Impotence is the difficulty in getting a proper erection enough to enjoy intercourse. The reasons for not getting a proper erection may be:
- Vasculogenic: The blood supply is compromised as in case of a diabetic patient.
- Neurogenic: The nerve supply to the penis is compromised.
- Psychogenic: eg: secondary to stress OR
- Combination of all of the above.
Assessment involves detailed history and proper examination. Nowadays we also do a Viagra test (The patient is examined after one hour of taking Viagra orally).When necessary Intrapenile injection test and Colour Doppler test are done.
80% of these problems can be handled with counseling and medication. If these fail, then a penile implant surgery can be carried out.
Male causes for infertility are various :
- Oligospermia (less number of sperms)
- Azoospermia (No sperms seen in semen): Azoospermia is of two types – Un obstructive Or Obstructive
- Low motility sperms.
Diabetic patients present with either erectile dysfunction, or Peyronie’s disease (bending of erect penis to one side or painful erection) or Retrograde Ejaculation. Diabetic patients are likely to get these problems more often than the general population. A detailed history, examination and Doppler test or intrapenile injection test are carried out to assess these patients. Treatment for these problems may vary from medical to surgical treatment.