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Libido VS Impotence

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Impotence

Erectile Dysfunction (ED or (male) Impotence) is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as cardiovascular leakage and diabetes, many of which are medically treatable. Nerve trauma from prostatectomy surgery can cause chronic erectile dysfunction. The causes of erectile dysfunction may be physiological or psychological. Physiologically, erection is a hydraulic mechanism based upon blood entering and being retained in the penis, and there are various ways in which this can be impeded, most of which are amenable to treatment. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this can often be helped. Notably in psychological impotence, there is a very strong placebo effect. Erectile dysfunction, tied closely as it is to cultural notions of potency, success and masculinity, can have devastating psychological consequences, including feelings of shame, loss or inadequacy; often unnecessary since in most cases the matter can be helped. There is a strong culture of silence and inability to discuss the matter. In fact, around 1 in 10 men will experience recurring impotence problems at some point in their lives.  Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of the first pharmacologically-approved remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by heavy advertising. The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms. The study of erectile dysfunction within medicine is covered by anthology, a sub-field within urology.

Overview & Symptoms

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. There are several ways that erectile dysfunction is analyzed:

• Obtaining full erections at some times, such as when asleep (when the mind and psychological issues, if any, are less present), tends to suggest the physical structures are functionally working. However, the opposite case, a lack of nocturnal erections, does not imply the opposite, since a significant proportion of sexually functional men do not routinely get nocturnal erections or wet dreams.

• Obtaining erections which are either not rigid or full (lazy erection), or are lost more rapidly than would be expected (often before or during penetration), can be a sign of a failure of the mechanism which keeps blood held in the penis, and may signify an underlying clinical condition, often cardiovascular in origin.

• Other factors leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).

Erection problems are very common. The Sexual Dysfunction Association estimates that 1 in 10 men in the UK have recurring problems with their erections at some point in their life

Pathophysiology

Penile erection is managed by two different mechanisms. The first one is the reflex erection, which is achieved by directly touching the penile shaft. The second is the psychogenic erection, which is achieved by erotic or emotional stimuli. The former uses the peripheral nerves and the lower parts of the spinal cord, whereas the latter uses the limbic system of the brain. In both conditions, an intact neural system is required for a successful and complete erection. Stimulation of penile shaft by the nervous system leads to the secretion of nitric oxide (NO), which causes the relaxation of smooth muscles of corpora cavernosa (the main erectile tissue of penis), and subsequently penile erection. Additionally, adequate levels of testosterone (produced by the testes) and an intact pituitary gland are required for the development of a healthy erectile system. As can be understood from the mechanisms of a normal erection, impotence may develop due to hormonal deficiency, disorders of the neural system, lack of adequate penile blood supply or psychological problems. Restriction of blood flow can arise from impaired endothelial function due to the usual causes associated with coronary artery disease, but can also be caused by prolonged exposure to bright light.

Causes

• Neurogenic Disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke.⁾
• Hormonal Disorders (pituitary gland tumor; low level of the hormone testosterone).
• Arterial Disorders (peripheral vascular disease, hypertension; reduced blood flow to the penis).
• Cavernosal Disorders (Peyronie's disease. )
• Nonphysical causes: Mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalized anxiety disorder, personality disorders or traits. ), psychological problems, negative feelings.
• Surgery (radiation therapy, surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.)
• Aging.
• Lifestyle: alcohol and drugs, obesity, cigarette smoking (Incidence of impotence is approximately 85 percent higher in male smokers compared to non-smokers^. Smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing.)
• Other disorders.

A few causes of impotence may be iatrogenic (medically caused). Various antihypertensive (medications intended to control high blood pressure) and some drugs that modify central nervous system response may inhibit erection by denying blood supply or by altering nerve activity.

Surgical intervention for a number of different conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. Complete removal of the prostate gland or external beam radiotherapy of the gland are common causes of impotence; both are treatments for prostate cancer. Some studies have shown that male circumcision may result in an increased risk of impotence, while others have found no such effect,  and another found the opposite. Excessive alcohol use has long been recognised as one cause of impotence, leading to the euphemism "brewer's droop," or "whiskey dick;" Shakespeare made light of this phenomenon in Macbeth. A study in 2002 found that ED can also be associated with bicycling. The number of hours on a bike and/or the pressure on the penis from the saddle of an upright bicycle is directly related to erectile dysfunction.

Diagnosis

Medical Diagnosis

There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as diabetes, hypogonadism and prolactinoma. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease. A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes (however rarely), it could be physiological or psychological. The current diagnostic and statistical manual of mental diseases (DSM-IV) has included a listing for impotence.

Clinical Tests Used To Diagnose ED

Duplex ultrasound

Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Measurements are compared to those taken when the penis is flaccid.

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease.

