STUDY - Technical - New Dacian's Medicine
Impotence
(Classical / Allopathic Medicine)
Impotence is the
inability to achieve and maintain penile erection sufficient
to complete satisfactory intercourse; ejaculation may or may
not be affected. Impotence varies from occasional and minimal
to permanent and complete. Occasional impotence occurs in
about one-half of adult men in the United States, whereas
chronic impotence affects about 1 in 8 million men in the
United States.
Impotence can be
classified as primary or secondary. A man with primary
impotence has never been potent with a partner but may achieve
normal erections in other situations. This uncommon condition
is difficult to treat. Secondary impotence carries a more
favorable prognosis because, despite present erectile
dysfunction, the patient has succeeded in completing
intercourse in the past.
A penile erection
involves increased arterial blood flow secondary to
psychological, tactile, and other sensory stimulation.
Trapping of blood within the penis produces increased length,
circumference, and rigidity. Impotence results when any
component of this process - psychological, vascular,
neurologic, or hormonal - malfunctions.
Organic causes of
impotence include vascular disease, diabetes mellitus,
hypogonadism, a spinal cord lesion, alcohol, and drug abuse,
and surgical complications. (The incidence of organic
impotence associated with other medical problems increases
after age 50.) Psychogenic causes range from performance
anxiety and marital discord to moral or religious conflicts.
HISTORY:
If the patient complains of impotence or of a condition that may be causing it, let him describe his problem without interruption.
Ask the patient when his impotence began. How did it progress? What's its current status? Make your questions specific, but remember that the patient may have difficulty discussing sexual problems or may not understand the physiology involved.
Ask the patient if he's married, single, or widowed. How long has he been married or had a sexual relationship? What's the age and health status of his sexual partner?
If you can do so discreetly, ask the patient about sexual activity outside marriage or his primary sexual relationship.
Ask the patient about his job history, his typical daily activities, and his living situation. How well does he get along with others in his household?
Review the patient's medical history for type 2 diabetes mellitus, hypertension, or heart disease, noting information on onset and treatment. Also, ask about neurologic diseases such as multiple sclerosis.
Obtain a surgical history, noting especially neurologic, vascular, and urologic surgery. If trauma may be causing the patient's impotence, find out the date of the injury as well as its severity, associated effects, and treatment.
Obtain a urologic history, including voiding problems and past injuries.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he smokes. If so, ask him how many packs he smokes in a year.
Ask the patient about his diet and exercise regimen.
Ask the patient to rate the quality of a typical erection on a scale of 0 to 10, with 0 being completely flaccid and 10 being completely erect. Using the same scale, also ask him to rate his ability to ejaculate during sexual activity, with 0 being never and 10 being always.
If the patient complains of impotence or of a condition that may be causing it, let him describe his problem without interruption.
Ask the patient when his impotence began. How did it progress? What's its current status? Make your questions specific, but remember that the patient may have difficulty discussing sexual problems or may not understand the physiology involved.
Ask the patient if he's married, single, or widowed. How long has he been married or had a sexual relationship? What's the age and health status of his sexual partner?
If you can do so discreetly, ask the patient about sexual activity outside marriage or his primary sexual relationship.
Ask the patient about his job history, his typical daily activities, and his living situation. How well does he get along with others in his household?
Review the patient's medical history for type 2 diabetes mellitus, hypertension, or heart disease, noting information on onset and treatment. Also, ask about neurologic diseases such as multiple sclerosis.
Obtain a surgical history, noting especially neurologic, vascular, and urologic surgery. If trauma may be causing the patient's impotence, find out the date of the injury as well as its severity, associated effects, and treatment.
Obtain a urologic history, including voiding problems and past injuries.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he smokes. If so, ask him how many packs he smokes in a year.
Ask the patient about his diet and exercise regimen.
Ask the patient to rate the quality of a typical erection on a scale of 0 to 10, with 0 being completely flaccid and 10 being completely erect. Using the same scale, also ask him to rate his ability to ejaculate during sexual activity, with 0 being never and 10 being always.
PHYSICAL
ASSESSMENT:
Inspect and palpate the genitalia and prostate for structural abnormalities.
Assess the patient's sensory function, concentrating on the perineal area.
Test motor strength and deep tendon reflexes in all extremities, and note other neurologic deficits.
Take the patient's vital signs and palpate his pulse for quality. Note signs of peripheral vascular disease, such as cyanosis and cool extremities.
Auscultate for abdominal aortic, femoral, carotid or iliac bruits, and palpate for thyroid gland enlargement.
Inspect and palpate the genitalia and prostate for structural abnormalities.
Assess the patient's sensory function, concentrating on the perineal area.
Test motor strength and deep tendon reflexes in all extremities, and note other neurologic deficits.
Take the patient's vital signs and palpate his pulse for quality. Note signs of peripheral vascular disease, such as cyanosis and cool extremities.
Auscultate for abdominal aortic, femoral, carotid or iliac bruits, and palpate for thyroid gland enlargement.
SPECIAL
CONSIDERATIONS:
Sildenafil can be used for the treatment of erectile dysfunction and is an alternative to surgery.
Sildenafil can be used for the treatment of erectile dysfunction and is an alternative to surgery.
AGING ISSUES:
In elderly people who suffer from sexual dysfunction, the organic disease must be ruled out first.
In elderly people who suffer from sexual dysfunction, the organic disease must be ruled out first.
PATIENT
COUNSELING:
Keep in mind that impotence is potentially frustrating, humiliating, and devastating to self-esteem and significant relationships. Encourage the patient to talk openly about his needs and desires, fears, anxieties, or misconceptions. Urge him to discuss these issues with his partner as well as the role they want sexual activity to play in their lives.
Keep in mind that impotence is potentially frustrating, humiliating, and devastating to self-esteem and significant relationships. Encourage the patient to talk openly about his needs and desires, fears, anxieties, or misconceptions. Urge him to discuss these issues with his partner as well as the role they want sexual activity to play in their lives.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)