NATIONAL INSTITUTE OF
HEALTH PANEL STATES THAT MALE IMPOTENCE IS TREATABLE
Contrary to popular belief, effective treatments for male impotence
are available for many of the 30 million American males estimated
to suffer from
erectile
dysfunction,
according to a panel convened by the National Institutes of Health.
Erectile dysfunction, often referred to as male impotence,
increases progressively with age, but many males assume incorrectly
that
it is an inevitable consequence of aging. However, this misconception
may be beginning to change.
"Increasingly, more and more males are seeking treatments
that will allow them to return to a satisfactory level and range
of
sexual activities," said panel chairman Dr. Michael Droller,
who is chairman of the urology department at the Mount Sinai Medical
Center in New York City.
Of the available treatments for erectile dysfunction, the panel
recommended that the least invasive procedures should be tried
first as a general rule.
The panel concluded that psychological therapy may be useful as
part of treatment for all patients with erectile dysfunction, even
if a physical cause has been identified. Psychological therapy
may be useful in relieving depression and anxiety as well as improving
sexual function.
Treatments that work by increasing blood flow to the penis have
shown success in selected patients. These include injection therapy,
which uses drugs to dilate the blood vessels in the penis, and
vacuum constriction devices, which use a vacuum pump to create
an erection. The panel noted that vacuum constriction devices are
effective in most patients with erectile dysfunction and have relatively
few side effects.
Vascular surgery, another type of treatment designed to improve
penile blood flow, involves a bypass operation to route blood past
blocked arteries to the penis. The panel cautioned, however, that
vascular surgery is best performed in suitable patients in a research
setting by a surgeon experienced with this procedure.
Penile prostheses, which can be rigid, malleable, or inflatable,
are available for selected patients who fail or refuse other forms
of therapy.
For unknown reasons, the panel noted, there is a substantial dropout
rate for all forms of therapy for erectile dysfunction.
Erectile dysfunction is usually caused by a combination of physical
and psychological factors. Some of the most common physical factors
include diabetes, vascular disease, hypertension, neurologic disorders,
and prescription medications and illicit drugs, while psychological
factors that may cause erectile dysfunction include depression,
anxiety, loss of self-esteem, and relationship problems. In addition,
the panel said that cigarrette smoking can adversely affect erectile
function by accentuating the effects of other risk factors such
as vascular disease and hypertension.
In diagnosing erectile dysfunction, the panel said that the most
important part of an appropriate evaluation of a patient is a careful
medical history including a detailed sexual history. In addition,
this should be followed by a physical examination and basic laboratory
studies.
The panel strongly encouraged not only patients but also health
care providers to discuss erectile dysfunction and treatment options
more candidly. Thus, the panel called for educational programs
to increase awareness among the general public and the medical
community about male sexual dysfunction.
Because of the lack of scientific knowledge about male sexual
dysfunction, the panel urged that additional research be carried
out in a variety of areas. These include studies on the racial,
cultural, ethnic, and societal perceptions of male sexual function
and erectile dysfunction; studies to develop and rigorously test
the effectiveness of various treatments for erectile dysfunction;
and investigations on the social and psychological impact of erectile
dysfunction on males and their partners.
This 3-day Consensus Development Conference on Impotence was sponsored
by the National Institute of Diabetes and Digestive and Kidney
Diseases and the NIH Office of Medical Applications of Research.
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