Dr. Huntley's
Diagnosis
Checklist
Have a symptom?
See what questions
a doctor would ask.
See what questions
a doctor would ask.
Impotence is the inability to achieve and maintain penile erection sufficient to complete satisfactory sexual intercourse; ejaculation may be affected. Impotence varies from occasional and minimal to permanent and complete. Occasional impotence occurs in about one-half of adult American men, whereas chronic impotence affects about 10 million American men.
Impotence can be classified as primary or secondary. A man with primary impotence has never been potent with a sexual partner, but may achieve normal erections in other situations. This uncommon condition is difficult to treat. Secondary impotence carries a more favorable prognosis because, despite his present erectile dysfunction, the patient has completed satisfactory intercourse in the past.
Organic causes of impotence include vascular disease, diabetes mellitus, hypogonadism, a spinal cord lesion, alcohol and drug abuse, and surgical complications. Psychogenic causes range from performance anxiety and marital discord to moral or religious conflicts. Fatigue, poor health, age, and drugs can also disrupt normal sexual function.
If the patient complains of impotence or of a condition that may be causing it, let him describe his problem without interruption. Then begin your examination with a psychosocial history. Is the patient married, single, or widowed? How long has he been married or had a sexual relationship? What's the age and health status of his sexual partner? Is he feeling stress or pressure from his partner to conceive a child? Find out about past marriages, if any, and ask him about his sexual experiences with former spouses. Ask about sexual activity outside marriage or his primary sexual relationship. Also ask about his job history, his typical daily activities, and his living situation. How well does he get along with others in his household?
Focus your medical history on the causes of erectile dysfunction. Does the patient have diabetes mellitus, hypertension, or heart disease? If so, ask about its onset and treatment. Also ask about neurologic diseases such as multiple sclerosis. Obtain a surgical history, emphasizing neurologic, vascular, and urologic surgery. If trauma may be causing the patient's impotence, find out the date of the injury as well as its severity, associated effects, and treatment. Ask about alcohol intake, drug use or abuse, smoking, diet, and exercise. Obtain a urologic history, including voiding problems and past injury.
Next, ask the patient when his impotence began. How did it progress? What's its current status? Make your questions specific, but remember that he may have difficulty discussing sexual problems or may not understand the physiology involved.
Other questions that can help yield helpful data include: When was the first time you remember not being able to initiate or maintain an erection? How often do you wake in the morning or at night with an erection? Do you have wet dreams? Has your sexual drive changed? How often do you try to have intercourse with your partner? How often would you like to? Can you ejaculate with or without an erection? Do you experience orgasm with ejaculation?
Next, perform a brief physical examination. Inspect and palpate the genitalia and prostate for structural abnormalities. Assess the patient's sensory function, concentrating on the perineal area. Next, test motor strength and deep tendon reflexes in all extremities, and note other neurologic deficits. Take the patient's vital signs and palpate his pulses for quality. Note any signs of peripheral vascular disease, such as cyanosis and cool extremities. Auscultate for abdominal aortic, femoral, carotid, or iliac bruits, and palpate for thyroid gland enlargement.
Central nervous system disorders.Spinal cord lesions from trauma produce sudden impotence. A complete lesion above S2 (upper motor neuron lesion) disrupts descending motor tracts to the genital area, causing a loss of voluntary erectile control but not of reflex erection and reflex ejaculation. However, a complete lesion in the lumbosacral spinal cord (lower motor neuron lesion) causes a loss of reflex ejaculation and reflex erection. Spinal cord tumors and degenerative diseases of the brain and spinal cord (such as multiple sclerosis and amyotrophic lateral sclerosis) cause progressive impotence.
Endocrine disorders.Hypogonadism from testicular or pituitary dysfunction may lead to impotence from a deficient secretion of androgens (primarily testosterone). Adrenocortical and thyroid dysfunction and chronic hepatic disease may also cause impotence because these organs play a role (although minor) in sex hormone regulation.
Penile disorders.With Peyronie's disease, the penis is bent, making erection painful and penetration difficult and eventually impossible. Phimosis prevents erection until circumcision releases the constricted foreskin. Other inflammatory, infectious, or destructive diseases of the penis may also cause impotence.
Psychological distress.Impotence can result from diverse psychological causes, including depression, performance anxiety, memories of previous traumatic sexual experiences, moral or religious conflicts, and troubled emotional or sexual relationships.
Alcohol and drugs.Alcoholism and drug abuse are associated with impotence, as are many prescription drugs, especially antihypertensives. (See Drugs that may cause impotence.)
Surgery.Surgical injury to the penis, bladder neck, urinary sphincter, rectum, or perineum can cause impotence, as can injury to local nerves or blood vessels.
▪ Ensure privacy, confirm confidentiality, and establish a rapport with the patient.
▪ Help the patient feel comfortable about discussing his sexuality.
▪ Adopt an accepting attitude about the sexual experiences and preferences of others.
▪ Prepare the patient for screening tests for hormonal irregularities, Doppler studies of penile blood pressure to rule out vascular insufficiency, voiding studies, nerve conduction tests, evaluation of nocturnal penile tumescence, and psychological screening.
▪ Discuss counseling for the patient and his sexual partner, if the patient has psychogenic impotence.
▪ Provide interventions to treat the cause, if the patient has organic impotence.
▪ Prepare the patient for other forms of treatment such as surgical revascularization, drug-induced erection, surgical repair of a venous leak, and penile prostheses.
▪ Discuss the importance of maintaining follow-up appointments and therapy for underlying medical disorders.
▪ Encourage him to talk openly about his needs and desires, fears and anxieties, or misconceptions.
▪ Urge the patient to discuss his feelings with his partner as well as what role both of them want sexual activity to play in their lives.
Read excerpts from these other book chapters related to Male sexual symptoms:
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7 
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