Discussion of Impotence and some treatments available

Men have always been reluctant to discuss the topic of impotence and for good reason. Impotence can leave a man feeling hopeless. But recent and ongoing advances in medical treatment programs can help. Replacing hormone levels to a younger level, different neutraceuticals, new medications, oral, transdermal and intracavernosal injections take advantage of the latest scientific discoveries in order to help you and your partner restore sexual intimacy in a discreet, convenient, and effective manner.


Impotence: common but treatable



According to the National Institutes of Health (NIH), impotence affects as many as 20% of men. It can create significant emotional stress and affect the quality of life of the men who experience it as well as their sexual partner. And although once thought to be an unavoidable result of aging, impotence is now understood to be caused by a variety of factors. Knowing how these factors contribute to impotence is the first step toward proper treatment.


Understanding the human sexual response

The human sexual response is made up of a cycle with four phases, all of which are experienced by both men and women.  Desire is defined as an interest in sex.  Thinking about sex, feeling attracted to someone, or feeling frustrated because of a lack of sex is all part of desire.  Desire is a normal part of life from the teenage years on.


Excitement is the phase when you feel aroused or “turned on”.  In a physical sense, your heartbeat and pulse speed up, your blood pressure rises slightly and your breathing gets heavy.  Blood is sent to the genital area, and in men, this surge of blood creates an erection.  Orgasm is the sexual climax.  Men experience intense pleasure in the genital area.  With men, the muscles around the genitals contract to send waves of feeling through the body causing ejaculation of semen.


Resolution is the return of the body to its unexcited state and occurs a few minutes after an orgasm.  If a person becomes excited but does not reach orgasm resolution still takes place, but more slowly.  In both cases, heartbeat and breathing slow.  Blood drains out of the genital areas and mental excitement subsides.


In men, a “refractory period” is also experienced (a time after one orgasm during which they are not physically able to have another one).  This period tends to get longer as a man ages so that a man in his 70’s may need several days before achieving another orgasm.  The refractory period is a normal part of the sexual response.


An erection occurs when… blood is carried to the penis during sexual excitement.  Blood flow occurs in two arteries that end in a maze of blood vessels.  These blood vessels deliver blood to two areas of spongy tissue that run the length of the right and left sides of the penis.  When the brain senses something arousing, an erection begins.  Nerve stimulation relaxes the blood vessels in the spongy tissue, creating more room for blood; like a sponge, the tissue fills with blood.  While these tissues fill with blood, they press against veins, keeping blood from leaving the penis.  Blood is trapped making the penis hard enough for intercourse.






Understanding Impotence



What is impotence?

Impotence is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse.  Impotence occurs when not enough blood is supplied to the penis, when the smooth muscle in the penis fails to relax, or when the penis does not retain the blood that flows into it.



When and how does impotence occur?

Impotence can occur at any age.  According to studies by the National Institutes of Health, 5% of men have some degree of impotence at age 40 and approximately 15%-25% at age 65 or older.  Impotence affects all races and ethnicities.



Physical causes of impotence

Although the likelihood of impotence increases with age, it is not an inevitable part of aging.  Impotence can be associated with physical factors, such as illness, accidents, injury, diabetes, high blood pressure or the side effects associated with medications used in treating certain diseases.  Heavy smoking and excess alcohol consumption also may contribute to impotence.  About 80% of impotence has a physical cause.



Psychological causes of impotence

Impotence can also be caused by psychological factors. These include unpleasant associations with past sexual activity, stress, depression and anxiety.  When psychological conditions such as these occur for long periods of time, they can decrease sexual desire and result in impotence.



Sexual activity and aging

The aging process may present some challenges that are often overlooked by couples.  Both men and women, for example, undergo various physical changes that alter sexual responsiveness.  These changes are a normal and an expected part of aging.

In undergoing your therapy for impotence both you and your partner should try to avoid making comparisons to sexual performances when you were younger or prior to other changes that may have caused impotence.  But most important, be patient, maintain a sense of enjoyment and consider this time an opportunity to rediscover your sexual intimacy as a couple.



