient acceptance is still an issue secondary to
expense and the low success rate as compared to other treatments
for Impotence.
Hormonal
Therapy: Impotence treatment is used to treat the small
percentage of individuals who have abnormally low levels of testosterone.
During the initial consultation, a physician will likely order LH
and Prolactin hormone test to exclude other causes of low testosterone
levels. If appropriate, testosterone is available in a transdermal
adhesive patch. 
Vascular
Surgery: Impotence treatment may involve both the arterial
and venous systems. Venous ligation has been reported to be effective
in patients with venous leakage. However, it is often difficult
to diagnose individuals with this condition with the current testing
capabilities; therefore, it is difficult to predict their outcome
prior to surgery. Arterial re-vasculation procedures are limited
to congenital or traumatic vascular abnormalities. Similar to venous
testing, complete standardization diagnostic testing has not been
established, so difficulties persists in predicting surgical results.
Penile
Implants: Impotence treatment requires surgical insertion
of a prosthetic device. Three forms of penile prosthesis are currently
available flexible, malleable and inflatable. Flexible or Malleable
rods consist of two semi-rigid, flexible rods that make the penis
firm enough for intercourse. There are also inflatable prosthetic
devices that produce a more natural erection. When an erection is
desired the pump (located in the scrotum) is squeezed, this in turn
inflates a cylinder, which creates an erection.
Psychotherapy
and/or Behavioral Therapy: Impotence treatment have been
found to be beneficial in treating Impotence. Although the majority
of causes of impotence are physical, there are quite frequently
underlying psychosocial factors involved as well. Psychotherapy
and/or behavioral therapy may be helpful in individuals whom no
organic cause for Impotence has been detected. Therapy often focuses
on complications surrounding performance anxiety, dysfunctional
relationships, loss of a partner, psychotic disorders, substance
abuse, etc. 
While Viagra remains the most prescribed
impotence treatment medication, Cialis represents the longest lasting
impotence treatment medication, the erection
enhancement benefits of Cialis can last up to thirty-six hours
following a single dose.
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