Impotence is defined as the inability of the male to achieve and/or maintain penile erection and thus engage in copulation.
A decrease in sexual desire, or libido, may be due to androgen deficiency (arising from either pituitary or testicular disease), psychological disturbance, or to some types of prescribed or habitually abused drugs.
Organic causes of erectile impotence include Endocrine causes: Testicular failure (primary or secondary) and Hyperprolactinemia; Drugs: Antiandrogens including Histamine (H2) blockers (e.g., cimetidine), Spironolactone, Ketoconazole, and Finasteride; Antihypertensives including Central-acting sympatholytics (e.g., clonidine and methyldopa), Peripheral-acting sympatholytics (e.g., guanadrel), Beta blockers, and Thiazides; Anticholinergics; Antidepressants: Monoamine oxidase inhibitors, and Tricyclic antidepressants;. Antipsychotics; Central nervous system depressants: Sedatives (e.g., barbiturates) and Antianxiety drugs (e.g., diazepam); and Drugs of habituation or addiction: Alcohol, Methadone, and Heroin.
Many types of neurologic disorders cause impotence, including lesions in the anterior temporal lobe, spinal cord disorders, insufficiency of sensory input as in tabes dorsalis, or damage to parasympathetic nerves, for example, following surgical procedures such as radical (total) prostatectomy or cystectomy.
As many as half of men with diabetes mellitus develop impotence within 6 years of the onset of diabetes, and impotence may be the first clinical manifestation of diabetic neuropathy.
Androgen deficiency results in a decrease in secretions of the prostate and seminal vesicles and in a decrease in the volume of ejaculate. Drugs such as guanethidine, phenoxybenzamine, phentolamine, and sertraline primarily impair ejaculation.
Men with vasculogenic impotence may present with total erectile impotence, decreased penile rigidity, or loss of erection during intercourse. Vascular insufficiency may be due to aortic occlusion (Leriche syndrome) or to more distal atherosclerotic disease in the hypogastric, pudendal, and cavernosa arteries.
Standard labs include CBC, Glucose, potassium, sodium, Albumin, BUN/creatinine, TSH, Prolactin, and Testosterone. A 24 hour urine zinc may be ordered.
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