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Impotence: Causes, Treatments and Prevention

Sexual Problems in Men: Types of erectile dysfunction, ranging from impotence (inability to maintain an erection) to difficulty achieving an erection. The causes of this condition include physical, psychological, hormonal factors and relationship problems.

Impotence: Causes, Treatments and Prevention Impotence: Causes, Treatments and Prevention

Sexual desire is an aspect that varies throughout life in both men and women. These variations are related to events such as the beginning or end of relationships, pregnancy, menopause, andropause, diseases and the use of medications.

Symptoms of decreased sexual desire:

Symptoms that indicate a decrease in sexual desire can be identified, including: A significant reduction in interest in having sexual relations, which also affects masturbation. Concern about lack of sexual appetite. Absence of sexual fantasies or motivations.

Causes of decreased libido:

The causes of decreased or absent libido can be diverse and can be classified into four main categories.

  • Physical causes: Pain during sexual intercourse, which can lead to an aversion to the sexual act. Surgical interventions that affect the genital organs or breasts, which can influence self-image and sexual function. Diseases, such as cancer, diabetes, arthritis, and neurological diseases. Medications, including antidepressants and others that can impact libido. Daily routine, such as excessive alcohol consumption, stress and fatigue, which can affect sexual desire.

  • Psychological causes: Depression and anxiety. Traumatic sexual experiences. Self-esteem problems. History of mistreatment or sexual abuse.

  • Hormonal causes: Menopause, which leads to decreased libido due to decreased estrogen levels and vaginal dryness. Pregnancy and breastfeeding, which can cause hormonal changes and fatigue.

  • Andropause in men.

  • Relationship problems: Conflicts and lack of communication in the relationship. When to seek help from a specialist: If lack of sexual desire becomes a concern, it is recommended to seek the assistance of a professional. In many cases, this situation can be resolved with appropriate advice.


Definition of low libido in men:

Libido refers to the desire to experience sexual pleasure. Low libido in men means lack of interest in sexual pleasure. Several types of decreased libido can be identified, such as primary, secondary, generalized and situational lack of desire.

Causes of low libido in men:

The causes of low libido in men can be varied and multifactorial, including physiological, psychological, toxic factors and debilitating diseases. Some common causes include age, testosterone deficiency and related disorders, psychological factors, relationship problems, systemic diseases, the use of certain medications, and multifactorial factors.

Relationship between sexual appetite and erectile dysfunction

It is very common for low libido to be accompanied by other types of sexual dysfunction. For example, it is typical for men with erectile dysfunction to suffer secondarily a decrease in their libido. And, conversely, it is also common for men who suffer from decreased libido for any reason to suffer secondary erectile dysfunction.

Relationship between testosterone and libido

From a hormonal point of view, testosterone plays a central role in maintaining normal sexual function, especially in men. It is the hormone responsible for male sexual characteristics such as beards and greater musculature than women and also for greater sexual appetite. As expected, testosterone decreases with age, which explains, in part, the progressive decline in sexual appetite that men suffer physiologically.

Relationship between general health, cardiovascular health and libido

It is obvious that a poor state of general health is counterproductive for sexual appetite. Men who do not take care of their diet, do not exercise and do not rest well, among other factors, are more likely to suffer from sexual problems. At this point, cardiovascular health is especially important since the erectile capacity of the penis depends largely on its correct functioning.

Psychological and couple health

Sexual function is clearly linked to the emotional state and the complicity and health of the couple's relationship. When there are relationship problems, sexual appetite suffers and it is worth focusing on this factor since it can provide great benefits in exchange for a small effort.

How is lack of libido studied?

Before performing any test or recommending a "blind" treatment, a detailed clinical assessment by a doctor who is an expert in the subject is necessary.

Urological clinical interview

In clinical practice, the first thing to do is to conduct an interview with the patient and perform an in-depth physical examination in search of the following details:

Chronology of the problem: when it started, see if it has progressed or if it has evolved very quickly. For example, when the onset of the problem has been very sudden, it is common for it to be a problem of "situational anxiety", a relationship problem or another emotional-psychological problem.

