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What are the different types of Male Impotence / Erectile Dysfunction?

A Narrowing of The Arteries
A narrowing of the arteries due to various reasons (like that in old age, high blood pressure, diabetes and injury to the genital region that may result a blockage in the arteries leading to the penis) may result in a reduced supply of blood to the penis resulting in erectile dysfunction / male impotence (an inability to produce an erection).

In younger men, injury to the genital region is very common. This can be a sudden and major injury such as can occur in a car / motor accident that causes a fracture in the pubic bones or pelvis.

It can also be gradual such as occurs in cyclists due to sustained friction in the penile area, causing a clot (thrombus) to develop in the artery to the penis. The clot increases in size gradually, and eventually blocks completely the supply of blood to the penis. The remedy for this then would be a microsurgical bypass operation which is a penile revascularization procedure.

Male impotence / erectile dysfunction that occur due to injuries to the arteries is common although it is rarely diagnosed, mainly due to ignorance of the possibility of such causes.

Such patients populate orthopedic and urology wards, and male impotence / erectile dysfunction is often discovered later by the patients themselves when the emergency is over and their more apparent injuries and fractures have healed.

Veins of the penis not closing completely to trap the blood required for an erection
During full erection in a healthy man, the veins in the penis close completely, preventing blood flowing out from the penis. The blood that accumulates in the sinusoids of the penis increases the pressure required for the hardness and rigidity of the penis. In the absence of this action on the part of the veins, blood filters out from the penis and thus the man experiences flacidity instead of rigidity in his penis.

This type of impotence is very common, and accounts for between 30 to 70% of all male impotence / erectile dysfunction. Some men are born with this condition and never experience a rigid erection at all. Other men afflicted with this type of impotence / erectile dysfunction usually experience this suddenly after years of normal erectile function.

Defective Nerve supply to the penis
The nerve supply to the penis plays a vital role in the initiation and maintenance of rigidity in an erection in a man. A good nerve supply allows for the proper conduction of impulses required for a healthy rigid erection. These nerves activate the arteries and veins in the penis, altering the dynamics of blood flow within them.

However, this nerve supply is highly complex and delicate, and many things can cause it to become defective, and result in erectile dysfunction / impotence in a man. Some possible causes include:

1, Back injuries, especially those involving the vetebral column and spinal cord.

2. Pelvic or perineal trauma.

3. Operations such as those on the spine, urinary bladder, rectum, prostate and urethra may lead to incidental injury to the nerves of the penis.

4. Nervous system disorders such as multiple sclerosis and tumors may cause male impotence / erectile dysfunction if the nerve supply to the penis is involved.

5. Some drugs can also cause impotence if they affect the neurotransmitters at the nerve endings. The list of such drugs is extensive, and include anti-hypertensives (for lowering blood pressure) and psychotropics. A medication prescribed for some medical condition (usually unrelated to impotence / erectile dysfunction) may well be the culprit of a man's impotence.

Hormonal Causes
An insufficiency or imbalance of sex hormones in the blood stream may lead to erectile dysfunction / impotence in a man. This can also result from a wide variety of diseases. About 10% of men suffering from impotence / erectile dysfunction fall into this group.

Mixed Causes
In some impotent men, there may be many many factors at play that lead to their condition. Such men usually have systemic disease like kidney failure, liver failure and diabetes.

Some men with a long-standing history of impotence / erectile dysfunction may suffer from secondary psychiatric disorders such as depression. These men begin with an organic health challenge that is either undiagnosed, untreated or maltreated, and which with time, plays on their minds and eventually takes its toll mentally. Such men think, or have been led to think, that their malady has no cure and give up hope.

Psychogenic Impotence
In the absence of an organic cause, the root of the problem then has to be entirely mental. In such cases, one must exercise caution and make the necessary investigations that give proof of the absence of organic or physical causes, after which treatment and management of the condition can proceed in an organized way.

A Message to all Men
Knowledge of the various physiological conditions that could lead to erectile dysfunction / male impotence is helpful for any man wishing to take charge of his sexual health.