Symptom finder - The causes of impotence
Symptom finder - The causes of impotence
Impotence and libido are terms that relate to sexual problems. Impotence may affect adult male . Impotence may be cause by psychological problems or organic causes such as diabetes mellitus. So what is impotence?
Impotence is inability to sustain adequate erection which is useful for vaginal penetration. Loss of libido is related to loss of sexual drive or loss of sexual desire which is associated with sexual dysfunction.
Psychological causes of impotence is depression. Drugs such as cocaine, antihypertensive medication, estrogens, alcohol and antidepressant may cause impotence. Vascular disease such as Leirche’s syndrome / aortoiliac disease and diabetic vascular disease and systemic diseases such as chronic renal failure, cirrhosis and malignancy may cause impotence. Impotence may also associate with neurological condition such as spina bifida, spinal lesions, nervi erigentes damage in the pelvic surgery and neuropathies disorder such as diabetes mellitus. Peyronie’s disease, phimosis and short frenulum are also contributing to impotence.
Endocrine disorders such as Addison’s disease, Cushing’s syndrome, hypothyroidism, diabetes mellitus and hypogonadism may also cause impotence.Aging may also contributes to impotence.
The history should focus on the present of any buttock claudication which is associated with Leriche’s syndrome. The present of any symptoms of chronic renal failure should be noted such as convulsions, pulmonary edema, peripheral edema, nocturia, hiccups, lethargy, vomiting ,dyspnea and nausea. Does the patient suffers suffer from any stress? Does the erection occur at any time? Does erection occur mostly at night? Drug history including any use of recreational drug should be taken. Notes any history of malignancy. Ask the patient regarding any local painful condition of the penis. Any previous surgery? ( abdominoperineal resection of the rectum ( pelvic surgery) which damage the nervi erigentes). Recorede the patient’s history of endocrine disorders such as Cushing’s syndrome, Addison’s disease, hypothyroidism and diabetes.
Full neurological examination should be performed. Observe for any signs of chronic renal failure such as pleural effusions, pericarditis, peripheral edema, pallor of the skin and hypertension. The penis is examined and look for short frenulum, Peyronie’s disease or phimosis. Bruits in abdomen or pelvis should be inspected by auscultating the regions. All pulses of the lower limb should be checked. Look for signs of cirrhosis such as ascites, Dupuytren’ contracture, spider nevi, liver palms, testicular atrophy, flapping tremor and leuconychia. Look for any evidence of peripheral neuropathy which is a complication of neurological disorders or diabetes.
The testes is examined and look for evidence of hypogonadism. Observe for male secondary sexual characteristic development. Hypotension, weakness, pigmentation of buccal mucosa and palmar crease, weight loss and weakness are associated with Addison’s disease. Cushing’s disease is commonly present with hypertension, buffalo hump, obesity, abdominal striae, Cushingoid facies and thin skin. Constipation, lethargy, hoarseness of voice , disliking cold weather and weight gain are commonly due to hypothyroidism.
Impotence and libido are terms that relate to sexual problems. Impotence may affect adult male . Impotence may be cause by psychological problems or organic causes such as diabetes mellitus. So what is impotence?
Impotence is inability to sustain adequate erection which is useful for vaginal penetration. Loss of libido is related to loss of sexual drive or loss of sexual desire which is associated with sexual dysfunction.
Psychological causes of impotence is depression. Drugs such as cocaine, antihypertensive medication, estrogens, alcohol and antidepressant may cause impotence. Vascular disease such as Leirche’s syndrome / aortoiliac disease and diabetic vascular disease and systemic diseases such as chronic renal failure, cirrhosis and malignancy may cause impotence. Impotence may also associate with neurological condition such as spina bifida, spinal lesions, nervi erigentes damage in the pelvic surgery and neuropathies disorder such as diabetes mellitus. Peyronie’s disease, phimosis and short frenulum are also contributing to impotence.
Endocrine disorders such as Addison’s disease, Cushing’s syndrome, hypothyroidism, diabetes mellitus and hypogonadism may also cause impotence.Aging may also contributes to impotence.