Risk factors for any of the aforementioned causes:

Illnesses, taking medications or drugs, general state of health, etc. Validated questionnaires specific to sexual function: these questionnaires help us objectively and systematically detect and assess sexual desire to ensure that we do not forget any details. The ones we use the most are the "International Index of Erectile Function (IIEF)", the "Sexual Health Inventory for Men (SHIM, or IIEF-5)" and the "Sexual Arousal, Interest, and Drive Scale (SAID)".

Assessment of emotional, interpersonal and relationship conflicts:

It is one of the most forgotten when, in reality, it is one of the most frequent causes and can also be treated effectively through psychotherapy.

Physical exploration

At the level of the physical examination we look for the following details of interest: Presence of pulse in the femoral arteries that points towards a vascular problem such as an atheromatous plaque that prevents correct blood flow to the penis.

Penis assessment

Looking for lesions suggestive of Peyronie's disease.

Loss of male sexual characteristics

Such as beard reduction, increased breast size or small testicles that indicate a testosterone deficiency. Evaluation of the cremasteric reflex (raising of the testicle when stroking the inner thigh) to check the integrity of the neurological center of the erection. Simply with this clinical assessment we can determine the cause of the problem in practically 100% of cases. From here, the tests considered necessary are requested to confirm the cause and decide the best treatment.

What tests should I have to study reduced libido?

Blood test

First, it will be necessary to perform a basic health analysis that includes glucose, lipids (cholesterol, triglycerides), blood count, and a basic metabolic study to evaluate kidney and liver function. Secondly, it is also essential to study sexual hormones. Initially, at least total testosterone and, if its deficiency is confirmed, extend the study with gonadotropins (FSH and LH). Finally, depending on the patient's suspicion and history, it may be necessary to study other hormones, mainly thyroid hormones and prolactin or other more specific analytical parameters. Other tests Since reduced libido may be secondary to previous erectile dysfunction or an ejaculation disorder, tests aimed at studying these other problems may also be necessary: Nocturnal penile tumescence test. Ultrasound of deep penile arteries. Angiography of penile arteries.

How is it treated?

As always, the ideal is to go to the root of the problem so the treatment of lack of sexual appetite depends on the cause.

Low libido of psychological origin

Treatment consists mainly of psychotherapy aimed at treating the underlying problem: anxiety, depression, etc. And also couples psychotherapy.

Testosterone deficiency (hypogonadism)

If the problem is testosterone deficiency, the first thing is to detect if this is due to a potentially curable problem. If not, the start of testosterone supplements should be considered with the help of an endocrinology specialist. Like for example, Nat-SX from Espadiet.

Drugs or drugs

When the problem is of toxic origin, we must assess the risk/benefit of withdrawing or maintaining the drug in question. Of course, if it is drugs, we will recommend stopping their use categorically. But unfortunately, in the case of opiates or antidepressants, we cannot always withdraw the medication. In these cases we must talk to the doctor who prescribes these drugs and study whether they can be withdrawn, the dose reduced or changed to an alternative without effects on libido. Other general health problems Regardless of the cause, improving the general state of health is always beneficial for sexual appetite. The basic recommendations are to take care of your diet and night's rest, exercise and, as far as possible, reduce stress.

Are there any long-term risks?

There is no direct risk as such, but there are related problems. For example, on a psychological level, you can fall into a vicious circle in which depression causes loss of libido and this closes the circle, making the depression even worse. On the other hand, at a hormonal level, if the origin of the problem is a testosterone deficiency, this can cause alterations in other organs and systems such as osteoporosis, loss of psychological well-being or increased cardiovascular risk.

Does loss of sexual appetite affect fertility?

