Panel Urges Discussion of Impotence

Effective therapies exist to treat impotence but access to them is hampered by the reluctance of physicians and patients to discuss the topic, a federal advisory panel said Wednesday.

Impotence afflicts an estimated 30 million American men, although accurate figures are difficult to obtain because many people are too embarrassed to discuss the problem, said a committee of outside experts convened by the National Institutes of Health.

The committee reached its conclusions after a three-day NIH-sponsored “consensus” conference, one of numerous meetings that take place each year to discuss--and reach agreement on--a variety of medical issues. The goal is to improve communication between medical researchers and practicing physicians. Reports from these conferences are widely disseminated among health professionals.

Impotence, the inability to achieve and maintain an erection sufficient to have sexual intercourse, can result from physical or psychological problems, or both, the committee said.

The most common physical conditions include diabetes, vascular disease, hypertension, neurological disorders, prescription medicines and illegal drugs. Psychological factors include depression, anxiety, loss of self-esteem and relationship problems.

Cigarette smoking can contribute to the problem by worsening the effects of other conditions, such as vascular disease and hypertension.

Although the problem grows worse with age, men should not believe the myth that impotence is an inevitable consequence of aging, the panel said.

Panel members urged physicians to obtain detailed sexual histories of their patients and recommended open discussions with patients about the problem. They also called for human sexuality courses to be added to medical education and for more overall public discussion about the problem, such as public service announcements and lectures.

Further, the panel suggested that the term “impotence” be discarded in favor of “erectile dysfunction” because impotence has “the connotation of powerlessness,” said Dr. Michael Droller, chairman of the urology department at Mt. Sinai Medical Center in New York City, who served as panel chairman.

“Impotence implies weakness,” Droller added. “It’s not a weakness at all.”

Psychological therapy can be valuable, the panel said, even if the cause is physical. Such treatment “may be useful in relieving depression and anxiety as well as improving sexual function,” the committee said.

Of the available therapies, the panel recommended trying the “least invasive” procedures first. Treatment includes increasing the flow of blood to the penis and the use of penile prostheses.

Therapies that increase blood flow include injections with certain drugs that dilate blood vessels in the organ and the use of external constriction devices, in which a vacuum pump is used to create an erection. The latter devices are effective in most patients and have relatively few side effects, the panel said.

Vascular surgery, another method used to increase blood flow, involves a bypass operation to route blood to the penis past blocked arteries. However, the panel said that patients considering this procedure should find a research setting with a surgeon experienced in the technique.

Penile prostheses, or implants, which can be rigid, malleable or inflatable, are also available “for selected patients who fail or refuse other forms of therapy,” the panel said.