Andrology Unit

It is defined as the inability to achieve or maintain an erection firm enough for satisfactory sexual intercourse.

Impotence is considered to be so when there is a failure in intercourse on more than 50% of attempts.

Male erection is a complex process that interacts with the vascular, neurological, endocrine and psychological system. It is sometimes possible by modern diagnostic techniques to find a problem with some of these systems, thus solving the specific cause leading to failure. In most cases, however, several of these systems may fail, or it may not be possible to solve the problem.

It is estimated that erectile dysfunction affects approximately more than 10% of men. The incidence increases progressively in our environment but it is still more common in people over 40 years. Recent studies suggest that over 50% of men between 40 and 70 years have some degree of erectile dysfunction.

 

Types of Impotence:

• Impotentia “coeundi” known as sexual impotence for lack of erection.
• Impotentia “generandi” known as lack of fertility.

At the same time is divided into:

• Primary: Approximately 10% of the total. The man has never had an erection.
• Secondary: This is the most common type. The man who has had normal erections before, may not have them now or has lower quality.
• Situational: Only good erections are achieved in certain situations or with certain people.

What can the causes of impotence be?

• From organic origin: Endocrine (diabetes), Vascular (arteriosclerosis), Neurological (brain injuries, spinal cord), Urologic (congenital lesions of the penis), pharmacological (drugs, alcohol, snuff, some types of medication), Traumatic (broken pelvis).
• From psychic origin: Fear of failure, guilt, infidelity, pre ejaculation, insecurity.
• Mixed.

One can assume that those who suffer from premature ejaculation if you experience one or more of the following symptoms:

• Inability to control ejaculation.
• Squatting a few minutes before or after penetration (less than 5 minutes).
• Squatting before being ready to make it or meeting their partner.

The causes can be diverse:

a) Organic causes: Some diseases of the posterior urethra and prostate, neurological diseases, vascular diseases, certain drugs, hormonal imbalances, etc.. can cause this disorder.

b) Psychological causes: The most frequent. Difficult to treat.

Among the predisposing factors  we can outline:

a) Hypersensitivity of the glans: Many men who suffer from premature ejaculation, have a hypersensitive glans and therefore feeling more than usual. At the slightest touch, ejaculation occurs.

b) Anxiety: Many other patients ejaculate quickly because they are in a state of anxiety, nervousness or tension, whether for a sexual encounter with a new partner or as a result of previous false. The individual, knowing that in the past has ejaculated quickly leaving her partner unsatisfied, feel pressured to last longer, and this makes him feel more tense and anxious, which in turn leads him to ejaculate quickly again, and this generates a vicious circle.

c) Erectile Dysfunction: Surprisingly, premature ejaculation can also be caused by a problem with erection. Faced with inability to keep it going, a man ejaculates quickly as a reflex, to reach the climax before complete loss of erection. In these cases, when the problem of erectile dysfunction is treated, premature ejaculation disappears.

d) defective learning: Another factor causing premature ejaculation is the lack of learning how to perform ejaculatory control. This is common in individuals who during their first sexual encounters were forced to “finish” quickly, for example in the back seat of the car or at their parents’ home. When the individual finally finds himself in circumstances that allow sexual enjoyment without distress and he continues to ejaculate quickly, it becomes a hard habit to break.

There are various treatments for premature ejaculation, depending on the cause of the problem. Treatments aim at delaying ejaculation for as long as possible, and allow to maintain erection even after ejaculation. Patients experience improvement from the beginning when treatment is started, both related to  duration of intercourse and in ejaculatory control. Individuals are intended to learn how to control ejaculation naturally without relying on drugs or treatment. Once ejaculatory control is achieved, a relapse is very rare. Treatment consists, in most cases, of combining drugs with psychological techniques. Only exceptionally surgery may be required.

Also called absence of ejaculation, anejaculation or ejaculatory incapacity. This happens when there is too much involuntary control of the ejaculatory reflex, and the individual who is affected cannot ejaculate.

Organic causes are due to the use of drugs and pharmaceuticals, as well as to diseases affecting the ejaculatory system.

Some of the following psychological causes stand out: feeling guilty, fear of pregnancy, marital problems, discovery of infidelity, etc..

Anorgasmia: A malfunction where ejaculatory response is only partially inhibited. The semen emission phase occurs in “drips” and there is a lack of pleasure.

Dyspareunia: Painful intercourse, which can occur during intercourse or after. The main reasons can be: extreme sensitivity of the glans, injury, poor hygiene, phimosis, urethral stricture, etc., or in some cases it could be a psychosomatic component.

Also called Peyronie’s disease, it is characterized by fibro-sclerosis with or without the penile curvature. Plates form hardened tissue in the penis cover, which often causes pain, and the curvature of the penis could also hinder or prevent penetration. This curvature can be in any direction and the plate or plates at any point of the penis.

The causes of this disease are unclear, engaging many factors: genetic predisposition, previous infections, trauma, vascular problems, certain types of medication, diabetes, hypertension, etc.. One thing is clear, that it is an inflammatory disease so this is where treatments are concentrated, in their early stages..

It can occur at any age, and for no apparent reason, but being more frequent between 40 and 60 years of age.

The most frequent clinical view is the existence of painful erection with progressive curvature of the erect penis. When palpation is done, fibrotic plaques or nodules on the penis are felt and penile shortening is noted.

The diagnosis is simple but it requires precise methodology to establish the correct treatment. If the disease is at the initial stage, treatment involves the application of drugs that interfere with the production of fibrous tissue. The treatment is performed in cycles between 4 and 6 weeks. The first signs of improvement can be seen around the second month of treatment, although some patients may notice improvement in the first weeks and others take a little longer. The evolution depends on the size of the plates and how early the condition is diagnosed. Surgical intervention is needed when the disease has been presented for more than six months and found stable, or for pharmacological treatment failure. Surgery is performed by 10% of men with Peyronie’s disease and only when the curvature hinders sexual intercourse.

The increasingly frequent existence of couples that cannot have children in our midst are caused by the male, and increases exponentially in our society with figures already reaching over 50%.

A couple should go to a physician if they have been trying to conceive without success for over a year. This usually starts by studying the male for simplicity and speed, and by performing a sperm analysis.

It is important to perform an accurate diagnosis of infertility or subfertility because some of the causes that make it appear are treatable and solvable. There are a number of processes that can lead to male infertility, both by alteration of the quality and the quantity of the sperm:

a) Varicose: Varicocele veins are pathologically testicular sperm. They can cause either pain, subfertility, or neither. They can alter the temperature and pressure of venous testicular return, worsening the number and the mobility of spermatozoa. It is the most common cause of acquired infertility in men and it can be treated surgically

b) Toxic: The most common are snuff and alcohol.

c) Iatrogenic: Different drugs such as cimetidine or nitrofurantoin, surgery on the bladder neck or prostatic urethra cause retrograde ejaculation, chemotherapeutics, etc.

d) Infectious: Different sexually transmitted diseases, orchitis, Genitourinary tuberculosis, etc.

e) Traumatic.

f) Testicular Origin: Testicular cryptorchidism (undescended testes), testicular torsion, postpubertal mumps orchitis, testicular removal, etc..

g) Testicular rare syndromes: Early puberty caused by congenital adrenal hyperplasia, Kallman syndrome, cystic fibrosis, etc.

Vasectomy is plain surgery performed under local anaesthesia in a doctor’s studio, where vessels are cut and ligated with the purpose of interrupting the passage of sperm. Contraceptive effectiveness is similar to female tubal ligation but much easier, faster and  less risky.