Clinical Specialties : Male Urologic Health

Erectile Dysfunction

What causes sexual impotence or erectile dysfunction?

Impotence or erectile dysfunction has been and continues to remain an extremely common disorder that is said to afflict as many as 10% of the male population. Andrological research in the past years has advanced tremendously and has established conclusively that in 80% to 90% of the cases of chronic impotence, the cause is not in the mind but in the body.

Some causes of impotence include:
• Diabetes Mellitus
• Hypertension (also know as High Blood Pressure)
• Atherosclerosis
• Renal (Kidney) Failure
• Heart Disease
• Neurological Disorders such as Multiple Sclerosis, Parkinson’s Disease, Stroke, Paraplegia, or Spinal Cord Lesions
• Sudden Pelvic or Perineal Injuries
• Gradual Injuries, as in bicycle-riders
• Surgery on areas such as Bowel, Rectum, Bladder, Spine, Prostate, Urethra
• Local Problem such as Peyronie’s Disease
• Some Prescribed Medications

Are all cases of impotence the same?

No. There are several types of impotence:

In this case, the arteries supplying blood to the penis do not bring in enough blood to cause an erection. This can occur because of the narrowing of arteries in the elderly, in diabetics, in those with high blood pressure, or injury to the pelvic region which causes a block in the artery to the penis (which is most common in younger patients). This is also found to be common in bicycle and other riders because of the sustained friction to the region.

In this case, the veins of the penis leak blood and prevent the development of a rigid erection. This type of impotence is extremely common and can occur either from birth or suddenly after years of normal sexual function.

In this case the nerve supply to the penis is interrupted. In order for an erection to be initiated and maintained a proper conduction of impulses along the delicate nerve supply to the penis is required. These nerves activate the veins and alter the dynamics of blood flow between them. This type of impotence occurs mostly in men who have had back or spinal injuries, injury to other nerves supplying the penis, a wide variety of surgical procedures that can cause incidental injury, disorders of the nervous system, and most commonly diabetes. Impotence is extremely common in diabetics and as many as 50% of all diabetics are impotent.

Endocrinological (or Hormonal)
This case occurs when there is an imbalance or insufficiency of sex hormones in the blood stream. Generally, hormonal changes can affect the libido (or sex drive) rather than the quality of the erection.

Sometimes, more than one factor can be operative in the same patient. Such patients generally have systemic disease (for example, diabetes, kidney failure, and liver failure).

Before labeling a case in such a manner, a thorough investigation is necessary to prove that no organic or bodily cause exists. Only then can treatments proceed.

What treatment options are available for me?

There are several treatment options available for impotence, among them:
• Sexual Counseling
• Oral Medication
• Hormone Replacement Therapy
• External Vacuum Devices
• Penile Injections
• Microsurgery

Make an appointment

Ranjith Ramasamy, MD
Director of Male Reproductive Medicine and Surgery
Call: (305) 243-6090
e-mail or make an online appointment.

Bruce Kava, MD
Associate Professor of Urology
Call: (305) 243-1000
e-mail or make an online appointment.