Kinds of Impotency

Impotence can be of several types:

Arteriogenic: This form of impotence is when the arteries that supply the penis with blood can't deliver sufficient blood to cause or sustain an erection. This can sometimes happen with the arteries begin to narrow, as within some elderly people, diabetics and people with high blood pressure, as well as some people who may have sustained an injury to the genitals causing a blockage. The last is very common in the young. The injury can be major and sudden as after a vehicular accident causing a fracture of the pelvis or pubic bones, or low grade and gradual, as in bicycle and other riders, and occurs because sustained friction in that region causes a clot-like substance (thrombus) to develop in the artery to the penis. The clot can continue to grow until it completely blocks blood flow going to and from the penis.

Recently, it's been recognized that signs of erectile dysfunction in men can serve as a warning for future cardiovascular diseases, such as heart attack or stroke. When disease within smaller arteries like the penis is discovered before they affect the larger arteries such as the heart or brain, treatment can be administered more easily. This makes a very strong case for the early diagnosis and management of ED, and this, in turn, will allow the early detection of diseases like diabetes, high blood pressure, high cholesterol, high lipids, etc..

In a case study, a 23 year old college student became completely impotent after being involved in a car accident in which he sustained a fractured pelvis and a ruptured urethra. This involved hospitalisation for nearly a month and an operation. The patient reported that his sex life with his fiance was completely normal prior to the accident. When the patient returned to speak to the doctors who treated the original injurty, he was informed that the problem was likely psychological and that it would be all right in a few months on its own. A year later, there was still no improvement and he wanted to break his engagement. It was only after reading a magazine article that prompted him to visit an andrologist. A phalloarteriogram study showed that the main artery to the penis was blocked. The patient was given a microsurgery operation to complete a penile revascularization procedure and was completely cured.

Impotence as a result from arteriogenic injuries is more common than many doctors suspect, but they are often unaware of the conditions that may cause this. Many such patients are to be found in orthopedic and urology wards. Unfortunately the impotence problem is often not discovered until after the more noticeable wounds or injuries have recovered. In these cases, it's the patient who learns of the impotence issues, not the doctor.

Venogenic: This form of impotence occurs when blood leaks from the penis, which prevents a fully hard erection from forming. In a normal man during full erection the veins close down almost completely and practically no blood flows out from the penis. When everything is working normally, blood accumulates within the penis, which raises pressure that makes the penis hard.

There is a very high occurrence of erectile dysfunctionm caused by venogenic impotence. It is said to account for as much as 30-70 percent of all impotence. Primary venogenic impotence afflicts men from the time they're born. Such men have never had a rigid erection all their lives. Others develop venogenic impotence suddenly after years of normal sexuality (secondary).

Neurogenic: The nerve supply to the penis is very complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. These nerves trigger the surrounding arteries and veins that will change and sustain the blood flow.

The nerve supply to the penis can be affected by a large number of things. Injuries to the back, especially if they involve the vertebral column and the spinal cord can cause impotence.

So also can injury to other nerves supplying the penis such as occurs after pelvic or perineal trauma. There are a wide range of operations that can cause impotence by causing injury to surrounding nerves of the penis. Those surgeries can include rectum, prostate, urethra, spine, urinary bladder and more.

There are also various disorders of the nervous system that involve nerves to the penis and can cause erectile dysfunction, such as multiple sclerosis, myelitis, and tumours.

Another disease affecting the nerves to the penis is diabetes mellitus. Diabetics are commonly afflicted with impotence. In fact, as many as 50 per cent of all diabetics are impotent. The cause of impotence in diabetics is mostly organic. Appropriate therapy for diabetes can never restore erectile function because the basic diabetic process can never be reversed. Unfortunately, diabetic treatments tend to only control the blood sugar levels and little else. Yet it is very possible to cure almost all cases of diabetes-related impotence with modern andrology treatments. Once again, this fact remains little-known among many people. Very few diabetologists offer their patients a way to treat the resulting erectile dysfunction their diabetes could be causing.

Some drugs may also be responsible for causing neurogenic impotence as they damage or otherwise affect the nerve endings. Notable among these are anti-hypertensives (BP lowering) and psychotropics. The list is very large. Most doctors will remain completely oblivious to the fact that the drugs being prescribed to treat various ailments could be the culprit for causing impotence as a side effect.

Endocrinologic (or hormonal): This occurs when there is an imbalance or insufficiency of sex hormones in the blood stream. It is believed between 5-10% of organic impotence cases come under this category. Usually, changes in hormonal levels can affect the sex drive instead of the hardness of an erection. There are many diseases that may cause changes in hormonal levels.

Mixed: Sometimes, more than one factor can be operative in the same patient. These patients are often diagnosed with systemic disease. Notable examples are diabetes, kidney failure and liver failure.

Another section of patients with mixed factors for impotence is where the erectile dysfunction itself may lead to other ailments and disorders, such as depression. Here, the basic causative factor is organic but being unrecognised and untreated (or maltreated) it eventually takes its toll on the mind, often because the patient thinks or has been led to believe that the condition is incurable and that it's all in his mind.

Psychogenic: Psychogenic impotence is a diagnosis only made after no organic causes can be identified and the problem really does stem from within the mind. However before such a label is given to a patient, it is absolutely necessary to have an andrologist investigate into any possible organic or bodily causes.

Only then can treatment proceed in a scientific and systematic manner.