Doctorweblog. About Health & Medicine

Artery surgery is an option for some men who don’t get enough blood into the penis to produce and maintain an erection because their arteries are partially blocked.

Sometimes the blood-flow problem can be corrected by replacing the narrow artery with a new, artificial one; sometimes the solution is to insert a tiny, deflated surgical balloon into the partially blocked artery and inflate the balloon to dilate the artery. Both types of surgery offer a real chance of restoring potency.

Another option for men whose potency problems can be blamed on malfunctioning arteries is to bring in a new blood supply to the penis. There are two basic ways to do this.

One method involves taking an artery, usually from the abdominal wall, and rerouting it so it carries blood into the penis. One end of the artery stays in the normal position, while the other is cut and swung around so it supplies the penis. The operation qualifies as major surgery and takes several hours.

The other option is to remove a well-functioning vein from the leg and hook it into an artery which normally supplies the leg. The vein then actually carries some of the blood meant for the leg into the penis. It’s a type of bypass operation, and the replaced vein actually functions as an artery.

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The shot is not without possible complications. Occasionally, a man will have some bleeding and a bruise where the medicine has been injected. But usually this clears up by itself and causes little or no pain. A more serious problem occurs when the artificially induced erection won’t go away. This can be a serious situation which, if left untreated, can cause permanent damage, when the blood clots and injures delicate tissues in the penis. If the erection won’t go down, the doctor will have to insert a larger needle into the shaft of the penis and suck the blood out with a syringe. Or he may need to inject another drug to counteract the effect of the first shot.

When you first have a shot, your erection should be gone before you go home. If the erection isn’t gone within four hours, or sometimes sooner, the doctor should remove the blood without delay.

Although these shots represent a real breakthrough in diagnosing impotence, they are not without risk. Clearly, patients who have such injections require expert supervision and care by physicians (usually urologists) who are able to handle the possible complications. Be sure you understand the procedure thoroughly before you agree to it.

Some experts think that the penile shots will become a commonly used diagnostic tool, and some researchers even believe the technique may eventually replace the NPT test in many cases.

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Roger, at forty-nine, was a twenty-eight-year veteran of the New York police force. Years of desk work had contributed to poor circulation, varicose veins, and chronic edema of the legs. When he first came to see me, he complained of leg swelling and intolerable itching. To relieve his symptoms, I prescribed 40 mg of Lasix, an often-used diuretic, and suggested that he begin a regular walking program to improve circulation. I also recommended that he cut back substantially on the processed meat sandwiches he often ate—they are infamous water retainers. He also took regularly scheduled breaks from his desk for badly needed stretches and new leg positions.

When I saw him five months later, his condition had greatly improved, but now he had a new complaint: periodic episodes of ED. Since he had responded so well to Lasix and had incorporated lifestyle changes into his daily routine, I decided to try lowering his dosage. The intention, of course, was to maintain his improved circulation as well as combat his ED. First, he tried taking the medicine every other day instead of daily. The result was a return of the edema and sporadic ED. The next step was to reintroduce the daily dose, but at lower levels. This time, the edema was reduced and the ED was eliminated.

Lowering the Dosage and Adding Another Drug

Bill was taking 100 mg of Hygroton, a diuretic used to lower his hypertension. Although the medicine worked, the forty-six-year-old soon developed erection problems. To counteract his ED, I chose to lower the dosage to 25 mg, although I knew that this alone would not be enough to control his blood pressure. So, I also prescribed a small dose °f Hytrin, a vasodilator. The combination of the two controlled the hypertension and got rid of his ED.

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Injury to the Testicles

Nature has done a fairly good job of protecting the testicles despite their somewhat vulnerable location. Simply getting bumped or bruised in the groin will not usually cause any permanent damage to these sexually vital organs—although it can be excruciatingly painful. But severe injury to the testicles, which results in significant swelling, bleeding and bruising, can permanently damage these organs and impair their ability to manufacture testosterone. Luckily, nature has given men some protection by providing testicles in pairs; if just one testicle is injured, the other will almost always produce enough testosterone to keep the body running properly. For potency to be affected, both testicles must be impaired.

Testosterone: Pills or Shots?

Your doctor can prescribe testosterone in pill form, or give you injections. Because the pills aren’t absorbed efficiently in the body, and may cause liver damage, we favor taking any needed testosterone by shot. The slight inconvenience of the needle seems outweighed by the increased effectiveness and safety of the drug. (Usually, the shots must be given about every three weeks.)

Nerve Diseases

Any disease or injury that damages the nervous system can cause erection problems. Multiple sclerosis, spinal cord injuries and other back problems, epilepsy, stroke and Parkinson’s disease are among the most common causes of nervous system-linked potency problems, a few of which are discussed below.

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Why would anyone want to know how not to get an erection? Actually most men already know how not to—they just don’t know that they know. And this ignorance can mess up their love lives, cause them needless stress and generate emotionally painful (though preventable) problems. Many men cause their own erection problems, often due to lack of information and a basic misunderstanding of just how the male body works. This self-sabotage can be stopped. Learning what can cause a man not to get an erection will allow him to more easily avoid that problem.

An erection is not something a man consciously decides to do, like flexing his biceps, kicking a ball or raising his arm. Instead, erection is a complicated physical and emotional response. The stage is best set with a willing (hopefully, enthusiastic) partner, a comfortable setting free from distractions and enough time not to feel pressured. Assuming all systems are go—that he has no medical problems that affect his ability to get or maintain an erection, isn’t too tired, depressed or distracted and is sufficiently aroused—the man will probably find himself with an erection. But because erection is such a complex, delicate process, there are many things that can prevent it from happening. Some are within a man’s control.

One key to sexual success is to know how to avoid sabotaging yourself so you don’t unknowingly create situations that make having and maintaining potency difficult, or downright impossible.

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