The history should focus on the present of any buttock claudication which is associated with Leriche’s syndrome. The present of any symptoms of chronic renal failure should be noted such as convulsions, pulmonary edema, peripheral edema, nocturia, hiccups, lethargy, vomiting ,dyspnea and nausea. Does the patient suffers suffer from any stress? Does the erection occur at any time? Does erection occur mostly at night? Drug history including any use of recreational drug should be taken. Notes any history of malignancy. Ask the patient regarding any local painful condition of the penis. Any previous surgery? ( abdominoperineal resection of the rectum ( pelvic surgery) which damage the nervi erigentes). Recorede the patient’s history of endocrine disorders such as Cushing’s syndrome, Addison’s disease, hypothyroidism and diabetes.
Full neurological examination should be performed. Observe for any signs of chronic renal failure such as pleural effusions, pericarditis, peripheral edema, pallor of the skin and hypertension. The penis is examined and look for short frenulum, Peyronie’s disease or phimosis. Bruits in abdomen or pelvis should be inspected by auscultating the regions. All pulses of the lower limb should be checked. Look for signs of cirrhosis such as ascites, Dupuytren’ contracture, spider nevi, liver palms, testicular atrophy, flapping tremor and leuconychia. Look for any evidence of peripheral neuropathy which is a complication of neurological disorders or diabetes.
The testes is examined and look for evidence of hypogonadism. Observe for male secondary sexual characteristic development. Hypotension, weakness, pigmentation of buccal mucosa and palmar crease, weight loss and weakness are associated with Addison’s disease. Cushing’s disease is commonly present with hypertension, buffalo hump, obesity, abdominal striae, Cushingoid facies and thin skin. Constipation, lethargy, hoarseness of voice , disliking cold weather and weight gain are commonly due to hypothyroidism.
The investigations require are full blood count, urea and electrolytes, ESR, liver function test, thyroid function test, blood glucose, doppler studies, nocturnal penile tumescence study, plasma cortisol, ACTH stimulation test, serum FSH and LH, urinary cortisol assay, serum testosterone, intracorporeal injection of papaverine, serum testosterone , serum prolactin, arteriography, MRI and CT scans.
Full blood count may reveal low Hb level ( anemia) that indicates underlying malignancy or chronic renal failure.Urea and electrolytes may reveal raise creatinine in chronic renal failure. ESR is elevated in malignancy. Abnormal liver function test is common with cirrhosis. Thyroid function test may reveal the present of hypothyroidism by raised TSH level and reduced T4 level. Blood glucose may reveal the present of diabetes mellitus. Doppler studies are important to rule out any peripheral vascular disease. Vascular causes of impotence is suggestive if penile - brachial pressure index is < 0.6.
Nocturnal penile tumescence study is useful to identify any erection versus no erection. Plasma cortisol level is related to Cushing ‘ syndrome. Pituitary abnormality is detected by CT scan and MRI scan of the head. Addison’s disease is confirmed by performing ACTH stimulation test. Pituitary dysfunction may present with low serum FSH and LH. Urinary cortisol assay is useful in detecting Cushing’s syndrome. In hypogonadism, serum testosterone is low. Serum prolactin is useful in identifying hypoprolactinemia. Intracorporeal injection of papaverine may also be useful in assessing vascular inflow. In normal individual erection will happen with injection. Penis will remain flaccid due to venous leakage excessively. Arteriography may detect any isolating narrowing of the internal iliac arteries in most cases of vascular lesion related to impotence.
Full blood count may reveal low Hb level ( anemia) that indicates underlying malignancy or chronic renal failure.Urea and electrolytes may reveal raise creatinine in chronic renal failure. ESR is elevated in malignancy. Abnormal liver function test is common with cirrhosis. Thyroid function test may reveal the present of hypothyroidism by raised TSH level and reduced T4 level. Blood glucose may reveal the present of diabetes mellitus. Doppler studies are important to rule out any peripheral vascular disease. Vascular causes of impotence is suggestive if penile - brachial pressure index is < 0.6.
Nocturnal penile tumescence study is useful to identify any erection versus no erection. Plasma cortisol level is related to Cushing ‘ syndrome. Pituitary abnormality is detected by CT scan and MRI scan of the head. Addison’s disease is confirmed by performing ACTH stimulation test. Pituitary dysfunction may present with low serum FSH and LH. Urinary cortisol assay is useful in detecting Cushing’s syndrome. In hypogonadism, serum testosterone is low. Serum prolactin is useful in identifying hypoprolactinemia. Intracorporeal injection of papaverine may also be useful in assessing vascular inflow. In normal individual erection will happen with injection. Penis will remain flaccid due to venous leakage excessively. Arteriography may detect any isolating narrowing of the internal iliac arteries in most cases of vascular lesion related to impotence.
