Impotence Center

Impotence Center

It's been a hushed subject for years. Men won't even talk about it with their best friends, much less their doctor. They think that they have some sort of mental or emotional problem preventing them from successfully engaging in sexual intercourse. The male withdraws from close contact with his partner, and figures he just has to live with this problem.
And his partner begins to think that she no longer excites him, and maybe even that he's found someone else to satisfy his sexual desires. She thinks it's her fault, and feels that their relationship is slowly falling apart.

Does this sound familiar? It accurately describes many situations. But it doesn't have to apply to yours. In recent years, medical breakthroughs have changed what was once thought to be a hopeless situation into an environment in which men have numerous options to address their secret problem.
Dr. Robert Modarelli, founder of the Northwest Urology Center, is a nationally recognized leader in the field of impotence and frequently lectures on this topic. His outreach efforts include founding Impotence Anonymous. He's pleased to share his knowledge and experience in this section.
Before you go into the Impotence Center, take a minute to test your knowledge about this subject by completing the following quiz. Click on True or False after each statement, and then click on Submit to see how well you did.


1. Impotence is usually caused by a psychological problem.  True  False
2. Impotence isn't a common condition.  True  False

3. Older men, say age 60 and more, are usually able to get an erection.  True  False

4. Impotence is usually permanent.  True  False
5. Male health problems like impotence also affect the female.  True  False
6. Impotence is primarily related to premature ejaculation.  True  False

We hope that you'll find the information presented here to be helpful and encouraging. Once you've learned more about it and the successful treatment options available, you will be motivated to take that important first step -- talk with your doctor.

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals use the term "erectile dysfunction" to describe this disorder, and to differentiate it from other things that can interfere with intercourse, such as lack of sexual desire and problems with ejaculation and orgasm.
It can be a total inability to achieve erection, and inconsistent ability to do so, or a tendency to sustain only brief erections.
Impotence usually has a physical cause, such as disease, injury, or drug side effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence.
There are many common causes of impotence, and diagnosis is painless. What's so exciting is that there are proven treatments to help. Some of those treatments involve new drugs, like Viagra, mechanical devices, or even implants. Your physician can help determine the approach that is most comfortable and appropriate for you.
You might want to consider seeking the help of the specialists at the Northwest Urology Center. This group of experienced physicians has helped thousands of men return to normal sexual function, and has a special package for those who live some distance away from the Center, located in Tacoma, Washington.
Special Services Package
Northwest Urology Center recognizes that for conditions such as impotence, men are interested in obtaining the best possible medical advice and treatment. As specialists in diagnosing and treating impotence, we have designed a package to make it economical and convenient for our patients who live some distance away to come to our Center in Tacoma, Washington. We will be happy to arrange for air or other travel, accommodations, and all of your diagnostic tests and treatment for a single fee. For details about the special services package, please email kjohnson@nwurology.com

What are the typical causes of impotence?
An erection requires a sequence of events, and impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa, a chamber in the penis that holds blood during an erection.
Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases -- including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease -- account for about 70% of impotence cases. Other causes include:
•Overeating and drinking, which diverts blood to the gastrointestinal organs
•Extreme fatigue
•Side effects of many common medicines, such as high blood pressure drugs, antihistamines, antidepressants, tranquilizers, and appetite suppressants
•Alcohol and drug abuse
•Surgery which injures nerves and arteries near the penis, such as prostate surgery
•Low levels of the male hormone testosterone

How is impotence diagnosed?
Patient History
Medical and sexual histories help define the degree and nature of impotence. Medical history can disclose diseases that lead to impotence, and a discussion of sexual history can help distinguish between problems with erection, ejaculation, orgasm, or sexual desire. The doctor will also want to identify prescription or other drugs being used.
Physical Examination
This can provide clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. And indications of hormonal problems could mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen.

