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Impotence - Understanding impotence

Auteur : Docteur Marc Galiano - Date de dernière mise à jour : 3 September 2015

What is impotence?

Impotence, also called erectile dysfunction or erection failure is defined as a difficulty getting or maintaining a stiff erection. To understand impotence, you need to understand the erection mechanism.

How do erections work?

An erection requires libido, integrity of the vessels and nerves and genitals (penis, prostate and testicles). Partial or complete impairment of one of the links causes erectile disorders of varying intensity. First, sexual stimulation is necessary to trigger the secretion of messengers in the brain. These messengers will use the nerves and arteries to reach the penis.
The arteries carry testosterone, among other things, and the nerves carry many messengers, including adrenaline and acetylcholine, which pass through the spinal column to innervate the penis, passing next to the prostate. The messengers stimulate the dilation of penile arteries and allow a massive influx of blood into the corpora cavernosa. The volume of the penis increases and compresses the return veins, which prevents the blood from leaving the erectile bodies. The penis becomes larger and stiff to give a nice erection.

In the erection illustration, you will see the important steps that lead to a hard erection. Each step may be subject to a dysfunction that is secondary to an illness or drug. This dysfunction will cause erectile dysfunction.

Lets go over these different stages:

To have a stiff erection, you need:

  • Desire: depression, overwork, an argument, fear, anxiety, certain drugs (neuroleptics), or hormone treatment for prostate cancer may alter or eliminate desire.
    (neuroleptics), or hormone treatment for prostate cancer may alter or eliminate desire.
  • Intact nerves to carry information from the brain to the penis: radical prostatectomy, paraplegia or diabetes can damage or destroy these circuits.
  • A flexible, expandable penis: Peyronie’s disease, penile fracture or priapism can alter the tunica albuginea or the corpora cavernosa.

Different types of impotence:

A common sexual disorder, the different types of impotence should, nevertheless, be distinguished in order to understand the origins.
For simplicity, we can classify erectile dysfunction into two groups: erectile dysfunction which is psychogenic and that which is classified as organic.

Psychogenic erectile dysfunction.

It is evoked when disorders occur suddenly, most often after mental fatigue or psychological trauma (death in the family, unemployment, divorce, etc.) and /or when a failure only occurs in certain situations (new partner, lights on, etc. ). In the case of psychogenic erectile dysfunction, morning erections always or almost always continue. In this context, a consultation with your GP or a specialist allows a quick diagnosis and often helps identify the cause responsible for the sexual failure. The problem can then be solved quickly, sometimes through psychological counselling.

Organic erectile dysfunction.

It is evoked when disorders occur gradually, in no particular psychosocial context. In the case of organic erectile dysfunction, morning erections are often less robust. In this context, the opinion of a specialist is recommended.

Sometimes the two situations are intertwined. Erectile dysfunction is then called “complex”, and the advice of a specialist is essential.


Doctor Marc Galiano


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