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PubMed1988

Impotence. Assessment in the private-practice office.

Impotence can have a psychogenic or organic basis, or a combination of both. Many times the partial erection or inability to maintain the erection is at least somewhat the result of the aging process. Once the cause has been established, through careful history taking and appropriate testing, the physician, along with the patient and his partner, can choose the most desirable treatment method. With patience and realistic expectations, the patient can usually achieve a satisfactory resolution of the problem.

Erectile Dysfunction↗
PubMed1990

Diagnostic evaluation of impotence.

A multispecialty approach to diagnosis of impotence is the most appropriate, because many factors may be at work. The expertise of professionals in the fields of urology, sex therapy, psychiatry, family practice, internal medicine, endocrinology, neurology, radiology, sleep evaluation, and vascular surgery may be needed to ascertain the correct organic or psychogenic cause in some cases.

Diabetes Complications↗
PubMed1990

Treatment alternatives for impotence.

More than 10 million men in the United States are chronically impotent. Fortunately, significant advances have been made in psychotherapy, pharmacologic management, arterial and venous surgery, penile prosthesis implantation, and use of external devices so that most find a satisfactory solution. After their dysfunction is sufficiently evaluated and the most appropriate treatment option is applied, most men achieve erectile capability sufficient for intercourse.

Erectile Dysfunction↗
PubMedDate not supplied

Restoration of satisfying sex for a castrated cancer patient with complete impotence: a case study.

We present a first-hand account of a fully impotent, testosterone-suppressed prostate cancer patient who has satisfying, multiorgasmic sex using a strap-on dildo. We use his narrative to examine dildos as an alternative to erectile dysfunction treatments for men, such as this patient, who find selective inhibitors of PDE-5 ineffective and surgical intervention unacceptable. We explore what conditions allowed this man to progress from suspicious distrust of the dildo to full acceptance. In terms of making a dildo acceptable to other patients, we contrast offering it to them as a penile prosthesis in a formal medical setting versus treating it as a toy in fantasy sex play. Last, we present a neurobiological hypothesis involving sensory integration to help explain why sex with the strap-on dildo can be satisfying to a male.

Coitus↗
PubMed1976

Assessment of anomalous erotic preferences in situational impotence.

Sometimes the main reason for situational impotence is a gross anomaly in a patient's erotic preferences. However, those patients who for one reason or other try to adjust in their sexual interactions to the general norm tend to hide or underestimate their true erotic preferences. This makes it necessary sometimes to base our diagnosis on data other than a patient's verbal report. An overview on nonverbal diagnostic methods is presented, and one of them, the phallometric test, is described in more detail, including a discussion of its limitations.

Adult↗
PubMed1978

The effectiveness of sex therapy for chronic secondary psychological impotence.

This paper describes the treatment results of sexual therapy with 16 couples. The men had chronic secondary psychological impotence. They were evaluated, treated, and followed up by the same sex therapist. Another psychiatrist evaluated each couple after therpay. Pre- and posttherapy Sexual Interaction inventories were administered as numberical measures of therapeutic effectiveness. By the end of treatment 6 men of the 16 were consistently potent and 4 were potent at least half of the time. Of the 11 men who had improved, 10 demonstrated considerable instability in erectile functioning over 1-year follow-up. Sex therapy can improve sexual functioning. However, it does not restore complete sexual health to couples with this complicated disorder.

Adult↗
PubMed1987

Intracavernosal injection in the treatment of impotence: a prospective study of sexual, psychological, and marital functioning.

This study assessed the sexual, psychosocial, and medical impact of intracavernosal injection of papaverine hydrochloride and phentolamine mesylate in the treatment of impotence. Ninety-six percent of patients initially achieved satisfactory erections with injections. Common side effects of self-injections included bruising (26%), nodule development (21%), abnormal liver function tests (7%), and pain (5%). No nodules resulted in penile bending or pain, and no patient discontinued treatment due to nodule development. Dropout rate to date was 35%. Self-injection treatment was associated with increases in erection quality, intercourse frequency, and sexual satisfaction, and decreases in masturbation frequency for patients. Partners also reported increases in intercourse frequency, coital arousal, and satisfaction. Decreases in general psychiatric symptomatology and increases in relationship satisfaction and self-esteem were apparent for patients, but not for partners.