Nocturnal penile tumescence (NPT)

It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. There are two methods for measuring changes in penile rigidity and circumference during nocturnal erection: snap gauge and strain gauge. (It should be noted that a significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections. Thus presence of NPT tends to signify physically functional systems, but absence of NPT may be ambiguous and not rule out either cause.)

Penile biothesiometry

This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence.

Penile Angiogram

Invasive test - allows visualization of the circulation in the penis and is used during the repair of a priapism.

Dynamic Infusion Cavernosometry

(Abbreviated DICC) technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection. To do this test, a vasodilator like prostaglandin E-1 is injected to measure the rate of infusion required to get a rigid erection and to help find how severe the venous leak is.

Corpus Cavernosometry

Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.

Digital Subtraction Angiography

In DSA, the images are acquired digitally. The computer creates a mask from lower-contrast x-rays of the same area and digitally isolates the blood vessels (this is done manually through darkroom masking with traditional angiography).

Magnetic resonance angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies. Aside from the IV used to introduce the contrast material into the bloodstream, magnetic resonance angiography is noninvasive and painless.

Treatment

Treatment depends on the cause. Testosterone supplements may be used for cases due to hormonal deficiency. However, the cause is more usually lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. This damage is more frequent in older men, and often associated with disease, in particular diabetes. Treatments (with the exception of testosterone supplementation, where effective) work on a temporary basis: they enable an erection to be attained and maintained long enough for intercourse, but do not permanently improve the underlying condition. There are different treatments available:

Oral treatment

3 different tablets are currently available from the doctor and these work when there is sexual stimulation. Depending on the treatment, it will need to be taken 20 minutes to 1 hour before sex and the period of time over which it works can vary between 3 hours and up to 36 hours.

Alprostadil

This can be injected into the penis or inserted using a special applicator - usually just before sexual intercourse.

Alprostadil has also bcome available in some countries as a topical cream (under the brand name Befar), and preliminary studies have shown a clinical efficacy of up to 83%. It has an onset of action of 10-15 minutes and its effects can last over 4 hours.

Libido

Libido in its common usage means sexual desire; however, more technical definitions, such as those found in the work of Carl Jung, are more general, referring to libido as the free creative—or psychic—energy an individual has to put toward personal development or individuation.

History Of The Concept

Sigmund Freud popularized the term and defined libido as the instinct energy or force, contained in what Freud called the id, the largely unconscious structure of the psyche. Freud pointed out that these libidinal drives can conflict with the conventions of civilized behavior, represented in the psyche by the superego. It is this need to conform to society and control the libido that leads to tension and disturbance in the individual, prompting the use of ego defenses to dissipate the psychic energy of these unmet and mostly unconscious needs into other forms. Excessive use of ego defenses results in neurosis. A primary goal of psychoanalysis is to bring the drives of the id into consciousness, allowing them to be met directly and thus reducing the patient's reliance on ego defenses. According to Swiss psychiatrist Carl Gustav Jung, the libido is identified as psychic energy. Duality (opposition) that creates the energy (or libido) of the psyche, which Jung asserts expresses itself only through symbols: "It is the energy that manifests itself in the life process and is perceived subjectively as striving and desire." (Ellenberger, 697 Defined more narrowly, libido also refers to an individual's urge to engage in sexual activity. In this sense, the antonym of libido is detrude.

Libido Impairment

Sometimes sexual desire can be impaired or reduced. It also may be weak or not be present at all, in occurrences such as asexuality. Factors of reduced libido can be both psychological and physical. Absence of libido may or may not correlate with infertility or impotence.

Psychological Factors

Reduction in libido can occur from psychological causes such as loss of privacy and/or intimacy, stress, distraction or depression. It may also derive from the presence of environmental stressors such as prolonged exposure to elevated sound levels or bright light. A comprehensive list of stressors include:

• depression
• stress or fatigue
• childhood sexual abuse, assault, trauma, or neglect
• body image issues
• adultery or attraction outside marriage
• lack of interest/attraction in partner
• sexual performance anxiety
• moral choices and/or conventions, such as observed in celibate people

Libido was first used in 1833 by Teresa Juncaj referring to her own life. This term was heard and spread quickly, and is now used in everyday language.

Physical Factors

Physical factors that can affect libido are: levels of available testosterone in the bloodstream of both women and men, the effect of certain prescription medications, various lifestyle factors and, according to studies, the attractiveness and biological fitness of one's partner. Inborn lack of sexual desire, often observed in asexual people, can be also considered to be a physical factor.

Lifestyle

Being very underweight, severely obese, or malnourished can cause a low libido due to disruptions in normal hormonal levels

Menstrual Cycle

Women's libido is correlated to their menstrual cycle. Many women experience heightened sexual desire in the several days immediately before ovulation

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