Changes in Men

As men age, testosterone and other hormones are produced in reduced amounts.  In addition, physical changes may occur within the testes and the glands around/near the prostate.  As a result, greater stimulation may be required to produce a sexual response.  The intensity, duration, and frequency of an orgasm, as well as the amount of semen may also decrease.  Erections may not be as firm.

It’s important to differentiate these changes from impotence.  Many changes that occur in men as they age are perfectly normal and should not interfere with your ability to be sexually intimate with your partner.



Changes in Women

The lower estrogen levels that women experience after menopause cause significant changes.  The vagina becomes less lubricated during sexual excitement and may lose some of its flexibility and thickness.  Changes to the uterus, cervix and ovaries may also occur.  As a result, orgasms may become shorter and less intense than they were in earlier years.  However, a woman’s ability to have multiple orgasms may not be affected.



Resuming sexual intimacy after extended inactivity

If you are resuming sexual intimacy after an extended period of sexual inactivity it is important that your partner also consider speaking to a healthcare professional.  Natural changes that occur during an extended period of sexual inactivity often involve making certain changes to your sexual habits upon becoming sexually active again.


Lubricants, for example, can help ease problems with foreplay, vaginal penetration, and should be water-based—especially if you use condoms to prevent pregnancy or transmission of sexually transmitted diseases (Petroleum-based lubricants should not be used as they may weaken the latex in the condom and cause it to break).  A number of water-based lubricants should be available at your local pharmacy.  Ask your Doctor or Pharmacist for more information.



Dosage for treatment of impotence:

Your first dosage of Intracavernosal Injections should be given under the supervision of your doctor.  You and your physician will determine the proper dose of Intracavernosal Injections.


Erections should last 45 minutes to 1 hour.  If an erection lasts longer, the patient can bring down the erection by taking a cold shower, applying ice wrapped in a towel on the penis or taking 60 mg of Sudafed.  Note: If you have an erection that lasts more than 4 hours and you have tried the above, see a doctor promptly and take along the medication and package inserts.



Factors that may reduce your erection

1. Anxiety, fatigue, tension and too much alcohol

2. Lying on your back too soon after the administration of Intracavernosal Injections (may decrease blood flow to the penis and result in loss of erection)

3. Using medications that contain decongestants, such as over-the-counter cold remedies, allergy, sinus medications and appetite suppressants which may block the effect of Intracavernosal Injections



Side effects

The most common side effects that have been observed using Intracavernosal Injections are:


  • Aching in the penis, testicles, legs and in the perineum (area between the penis and rectum)
  • Redness of the penis due to increased blood flow
  • Prolonged erection over 4 hours
  • Swelling of leg veins
  • Light-headedness/Dizziness
  • Fainting
  • Rapid pulse


If you have a history of fainting, discuss this with your doctor prior to using Intracavernosal Injections.  If you do experience dizziness or feel faint lie down immediately and raise your legs.  If symptoms persist, call your doctor promptly.


Sexually transmitted diseases: Intracavernosal Injections will not protect you or your partner from sexually transmitted diseases like chlamydia, gonorrhea, Herpes Simplex Virus (HSV), Viral Hepatitis, AIDS, Human Immunodeficiency Virus (HIV), Human Papilloma Virus (genital warts) and syphilis.  Latex condoms should be used if protection against these sexually transmitted diseases is desired.  Always use a fresh needle and never share a needle with another person when using Intracavernosal Injections. Sharing of needles can transmit sexual diseases such as AIDS.



Seldom men using this medication do not get the desired results.  If this medication does not work for you please inform our pharmacists so that they may discuss with you the proper technique of injecting. If this still does not work we will consult with your physician on an alternative medication combination that may be more effective.











Dr. Pugen's Anti-Aging Clinic

Clinical and Aesthetic Medicine

G1-3215 Hwy 7 East, Markham, ON L3R 3P3

OFFICE: (905) 475-9433

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This website is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment.