1. Assessment
- full sexual history
- physical examination
- penile-brachial artery pressure index of less than 0.6 is indicative of arterial disease to penis; angiography may be necessary in younger patients
- nocturnal penile tumescence monitoring can distinguish organic (no nocturnal erections) from psychogenic causes
- dynamic cavernometry (normal saline infused into corpus cavernosum) can detect venous incompetence
- intracorporeal injection of PAPAVERINE or PHENTOLAMINE can be diagnostic to establish the capacity for erection
2. Treatment
a) Physical
i) intra-cavernosal injection of vasoactive drugs:
- PAPAVERINE, self-injected can give an erection lasting about an hour, and can be used up to twice a week
- complications include priapism, fibrosis, haematomas, and bruising
- provide a safe method of obtaining an erection in up to 90% of patients
- problems include lack of spontaneity, decreased sensation, and delayed or absent ejaculation
iii) vascular surgery
iv) penile prosthetic implants:
- three types – malleable, self-contained inflatable, and multipart inflatable
- few problems with those with organic cause, but for those with psychogenic impotence, it can exacerbate pre-existing marital difficulties
b) Psychological
i) counselling
ii) psychotherapy
- CBT reports success rates of 70%
- couple therapy seems more effective than surrogate or individual therapies
- factors associated with better outcome include:
(a) good marriage
(b) better pre-treatment communication
(c) better general sexual adjustment
(d) female partners interest and enjoyment of sex
(e) absence of psychiatric history in female partner
(f) early engagement in homework assignments
(b) better pre-treatment communication
(c) better general sexual adjustment
(d) female partners interest and enjoyment of sex
(e) absence of psychiatric history in female partner
(f) early engagement in homework assignments
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