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About Erectile dysfunction

Impotence is a very common affliction. About 50 percent of men between the ages of 40-70 (and about 7 in 10 men aged 70 and above), are affected by impotence and yet despite this frequency, many men do not seek treatment due to inappropriate feelings of embarrassment. Erectile dysfunction will affect at least 1 in every 10 men at some point in their lives.

Impotence refers to the inability to have an erection or maintain an erection until ejaculation, which is often seen in sexual neurastenia and some chronic diseases.

Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Many common medicines can produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug).

Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

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 impotence is being treated.

Other causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire. A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.

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 behaviour modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).

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 (in the U.S) approved sildenafil citrate (marketed as Viagra), the first oral pill to treat impotence. Taken 1 hour before sexual activity, sildenafil works by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation, allowing increased blood flow. While sildenafil improves the response to sexual stimulation, it does not trigger an automatic erection as injection drugs do. The recommended dose is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the needs of the patient. The drug should not be used more than once a day.

Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs, including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone, but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed that improvements following their use might be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marked as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as MUSE. The system uses a pre-filled applicator to deliver the pellet about an inch deep 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. The most common side effects of the preparation are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness of the penis due to increased blood flow; and minor urethral bleeding or spotting.

Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.

 

Western Medicine View

The cause and therefore treatment of impotence varies greatly. Many men suffer from psychological impotence due to stress, performance anxiety, insecurities in the relationship etc. Conventional medicine tends to treat this with counselling. Medical impotence on the other hand, can be brought on by factors such as hypertension, diabetes, obesity, excessive smoking and alcohol consumption, MS, drug side effects as well as direct problems with the penis function. Conventional medicine uses a variety of treatment methods from oral drugs, injections, and in some cases, penile implants.

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term Erectile Dysfunction to describe this disorder, and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. Impotence can also be a total inability to achieve erection, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult.

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. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. However, it is not an inevitable part of ageing.

Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence - especially complications of impotence.

Since an erection requires a sequence of events, impotence can occur when any of these 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.

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 percent of cases of impotence.

 


Between 35 and 50 percent of men with diabetes experience impotence.

 

Chinese Medicine View

Acupuncture has been shown to have a therapeutic effect on male sexual dysfunction (non-organic) i.e. erectile dysfunction, and defective ejaculation, according to the World Health Organisation*.

According to Chinese Medicine theory acupuncture and Chinese herbs can be prescribed to treat most causes of impotence by using Chinese Medicine’s dual approach of healing mind and body.

 

According to CM theory the state of the internal organs and the flow of Qi (the body's essential energy) throughout the body must be diagnosed, paying attention to small signs that are often missed when Western medical methodology is used. This can enable the Chinese Medicine doctor to quickly assess the causes of the impotence. If it is mainly psychological, treatment will primarily involve balancing the emotions, reducing stress and strengthening the flow of energy to the sexual organs.



Physical impotence in Chinese medicine is primarily due to disorders of the Kidney, as this is where the Jing essence (essential to proper sexual function) is stored . Most cases of impotence are due to a form of Kidney Energy Deficiency, which is also aggravated by obesity, stress, smoking and alcohol.



Impotence is usually caused by the decline of Fire in the Gate of Life, and the exhaustion of Essence and Lifeblood (blood together with Qi – the body's essential energy). This Fire is the warmth generated in between the kidneys that is essential for the body's physiological processes as well as for all the internal organs. This can be caused by Indulgence in sexual activity or frequent masturbation, damage to the Kidney by fright, damage to the Heart and Spleen as well as further damage from worries to the Stomach Meridian of Foot-Yangming and Chong Meridian. There are also some cases caused by the downward flow of Dampness-Heat.



Failure to have an erection or inability to maintain a satisfactory erection and premature ejaculation are accompanied by such symptoms as dizziness, blurred vision, tinnitus, insomnia, pale complexion, lassitude, soreness and weakness in the loin and knees, thready and weak pulse.

 

According to Chinese Medicine theory a combination of Acupuncture and Chinese herbal medicine can be prescribed to restore balance into the Kidney which can result in an increased sexual appetite and penile erection.

 

Often the treatment principle is to invigorate Kidney Qi (the kidney's essential energy) and benefit the Heart and Spleen. This is achieved by applying acupuncture treatment with reinforcing manipulation on the acupoints on the Kidney Meridian of Foot-Shaoyin, the Stomach Meridian of Foot-Yangming and the Back-Shu points. Moxibustion can also be used if necessary.

 

Acupoints normally used are: Shenshu (BL 23), Zusanli (ST 36) and Neiguan (PC 6).

 

Since the disease is chiefly due to the deficiency of Kidney Qi, Shenshu is used to invigorate Kidney Qi and improve the function of the Kidney Meridian. Zusanli, the point on the Stomach Meridian of Foot-Yangming, helps relieve stagnation, calm the mind and invigorate the Heart and Spleen when used together with Neiguan.

 

Other acupoints and methods can also be used:

 

Acupoints: Shenshu (BL 23), Mingmen (DU 4), Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Sanjiaoshu (BL 22), Guanyuanshu (BL 26), Baihui (DU 20), Dazhui (DU 14), Dazhu (BL 11) and Changqiang (DU l). The Chinese Medical doctor will select one to two points each time. Prompt prick and sway the needle for 5- 10 minutes. Fine needles will be used to prick the tendons if the patient is of weak constitution, and moxibustion treatment can be used at the same time. The treatment is given every two days, and a complete course includes five treatment sessions.

 

As an alternative to needles, electro-acupuncture can be applied on to Qugu (RN 2), Rangu (KI 2), and four pairs of points Shangliao (BL 3l), Zhongliao (BL 33), Ciliao (BL 32) and Xialiao (BL 34) on both sides of the body, using low-frequency pulse circuit. The treatment lasts three to five minutes each time. When puncturing at Qugu, it's better to conduct the needling sensation towards the external genitalia.

 

Ear acupuncture might also be appropriate; Auricular points for uterus (seminal vesicle, external genitalia, testis (ovary) and internal tragic apex will be selected (two to four points each time). The needle must be kept in the skin for 10-20 minutes. If needle embedment therapy is used, it should last three to five days.

 

Tonics which benefit the body's essential Qi and strengthen the Kidney Yang (the Kidney's warm energy) can be taken during the acupuncture treatment to achieve a better result.

 

Lifesyle Advice for the Prevention and Treatment of Erectile Dysfunction

 

For expert advice on achieving and maintaining optimum sexual health (for men and women), please take a look at our special Guide to Supercharged Sex.

 

For personalised advice on diet and lifestyle, please ask the doctor during your consultation.

 

Please be reminded that we offer free online health advice.

 

 

*CLINICAL TRIALS

Aydin S et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scandinavian Journal of Urology and Nephrology, 1997, 31(3):271-274.

Shui HD. [Acupuncture treatment of defective ejaculation.] Chinese Acupuncture and Moxibustion, 1986, 6(1):19 [in Chinese].

 

Case Histories

A 28-year-old man was diagnosed with impotence having come to AcuMedic complaining of insmonia; listlessness; irritability; abdominal distension; weak immune system; poor appetite and an inability to have an erection - a problem that lasted for over a year and a half. The doctor diagnosed a stagnation of Qi in the Liver and an impairment of the Spleen and Heart. During the 3-month treatment of acupuncture and herbal medicine, the patient felt constant improvement in his well-being (including sleep, appetite and mood) and was able to have normal sex with his girlfriend once a week or once a fortnight. The patient chose to continue to receive treatment to improve his health.   

Last Updated: December 13, 2012

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