Erectile Dysfunction↗
PubMed1989

Why do so many people drop out from auto-injection therapy for impotence?

Although intracavernous injection of vasoactive substances has been shown to be a reasonable and reliable method of reversing impotence, studies assessing patient acceptance of this new technology are lacking. By prospectively following patients and willing partners over a 2-year period, this study sought to document patient utilization rates and the reasons why patients decline or discontinue injection therapy. The cumulative dropout rate was 46%, with patients being most at risk for leaving the program after evaluation or during the trial dose phase. Patients decline treatment because they are unable to accept the idea of injecting themselves or because of potential side effects. Patients discontinue treatment because of perceived lack of efficacy. Patient and programatic obstacles to utilization of self-injection therapy are analyzed.

Erectile Dysfunction↗
PubMed1989

Self-injection of papaverine and phentolamine in the treatment of psychogenic impotence.

This study prospectively assessed the use, effectiveness, and sexual and psychosocial impact of self-injection treatment in 15 men with psychogenic impotence. Sixty percent dropped out of self-injection treatment by 6 months. Those who remained used self-injections about four times monthly with a 94% success rate. Frequency of intercourse and sexual satisfaction increased. Anxiety decreased, and trends toward improvement in depression and self-esteem were evident. Qualitative data indicated that performance anxiety was not alleviated, dependence upon injections for intercourse remained, symptom substitution did not occur, and capacity for intimacy was not improved.

Erectile Dysfunction↗
PubMed1990

The role of yohimbine for the treatment of erectile impotence.

A double-blind crossover study of yohimbine vs. placebo was carried out in 40 patients. Eleven of 33 patients (33%) who completed the study had subjective improvement of erection while taking yohimbine alone, five of 33 (15%) responded while taking both yohimbine and placebo, five of 33 (15%) responded to placebo alone, and 12 of 33 (36%) responded to neither. Of 215 impotent patients subsequently treated with yohimbine, 38% reported some subjective improvement, but only 5% were completely satisfied. The physiologic response of yohimbine appears to occur in the central nervous system. Recent experience suggests that the typical dose has little side effect and higher doses achieves better results, but this conclusion requires more evaluation.

Administration, Oral↗
PubMed1983

Effect of the administration of zinc sulfate on hypogonadism and impotence in patients with chronic stable hepatic cirrhosis.

Zinc sulfate was administered in a double-blind manner for 6-8 months to cirrhotic outpatients with impotence and/or hypogonadism. Seven placebo and six zinc-treated patients showed mild symptomatic improvement; however, there was no significant clinical difference between the two groups. Serum zinc levels rose significantly in the zinc-treated group but urinary gonadotropin and serum testosterone levels did not change in either group. Zinc sulfate does not appear to be an effective treatment for sexual dysfunction associated with alcohol-induced hepatic cirrhosis.

Adult↗
PubMed1996

Nightly variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms.

We retrospectively analyzed night-to-night variability in the indices of sleep apnea in a group of men who underwent consecutive polysomnograms (PSGs) in the evaluation of impotence. The study group consisted of 37 subjects. Fifty-seven percent of the subjects had an apnea/hypopnea index (AHI) of 5 or more on the first PSG, whereas 70% met this criterion on the second study. On both PSGs, 49% of the subjects exhibited an AHI of 10 or more. The AHI varied by 10 or more between the two PSGs in 32% of the cases. Using a threshold AHI of 5 or more to establish a diagnosis of sleep apnea, 22% of the subjects would not have been diagnosed by the first PSG, and the negative rate for the first PSG was 50%. The variability observed in the AHI could not be explained by differences in total sleep time; sleep stages [1 through 4 and rapid eye movement (REM) sleep]; the amount of time sleeping supine, or a combination of sleep stage and position. The mean AHI, the apnea/hypopnea-related nadir, and the mean oxyhemoglobin saturation did not differ among the two PSGs. Our observations support the notion that for groups of subjects the mean AHI is relatively constant across 2 nights of study in the sleep laboratory. However, when an AHI of 5 or 10 or more is the sole criterion used to establish the diagnosis of sleep apnea, a single PSG may not be sufficient to rule out the presence of a sleep apnea syndrome.

