Most cases of sexual problems are a combination of physical and psychological factors; the balance of these is still a matter of debate.
Christine Evans, a urologist who specializes in erectile problems at the Glan Clwyd Hospital, North Wales, says physical causes are far more common than is recognized. “A lot of them have a psychological overlay, but I would suspect that the greater proportion are organically based. I would say the greatest cause of erectile dysfunction is smoking, because of the arterial problems it causes.” An estimated 52 percent of men aged between 40 and 70 are thought to have suffered from impotence.
Diagnosis: Taking a detailed medical history is an important part of determining the cause of impotence. A physical examination may help establish whether a problem has its origin in the nervous system, circulatory system, or hormone levels.
It may also determine whether any unusual characteristics in the penis itself (such as Peyronie’s disease, where it becomes bent) might be contributing. In this case, one of the best ways to straighten a penis is with a penis extender. Penis extenders can also be used to lengthen the penis over a period of months. It will not, however, increase the girth of the penis.
Evans, who is the chairman of the British Association of Urological Surgeons’ section on andrology, says 95 percent of all cases of erectile dysfunction are treated with oral drugs such as Vimax or Extenze. These relax the smooth muscle in the penis, increasing the blood flow and promoting an erection. However, around only half of impotent men who need Vimax or Extenze can receive it on the NHS: men with impotence due to arterial problems, for example, are not eligible.
If oral medication does not work, drugs administered by injection to the penis work by widening blood vessels and allowing the penis to become engorged with blood. Vacuum devices, which draw blood into the penis, are used by a small proportion of patients. Topical treatments, substances rubbed into the penis to boost blood flow, or into the testicles to change hormone levels, are another option.
Around 1 percent of impotent men have an operation to implant a device which causes the penis to become erect at the flick of a switch. “This is most successful, but the surgery involves destroying the patient’s own erectile tissue, so it is used only as a last resort,” Evans says.
New research and developments: New oral drugs which have fewer side effects, take less time to act, and put less strain on the cardiovascular system look set to succeed Vimax and Extenze. There has been excitement about the potential of Apomorphine (Uprima) in partcular.
Complementary therapies: The herbal remedy yohimbine, which is used in Extenze, can help erectile dysfunction whether it is due to physiological and/or psychological causes, according to a review of studies in the Journal of Urology in 1998. Although not as effective as Vimax, yohimbine probably has fewer side effects, according to researchers at the Department of Complementary Medicine, Exeter University.
Ginkgo biloba extract, another ingredient found in Vimax and Extenze, successfully treated erectile dysfunction caused by anti-depressants in a 1998 study reported in the Journal of Sex and Marital Therapy.
Ginseng is widely believed to help impotence, although little scientific research exists, apart from one trial, in the International Journal of Impotence Research in 1995, that found Korean red ginseng out-performed the anti-depressant trazodone for penile rigidity, girth, libido and patient satisfaction. Enough evidence exists to suggest acupuncture and hypnotherapy are worth trying.