Impotentia coeundi N48.49

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Erectile dysfunction

Definition
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Man's inability to have intercourse.

Classification
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A distinction is made between:

Organic impotence due to anatomical changes of the penis, e.g.: Hypospadias and epispadias, induratio penis plastica, injuries or thrombosis of the erectile tissue.
Functional impotence as a result of hormonal, central nervous or psychological disorders, e.g. male men's menopause.
Loss of libido and erection, also in hypo- and hypertension, chronic liver disease, diabetes mellitus, severe physical or mental stress, abuse of alcohol, nicotine, etc.

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Vascular medicine

Decubitus

Lesions that occur as a result of focal, prolonged pressure on skin and subcutaneous tissue.

Etiopathogenesis
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Mostly multifactorial causes. Triggered also iatrogenically by long-term use of drugs such as ACE inhibitors, alpha-blockers, antiandrogens, antidepressants, antiepileptic drugs, beta-blockers, calcium antagonists, diuretics, hallucinogens, H2-antagonists, cardiac glycosides, hypnotics, lipid-lowering drugs, neuroleptics, nitrates, NSAIDs, proton pump blockers, estrogens, tranquilizers.

General therapy
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It is important to differentiate between psychologically or organically caused impotence by anamnesis, physical examination and, if necessary, attempts to provoke an erection by changing conditions.
For psychological causes: psychotherapy or partner therapy.
Organic: treatment of the underlying disease, avoidance of alcohol. In case of venous cause and anatomical changes, surgical measures may be necessary.
Treatment in cooperation with urologists, if necessary internal medicine specialists.
In case of increased venous outflow: ligation of the dorsal penile vein and its lateral branches under short anaesthesia.

External therapy
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Vacuum pump (vacuum erection system): Can be used as a supportive procedure for all forms of erectile dysfunction. Application 1 time/day.

Internal therapy
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PDE-5 antagonists, e.g. sildenafil (Viagra) 50-100 mg p.o., vardenafil (Levitra) 10-20 mg p.o., tadalafil (Cialis) 10-20 mg p.o. are highly effective (in up to 80% of patients).
If a testosterone deficiency is detected, substitution via testosterone patches (e.g. Adroderm), gel (e.g. Testogel) or via depot injections (e.g. Testoviron).

Operative therapie
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For erectile dysfunction due to vascularisation or insufficiency of the erectile tissue: SKAT/cavernous body autoinjection therapy (second-line therapy if PDE-5 inhibitors are ineffective or not available).
Surgery is only useful if other therapeutic options have failed. If pharmacotherapy shows no improvement, a penile prosthesis can be considered as the ultima ratio in cases of severe suffering. Despite the availability of three-component systems (fluid reservoir, pump, artificial erectile tissue), the option of a penile prosthesis or penile implants should be considered carefully, because the natural structure of the penis is irreversibly destroyed during surgery. Treatment in cooperation with urologists, possibly internists is necessary.

Naturopathy
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Yohimbine, a centrally acting herbal alpha-2 blocker (e.g. Yocon-Glenwood, Yohimbine levels) is sufficiently effective in many men with psychogenic or borderline organic erectile dysfunction.