The causes and management of impotence

Sexual impotence in man

An analysis as to etiology and complaints of 486 cases of male sexual impotence was performed and is presented. Psychological factors are dominant in 68%. Physico-organic or iatrogenic causes accounted for deviations in 26% of the patients examined. Educational factors took an important part mainly in ejaculation disturbances. Primary anejaculation as a consequence of educational flaws occurred in 15% of the patients. Erection disturbances were often the consequence of physico-organic affections. The loss of libido was a real complaint in 19% of the patients.

Serum and urinary levels of pituitary--gonadal hormones in insulin-dependent and non-insulin-dependent diabetic males with and without neuropathy

Diabetic neuropathies were studied in 100 insulin-dependent diabetes mellitus patients, 314 non-insulin-dependent diabetes mellitus patients with and without an objective evidence of neuropathy (age span, 15-80 years; duration of diabetes distributed over 1-33 years), and their age-matched nondiabetic controls. Serum and urinary levels of pituitary-gonadal hormones were evaluated in the diabetic subjects. There were striking results, i.e., a significantly low serum total and serum free (urinary) testosterone level (p < .0005) and a significantly high serum and urinary FSH and LH and serum prolactin level (p < .0005), specifically in the neuropathic diabetic patients, suggesting a series of pathological reactions in the smooth musculature of genital organs characterized by an increase in the interstitial thickness of seminiferous tubules, peritubular and intertubular fibrosis, and tubular sclerosis. Testicular necrosis, probably due to neuropathy, provided an additional aid to confirm these findings. A decrease in semen volume and sperm motility in the diabetic neuropathic patients further suggested the involvement of the entire smooth musculature of the reproductive tract, leading to atonia of the bladder and urethra. Such complications are purely neurogenic. The low serum and urinary testosterone levels and increased serum and urinary FSH and LH and serum prolactin levels in the diabetic men with neuropathy suggest gonadal disorder (hypogonadotropic hypogonadism), which may be due to testicular necrosis and thickening of seminiferous tubules, causing autonomic lesion.

The correlation of increased serum prolactin levels with decreased sexual desire and activity in elderly men

Serum prolactin levels and sexual function were evaluated in 28 men from 60 to 64 years of age and in 44 men from 65 to 70 years of age. All subjects were married, physically healthy, and had no psychopathology or marital problem. About a third of the men aged 60 to 70 years suffered from impotence. No obvious correlation between elevated levels of serum prolactin and impotence was obtained. Subjects aged 65 to 70 who had decreased libido exhibited a significant elevation of serum prolactin levels, while subjects of the same age group who had reserved (normal) libido appeared to have low serum prolactin levels. Nine of ten men aged 60 to 70 years with serum prolactin levels above 40 ng/ml reported decreased libido. Potent men of both age groups (60-70 years) with high prolactin levels showed a tendency to have a decrease in frequency of sexual intercourse. Thus, it seems that mild hyperprolactinemia in aging men may be associated with decreased sexual desire and frequency of sexual activity.

Pituitary gonadal function in diabetic male patients with and without impotence

Assessment of pituitary function was undertaken in diabetic male patients with and without impotence, and in normal subjects, using a combined gonadotropin releasing hormone (GnRH) and thyrotropin releasing hormone (TRH) test. Basal plasma levels of testosterone, gonadotropins, PRL and TSH were similar in the diabetic patients and controls. Following the administration of I.V. GnRH 150 microgram and TRH 500 microgram, diabetic patients with impotence demonstrated a lower LH response at 30 and 150 minutes and an increased PRL response at 20 minutes, which was statistically significant when compared to controls. FSH and TSH were similar in the diabetic patients and controls. The GnRH and TRH test was repeated in impotent diabetic patients while receiving 0.8-1 mU/kg/hr of insulin through an infusion pump. No difference in LH and PRL response could be demonstrated. These results demonstrate that following GnRH and TRH test, diabetic patients with impotence have a significantly different LH and PRL response than controls. In these patients acute control of hyperglycemia using an insulin infusion pump did not reverse the abnormal response.

Circadian variation in plasma prolactin, gonadotropins, and testosterone in diabetic male patients with and without impotence

The circadian variation in plasma levels of prolactin, gonadotropins, testosterone, and glucose were studied in 10 young diabetic male patients. Four patients were asymptomatic without sexual dysfunction and six patients had organic impotence. The results of this study indicate that diurnal levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone are similar in diabetic patients with and without impotence. During the nocturnal period, a sleep-related increase in plasma prolactin levels was noted in diabetic patients without impotence. In diabetic patients with impotence, plasma prolactin levels were similar during the diurnal and nocturnal periods. These results further support previous findings that diabetic patients with organic impotence do not have abnormal gonadotropin and testosterone levels.