-IBIS-1.5.0-
tx
reproductive system
impotence
diagnoses
definition and etiology
definition:
Inability to attain or maintain an erection satisfactory for both partners during coitus. It is recommended that clinicians refer to the condition as "erectile inhibition" to escape the connection that a man is "impotent" (Latin: without power) in the bedroom if he is unable to have a hard sustained erection.
etiology:
The diagnosis is "erectile inhibition" when it occurs >25% of the times coitus is attempted. It can be primary or secondary:
primary: This is uncommon and means the man has never experienced maintained penetration with a partner his whole life, though he may have night-time erections or have erections during masturbation. It is almost always due to psychological factors: sexual guilt, fear of intimacy, depression, performance anxiety etc.
secondary: This is very much the preponderance of cases and is the term used to describe a man who previously had erections and now is consistently unable to maintain erections. Factors include: fatigue/worry/relationship problems/life stress; some drugs (alcohol, narcotics, hypertension medications); advanced diabetes; infections, neurological conditions/injuries; surgical injuries; chronic kidney failure; cardiorespiratory or vascular disease. Although aging will decrease the amount and force of ejaculate, erections are typically common even into a man's 70s and 80s.
Easley suggests it may be a sympathetic response to low blood sugar, or testosterone/prostate deficiency.
signs and symptoms
signs and symptoms:
Erectile inhibition at least 25% of the times coitus is attempted.
medical procedures and lab findings:
Full physical exam: including exam of the genitals and neurologic exam.
Evaluation of prescribed, OTC, and recreational drug and alcohol use.
Vascular and endocrine evaluations.
Glucose tolerance test.
Testosterone levels.
LH.
Prolactin levels.
Check for nocturnal penile tumescence during REM sleep.
course and prognosis
In most cases, which are usually psychological in origin, counseling with the patient and the patient's partner is beneficial. The prognosis when other conditions are involved are specific for the condition.
differential diagnosis
determine the cause
footnotes