Causes and Treatment for Erectile Dysfunction (Impotence)

Man is full of potential as he is of impotence. The corollary to this hard fact holds true nowadays. For man is no longer limp by his impotence, he’s done something to alleviate it.

Defining Impotence

It is the male erectile disorder characterized by an inability to either have, or sustain an erection for proper penetration till the completion of satisfactory sexual activity.

The Human Sexual Response Cycle

The normal phenomenon has five phases

Appetitive Phase

A mental fantasy ignites the desire for sex.

Excitement Phase

These events make up sexual arousal in either sex.
Manifestations include penile erection due to vascular congestion of the ‘Corpora Cavernosa’ or the spongy penile muscles and elevation of the testes within the scrotal sac.
excitement is seen with vaginal lubrication by Bartholin gland discharge, swelling of the inner vaginal lips ‘labia minora’ and most importantly there is erection of the clitoris and nipples.

Plateau Phase

This intermediate phase builds up to peak sensations and decides the length of the sexual encounter. It is an intense psychological phase of sex which needs some support from the sex organs. It is also the make or break phase, particularly for men. To maintain continuous thrust through sustained erection, without premature ejaculation, is the hallmark of this phase.
Understandably it is the most affected in impotence. The success of this phase is decided by how fit you are, how fat you are, how much you smoke and how high you are. Generally those who do not exercise, those who smoke, those who are inebriated with alcohol or narcotics and those who have just had a preceding sexual encounter will invariably fail here. Remember, narcotics and alcohol projects the appetitive phase with its fantasy and desire, to the sky, but murders the actual performance of the act!

Orgasmic Phase

This is the curtain call, with erection spurting into an ejaculation of bliss.
Males show contractions of the penile urethra, Vas Deferens and Seminal vesicles. Marked Autonomic excitement is notable with doubling of the heart rate, respiratory rate and rise in both systolic and diastolic blood pressure. Ejaculatory inevitability and spurt accompanied by contractions of both external and internal urethral sphincters is classical. Males orgasm rapidly, predictably and need little arousal. It’s as easy as lighting a fire using a gas lighter.
Contractions of the lower 1/3rd of the vagina, cervix and uterus precipitate a similar autonomic response. Multiple orgasms are known. Orgasms in any phase of the sexual response cycle are possible in women. More often than not the female orgasm is like building a flame from two flint stones, a patient and persistent task.

Resolution Phase

This phase is characterized by an initial clouding of consciousness that rushes into a high of relaxation. Sexual flush abates with fine perspiration and leads to a refractory period before one can get aroused again. Refractoriness applies mostly to males and varies from a few minutes to many hours.

Etiology or Causes of Impotence

Psychological causes predominate but can simultaneously exacerbate the physical causes

Psychological Causes Of Impotence

Fear of failure and performance, partner conflicts, fatigue, anxiety and mood disorders, concerns over pregnancy, fear of contracting HIV or STD’s (Sexually Transmitted Disorders), lack of privacy, worries over commitment in premarital/extramarital relationships and last but not the least sexual abuse in childhood. More than one cause can co-exist.

Physical Factors causing Impotence

Endocrine Disorders

Thyroid dysfunction.
Testicular atrophy secondary to Cirrhosis or Hemachromatosis.

Neurological Defects

Autonomic neuropathy of diabetes, alcoholism and nutritional deficiency.
Spinal Cord damage.
Head injury with temporal lobe trauma.
Multiple Sclerosis.

Genital Pathology

bifid urethra, chordee
painful erection from phimosis (penile skin tightly wrapped over the glans) or ulcers Mumps, Hydrocele, Varicocele.

Vascular Problems

Le Riche syndrome entails a saddle embolus in the iliac artery bifurcation that interferes with penile blood flow.

Drugs And Toxins

Alcohol, Smoking, Narcotics
Anti Hypertensives – B- blockers, Spironolactone, Methyldopa
Hormonal – Corticosteroids
Anti Depressants- TCA (TOFRANIL/PAMELOR), SSRI (PROZAC), Chlorpromazine (LARGECTIL)
Sedatives- Valium, Barbiturates

Be Sure To Diagnose Impotence Accurately

Psychological impotence is sudden and short term. Early morning erections and erections during REM sleep are usually preserved.
Standard blood testing is essential e.g. blood sugars, liver and thyroid function tests, hormonal profile – LH, FSH, serum Testosterone and Urine microscopic with culture.
Specific Tests
If nocturnal penile tumescence during REM sleep is abnormal then ancillary tests are mandated. These include Penile Doppler, Penile Duplex ultrasound, Pelvic vascular Doppler, Papaverine Injection testing, Dynamic Infusion Cavernosomatography and Cavernosonography (DICC) and penile biothesiometry.

