Until recently, a man unable to develop or sustain an erection sufficient for penetrative sexual intercourse has been referred to as ‘impotent’. This term, however, has negative connotations which imply a general loss of prowess in other domains of mental and physical function. Although the problem is most commonly the result of isolated malfunction of penile erection, diminished or absent libido and delayed or absent orgasm and ejaculation frequently coexist with erectile dysfunction, each in its own way contributing to the afflicted individual’s sense of failure and personal inadequacy.
Many millions of men world-wide are afflicted by erectile dysfunction. Although the ability to develop and sustain an erection may not always result in complete loss of sexual satisfaction, in most men, it creates a psychological stress that adversely affects the relationship with their partner. This, in itself; often compounds the physical problem. In men of all ages; erectile dysfunction diminishes the willingness to initiate or continue sexual relationships, not only because of loss of self-esteem, but also because of the fear of the humiliation associated with inadequate sexual performance and the risk of subsequent rejection.
However, this assumption is often incorrect. Erectile dysfunction is not uncommonly the result of some other illness, such as diabetes mellitus or hypertension, or a consequence of the treatment of the latter disorder with anti-hypertensive agents. The correct diagnosis of erectile dysfunction depends on an accurate and sympathetically elicited history which recognizes that the physical component may be only part of the problem. The psychological, interpersonal and wider social ramifications also need to be tactfully assessed. Careful physical examination and judicious step-wise use of investigations help to complete the picture.
Now, for the first time, an increasing range of safe and effective treatment options is available for men who suffer from erectile dysfunction. Many of these options, however, are poorly appreciated not only by patients, but also by health-care professionals, many of whom still feel too embarrassed to address this highly prevalent and distressing problem in a serious and sympathetic manner. Erectile dysfunction often has a major impact on the self-esteem and quality of life not only of the man, but also of his partner. Thus, there are few areas in medicine where so much remains to be done and with so much potential to improve the outlook for the many millions of sufferers as well as for their partners.
E241 – Diabetes and Impotency – www.diabetic.today