Laboratory Tests
Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. For cases of low sexual desire, measurement of testosterone in the blood can provide information about potential problems with the endocrine system.
Other Tests
Monitoring erections that occur during sleep can help rule out certain psychological causes. Also, the doctor may want to test penile blood flow and pressure.
Psychosocial Examination
Psychological factors can be revealed using an interview and questionnaire. The man's sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

What are some of the treatment options available?
Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices. Only specialists, such as those at the Northwest Urology Center, can recommend a particular treatment that is appropriate for you.
Psychotherapy   
Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical causes of impotence are being treated.
Drug Therapy
Drugs for treating impotence can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March, 1998 the Food and Drug Administration approved the first oral medication to treat impotence, marketed as Viagra. Viagra enhances the relaxation of smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While it improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. Other drugs may also be effective.
Oral testosterone can reduce impotence in some men with low levels of this hormone.
Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Several drugs, included one marketed as Caverject, widen blood vessels. There may be unwanted side effects, however, including persistent erection and scarring.
A system for inserting a pellet of a drug into the urethra, marketed as MUSE, delivers the pellet about an inch into the urethra at the tip of the penis. An erection will begin within 8 to 10 minutes, and may last 30 to 60 minutes. As with any drug, there may be side effects.
Vacuum Devices 
Mechanical vacuum devices cause erection by creating a partial vacuum around the penis. This draws blood into the penis, engorging it and expanding it. A cylinder is placed over the penis, a pump draws air out of the cylinder, and an elastic band is placed around the base of the penis to maintain the erection after the cylinder is removed and to prevent blood from flowing back into the body during intercourse.
Surgery 
Surgery usually has one of three goals:
•To implant a device that can cause the penis to become erect
•To reconstruct arteries to increase flow of blood to the penis
•To block veins that allow blood to leak from the penile tissues
Implanted devices can restore erection in many men with impotence. Malleable implants usually consist of paired rods that are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment doesn't affect the width or length of the penis.
Inflatable implants consist of paired cylinders that are surgically inserted inside the penis and can be expanded using pressurized fluid. Tubes connect the cylinders to a fluid reservoir and pump, also surgically implanted. The user inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. These implants can somewhat expand the length and width of the penis.
Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. Surgery to veins that allow blood to leave the penis usually involves and opposite procedure-intentional blockage. Blocking off veins can reduce the leakage of blood that diminishes rigidity of the penis during erection.
Viagra   
Northwest Urology Center does not endorse particular products. The information provided here about Viagra is presented solely as a convenience to the many people who have expressed interest in this new drug.
There's been a great deal of publicity about Viagra, made by Pfizer, Inc., since the Food and Drug Administration approved it in March, 1998. It is the first oral medication to treat impotence, and is taken only when needed.
Taken about 30 minutes before sexual activity, it works by enhancing the effects of nitrous oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.
While it improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do.
Pfizer has established a Web site that contains information about erectile dysfunction and how Viagra may help. To go to that site, click on the address below, or make a note of it for future reference: www.viagra.com


•Experts believe that impotence affects upwards of 20 million American men. Some put the figure even higher.
•Impotence usually has a physical cause.
•Studies indicate that only 10% to 20% of cases involve psychological factors.
•It is quite normal for most men to have an occasional instance of impotence when tired or nervous.
•Side effects from prescription drugs or illegal drugs can cause impotence.
•A 1990 study conducted by the American Medical Association found that the main reasons men don't go to the doctor to discuss impotence are fear, denial, embarrassment, or threatened masculinity.
•Diseases such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease account for about 70% of cases of impotence.
•The National Ambulatory Medical Care Survey counted 525,000 visits to doctors for impotence in one year.

1. Can lifestyle factors cause impotence?
 Extreme fatigue, and even jet lag, can cause it. Depression, stress and anxiety are potential reasons as well. And smoking, overeating, chronic or excessive alcohol consumption, and poor diet can be factors.
2. Should both the male and his sexual partner seek help together?
Some men choose to deal with their impotence without help or assistance from their partner. Others even obtain medical advice and treatment without their partner's knowledge. But, most doctors feel that the couple benefits much more if they work together on resolving the man's impotence.
3. I tried a drug to treat impotence, and it didn't help. Are there other options?
There are many effective treatment options available today, and more are being studied. Current approaches include:
•Oral drugs
•Self-injected drugs
•Vacuum devices
•Medicines inserted into the urethra
•Surgical implants
4. Isn't impotence just a natural part of getting older?
It's true that the aging process involves changes in blood circulation and sexual functions. Older men are more likely to have physical conditions that are known to cause impotence, such as diabetes and heart or kidney disease. Also, older men use more drugs that may interfere with obtaining an erection. But, impotence is not just an inevitable result of aging.