Getting It Up – Treatment For Erectile Dysfunction

If a physical cause is found e.g. diabetes, it must be treated first.
The goal is to resolve underlying unconscious conflicts.
Suggestible patients do well with this form of therapy.
Behavior Therapy
involves relaxation training and Biofeedback using penile plethysmograph. It works wonders for Anxiety induced erectile dysfunction.
Masters’ and Johnson’s Conditioning Technique
Both partners are treated together in this highly successful ‘sex –retraining’ program. This ‘dual sex therapy’ modality entails the use of techniques such as Sensate Focus, Foreplay, Squeeze technique, Orgasmic conditioning and Desensitization. High success rates of up to 80% are noted especially in patients with premature ejaculation.

Oral Drug Therapy For Impotence

Phosphodiesterase Inhibitors For Erectile Dysfunction

The groundbreaking Sildenafil (Viagra/ Kamagra/Silagra/Caverta) and its congeners Tadalafil (Forzest / Tadalis / Cialis /Megalis) and Vardenafil ( Levitra ) are competitive and selective inhibitors of Phosphodiesterase type 5, an intracellular enzyme.
Kamagra relaxes the cavernal smooth muscle of the penis flooding it and compressing the adjacent subtunical veins leading to erection of the organ. More details regarding oral drug therapy are given in the two presentations below. The first presentation is about Alphagra Tablets, which has the same active ingredient Sildenafil Citrate as Viagra and the second is on Valif Oral jelly containing Vardenafil as it's active ingredient.

Variations Between Kamagra, Megalis And Levitra

Kamagra requires a higher dose (50-100 mg) compared to Tadalis(20 mg) or Levitra (20 mg) and it remains in the blood stream the longest. It also requires a longer time to act. Levitra acts most rapidly (15 to 30 min) and its effects last the longest (4 to 6 hours). Megalis has an intermediate profile between Kamagra and Levitra.
Kamagra can also be used as an oral jelly (available online in multiple flavors) to hasten absorption via the buccal mucosa. This route reduces its otherwise longer onset of action.

Side Effects of Kamagra

Whether it is Kamagra, Viagra, Levitra or Megalis, they must never be combined together and should be taken within an hour prior to coitus.
Kamagra and the others should be taken only once in 24 h. This once a day safety margin is needed to avoid potential cardiovascular adverse events namely Low Blood Pressure hypotension, angina and myocardial infarction. Headache, flushing, nasal congestion, dyspepsia and blue-green tingeing of vision are other notable side effects.

Contraindications to using Kamagra

Contraindications to using Kamarga include
Avoidance of use with concurrent antianginal, nitrate (ISORDIL/SORBITRATE) or anti hypertensive Therapy(AMLOPRESS/LASIX)
Priapism risk states – sickle cell disease, myeloma, leukemia.
Hepatic and Retinal impairment.
Bleeding disorder states and Peptic/gastric Ulcer disorders.

Drugs Targetting Premature Ejaculation

Clomipramine is a TCA that retards ejaculation.

Drugs Promoting Penile Circulation

Alpha blockers – Yohimbine (PROCOMIL)

Phosphodiesterase Inhibitor- Pentoxifylline (TRENTAL) promotes RBC deformability; it also prevents platelet aggregation and thrombus formation in the micro circulation.
Topical Agents- Minoxidil, glyceryl Trinitrate.


Benzodiazepines (Alprazolam – XANAX)- allay anxiety.


Papaverin is used as an intracavernosal or intrapenile injection either alone or in combination with Phentolamine or Misoprostol. It is used not only to treat impotence but also to aid diagnosis when differentiating between organic and non organic impotence.

Physical Devices

Suction devices and penile prosthetic implants are limited to only those patients with organic causes or in whom sufficient psychological management has been a failure.


Hydrocele, Varicocele and Phimosis are some causes of impotence which may be corrected surgically.

Causes and Treatment for Erectile Dysfunction - Conclusion

With the induction of KAMAGRA into the arsenal of therapy, almost all psychological based erectile dysfunction treatments have shown remarkable success. Its benefits have spilled into other organic categories as well e.g. diabetes. ‘Lucky indeed are those that are upright, nevertheless, hope for the impotent stands tall’!