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Excessive alcohol use has long been recognised as one cause of impotence, leading to the euphemism "brewer's droop"; Shakespeare made light of this phenomenon in Macbeth.
Evaluating the patient for diabetes with a hemoglobin A1c measurement is a useful screening test.
A test that was frequently performed in the past was nocturnal penile tumescence testing. This was thought to be useful in distinguishing psychogenic from organic impotence. This test involves placing a band around the penis and instructing the patient to wear it for 2-3 successive nights. If an erection occurs, which is expected during rapid eye movement sleep, the force and duration are measured on a graph. Inadequate or absent nocturnal erections suggest an organic dysfunction, while a normal result indicates a high likelihood of a psychogenic etiology. Other devices are available to provide similar information. Some are also able to measure rigidity (resistance to mild compression) and tumescence (size). This test is rarely used in current practice, but it can be helpful in situations in which the diagnosis is in doubt.
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With the introduction of effective pharmacologic therapies for erectile dysfunction, more men are seeking treatment. The underlying cause of erectile dysfunction is usually a chronic medical illness or a side effect of certain drugs. Less commonly, the problem is psychogenic. Even after optimal treatment of common medical disorders such as diabetes mellitus and hypertension, erectile dysfunction may persist. Pharmacologic treatments, such as the intracavernosal or transurethral administration of alprostadil or the use of the new oral medication sildenafil, may offer patients substantial benefit. Before any of these drugs are prescribed, consideration should be given to existing medical illnesses and medications, partner satisfaction, comfort with the method of administration and the side effect profile. (Am Fam Physician 1999;60:1159-72.)
Within the past years many medical practitioners have instigated recommending it over the artificial drugs because of its higher safety and the dearth of unpleasant effects.
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A condition called "corporal fibrosis" -- where the tubes of penile "spongy tissue" that maintain erection are gradually replaced by inactive, fibrous scar tissue -- remains largely untreatable. The disorder occurs when the penis' sensitive spongy-tissue cells don't get the oxygen they need to survive, usually because of a chronic reduction in blood flow.
66 percent of men characterize their own penis size as average; 22 percent as large and 12 percent as small
This Eli Lilly study included 244 men, ages 30 to 65, who were randomly selected to take either 5 milligrams of tadalafil, 50 mg. of sildenafil, or a placebo daily for six months. The men underwent thorough eye tests before, during and after treatment.
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Potential Conflicts of Interest: Grants received: V. Snow (Bristol-Myers Squibb, Centers for Disease Control and Prevention, Novo Nordisk, Merck Vaccines, Boehringer Ingelheim, Wyeth, Sanofi Pasteur), P. Shekelle (Pfizer). Royalties: P. Shekelle (Up-to-Date). Any financial and nonfinancial conflict of interest of the group members were declared, discussed, and resolved.
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