Adult↗
PubMed1987

Penile revascularization in the treatment of vasculogenic impotence.

Arterial insufficiency is the most common organic cause of impotence. The diagnosis can be established on a clinical basis through the use of Doppler probe evaluation of the penile pulses, penile blood pressure measuring, and nocturnal penile tumescence monitoring. The diagnosis may be confirmed by internal pudendal arteriography. Through microsurgical arterial revascularization, a 60 percent long-term success rate has been achieved. Two early and two late failures suggest the need for improved patient selection and confirm the progressive nature of the arteriosclerotic process.

Erectile Dysfunction↗
PubMed1977

Dormancy and Impotency of Cocklebur Seeds: IV. Effects of Gibberellic Acid, Benzyladenine, Thiourea, and Potassium Nitrate on the Growth of Embryonic Axis and Cotyledon Segments.

Germination of nondormant but impotent small cocklebur seeds (Xanthium pennsylvanicum Wallr.) was promoted profoundly with thiourea or benzyladenine, and slightly with gibberellic acid. Gibberellic acid was ineffective in causing the germination of dormant cocklebur seeds, although thiourea and benzyladenine were effective. Experiments with excised seed pieces showed that the promotive effects of thiourea, benzyladenine, and gibberellic acid on cocklebur seed germination were associated with the enhancement of growth of seed parts; thiourea stimulated predominantly the axial growth, whereas benzyladenine stimulated predominantly the cotyledonary growth.Potassium nitrate or indoleacetic acid had little effect on the initial growth of either axes or cotyledons. Except for gibberellic acid, all of the compounds employed enhanced ethylene production, but in general, the ethylene production seemed more likely to be a consequence of growth rather than a cause of it. We concluded that the chemical regulation of seed germination may be a consequence of the alteration of growth capabilities in either the axes or cotyledons, or both.

Journal Article↗
PubMed1976

A double blind cross over trial of gonadotrophin releasing hormone (LHRH) in sexually impotent men.

A double blind cross over trial of 500 mug of gonadotrophin releasing hormone or placebo subcutaneously every 8 h for 4 weeks in ten men with secondary sexual impotence is reported. No obvious clinical improvement occurred but statistical analysis of a libido score showed some overall improvement, especially the spontaneous occurrence of erections during the treatment period (P LESS THAN 0-05).

Adult↗
PubMed1977

Study of the effects of bromocriptine on sexual impotence.

Serum testosterone, prolactin, LH, FSH and plasma 17 beta-oestradiol levels were determined in forty-seven male patients with sexual impotence. Low testosterone values and slightly elevated prolactin levels were observed in 19% and in 17% of cases, respectively. Since sexual function in the male seems to be controlled by both dopaminergic stimulatory and serotoninergic inhibitory mechanisms, bromocriptine was given orally to seventeen patients. As the preliminary results appeared encouraging, a double blind study was undertaken in the other thirty patients. No appreciable difference in hormonal pattern was noticed between bromocriptine and placebo treatment. As far as sexual function was concerned, good results were obtained in 52% of cases treated with bromocriptine and in 44% of patients given placebo.

Adult↗
PubMed1975

Sexual impotence in man.

An analysis as to etiology and complaints of 486 cases of male sexual impotence was performed and is presented. Psychological factors are dominant in 68%. Physico-organic or iatrogenic causes accounted for deviations in 26% of the patients examined. Educational factors took an important part mainly in ejaculation disturbances. Primary anejaculation as a consequence of educational flaws occurred in 15% of the patients. Erection disturbances were often the consequence of physico-organic affections. The loss of libido was a real complaint in 19% of the patients.

Adult↗
PubMed1979

Effects of serotonin antagonists in sexually impotent men.

Thirty-one men affected with sexual impotence were studied. Since sexual function in the male seems to be controlled by both dopaminergic stimulatory and serotoninergic inhibitory mechanisms, the patients were treated with serotonin antagonists. In basal conditions mean serum LH, FSH, PRL and testosterone did not significantly differ from those found in normal subjects; no significant variations, except for PRL reduction, were observed after treatment. Both methysergide, in association with bromocriptine or mesterolone, and metergoline, either alone or in association with mesterolone, were ineffective in significantly improving sexual activity.

Adult↗