Although it does not have to affect long-term fertility, it is obvious that the lack of sexual appetite limits the opportunities to have a sexual encounter and therefore to produce offspring. On the other hand, it must be taken into account that the impact on fertility does not depend on one's libido but on the underlying cause that generates the problem. For example, if the reduction in libido is due to a small emotional conflict, it will be resolved without major problems. However, if it is due to a severe testosterone deficiency or another debilitating disease, fertility could be irreversibly affected.

When should I consult the doctor?

In the event of any decrease in libido that affects your quality of life, especially if there is no clear trigger.

How can I increase my sexual desire?

First of all, I advise you to consult a urologist to assess the origin of the problem. Eliminating it from the roots will be the best way to increase your sexual desire. On the other hand, if you don't have any detectable problem, my advice is that you go to a sexologist.

Is there any natural treatment?

On a medical level, a natural treatment that improves libido and that has proven effective in scientific studies is Nat-SX from Espadiet.


Erectile dysfunction: causes, diagnosis and treatment



I will tell you what it is and when it is considered a disorder, types of erectile dysfunction and causes that cause it, how it is diagnosed and how it is studied at a medical level, at what age it starts, how it is treated and how it is prevented, as well as other frequently asked questions. Erectile dysfunction, also known as " impotence ," is a condition in which a man experiences difficulty achieving and maintaining an erection firm and long enough for satisfactory sexual intercourse. It is considered a disorder when this difficulty occurs repeatedly and persists over time. Isolated episodes of erection difficulty, known as "triggers," are not considered erectile dysfunction, as they are common and usually resolve on their own without major repercussions.

There are several types of erectile dysfunction:

  • Impotence coeundi: inability to maintain an erection during intercourse.

  • Impotence erigerandi: inability to achieve penile erection.

  • Impotence generadi: inability to procreate even if penetration is achieved.

  • Psychological impotence: when the erection problem is due to psychological causes.

Erectile dysfunction is not defined quantitatively, but qualitatively, and is classified according to the severity of the problem: Possibility of achieving an erection on some occasions, but not consistently. Possibility of achieving an erection, but not for the time necessary to maintain a satisfactory sexual relationship. Possibility of achieving an erection, but not firm enough for penetration. Inability to achieve an erection on most or all occasions.

The causes of erectile dysfunction are diverse and may be related to factors such as age, cardiovascular diseases, diabetes, cardiovascular risk factors (hypertension, smoking, sedentary lifestyle, alcohol, etc.), kidney or neurological diseases, psychosocial factors (depression, stress, relationship problems), drugs, recreational drugs, endocrine diseases, sleep disorders, among others. In particular, some medications can cause erection problems, and it is estimated that up to 25% of erection problems are caused by drug treatments. The likelihood of developing erectile dysfunction increases with age, and your risk increases significantly after age 40. However, erectile dysfunction can be temporary or permanent, depending on its cause.

Diagnosing erectile dysfunction involves an in-depth clinical evaluation, including a medical interview, physical examination, and blood tests to evaluate hormonal and cardiovascular factors. Additionally, nocturnal penile tumescence testing, penile artery ultrasound, and other specific tests may be performed as needed.

Treatment of erectile dysfunction depends on the underlying cause. This may include correction of general health problems, treatment of hypogonadism (testosterone deficiency), psychological therapy, lifestyle modifications, medications such as phosphodiesterase-5 inhibitors, local treatments or mechanical devices, and in severe cases, surgery. To prevent erectile dysfunction , steps should be taken to maintain good cardiovascular health, including exercising regularly, maintaining a balanced diet, avoiding tobacco and excess alcohol, controlling risk factors such as hypertension and diabetes, and reducing stress.

Partner support is essential in the treatment and management of erectile dysfunction, and there are different treatment options in cases of erectile dysfunction in patients with diabetes.

As for natural treatments , the effectiveness of certain supplements and herbs has been studied to improve erectile function. Some that have shown positive results include Nat-SX, DHEA, L-Arginine, ginseng, and propionyl-L carnitine.



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