Common Causes of Impotence

Common Causes of Impotence

By Sara Ryding, B.Sc.

Reviewed by Emily Henderson, B.Sc.

This article is a repost which originally appeared on NEWS MEDICAL

Edited for content

Impotence, which is also known as erectile dysfunction, is the inability to get and maintain an erection for intercourse. While the occasional issue with impotence is not considered rare or cause for concern, persistent issues can cause severe stress and be a sign of an underlying health issue. The causes of impotence can include physical and psychological sources.

Impotence and sexual arousal

The processes around sexual arousal are complex and can be difficult to distinguish. For males, the sexual arousal process involves the brain, hormones, emotions, nerves, muscles, and blood vessels to achieve an erection.

As such, impotence can stem from any of these areas or a combination of them. For example, impotence caused by blood vessel issues can be worsened by subsequent stress and mental health concerns.

Physical causes of impotence

Vascular causes of impotence are among the most common causes of impotence. In some cases, impotence can be a symptom of progression towards cardiovascular disease. For example, impotence is common in people with atherosclerosis and can later progress into heart disease. If the veins are unable to close during an erection, this can cause impotence as it hinders the erection from being maintained. This is called veno-occlusive dysfunction.

Veno-occlusive dysfunction can be caused by the development of venous channels that drain blood from the corpora cavernosa where blood would otherwise be trapped during health erections. Veno-occlusive dysfunction can also be caused by deleterious alterations to the tunica albuginea, which would otherwise be responsible for stopping blood from leaving the penis. These alterations can occur as a result of old age, diabetes, or Peyronie’s disease. Other causes include traumatic injury, alterations to muscles around the area, and shunts that are acquired during certain surgery.

Neurological issues are another physical cause of impotence. This can occur as a result of diseases, such as Parkinson’s or Alzheimer’s disease, or due to trauma and injury. These can cause impotence by both decreasing libidos and by inhibiting the onset of an erection. In the event of spinal cord injury, the effect on impotence can depend on the nature, location, and extent of the injury. Similarly, neurological issues can be the cause of impotence in old age as sensory stimuli abate with age.

There is some evidence that hormonal issues can cause impotence. A deficiency in androgen, a hormone needed for male sexual characteristics and sex drive, can lower nocturnal erections and decrease libido. However, there is also evidence that erections in response to sexual stimulation still occur in patients with decreased hormonal activity, meaning androgen is not essential.

Psychological causes of impotence

Psychological issues were previously believed to be the main cause of impotence, and it is still considered a common cause of impotence. If the onset of impotence is sudden, this might indicate that the cause is psychological rather than physical.

Psychological issues can range from serious mental disorders, such as schizophrenia, to issues in the relationship with whom impotence occurs. The brain is a starting point for sexual arousal, and issues at this stage can be detrimental to the onset of an erection.

Mental health issues such as depression have a particularly strong link to impotence. This can be due to a lack of libido, performance anxiety, or persistent loss of interest and enjoyment. In schizophrenic people, lowered libido is the main cause of impotence. Some drugs to treat schizophrenia can increase libido, but there can still be persistent issues with erections and orgasms.

Risk factors of impotence

While the causes of impotence can be physical and psychological, there are certain lifestyle and medical factors that can increase the risk of these causes. For example, using tobacco can restrict blood flow the veins and arteries and can thus, over time, lead to vasculature issues which lead to impotence.

Age is one of the biggest risk factors in impotence. Impotence occurs in around 20-40% of older men. Studies have found that the risk of impotence rises by 10% every year in men aged 40-70 years old. The reasons for this are numerous: the penis becomes less sensitive to stimulation, hormone levels decrease, cardiovascular issues become more common, and libido naturally decreases with age.

Other risk factors include obesity, injuries that damage nerves or arteries that are involved in erections, persistent drinking, or alcoholism. Impotence can be avoided by sometimes making changes to lifestyle, such as reducing drinking and smoking but may sometimes need focused treatment. Other times, medical treatments such as radiation treatment or prostate surgery can be risk factors for impotence and may be needed to save the patient’s life.

Sources

  • Mayo Clinic. 2020. Erectile Dysfunction – Symptoms and Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776> [Accessed 26 August 2020].
  • Lue, T., 2000. Erectile Dysfunction. New England Journal of Medicine, 342(24), pp. 1802-1813.
  • Wyllie, M., 2005. The underlying pathophysiology and causes of erectile dysfunction. Clinical Cornerstone, 7(1), pp. 19-26.

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Medically reviewed by Alana Biggers, MD on May 29, 2018 — Written by Tim Jewell

This article is a repost which originally appeared on HealthLine

Edited for content

What are testes?

The testes — also called testicles — are two oval-shaped organs in the male reproductive system. They’re contained in a sac of skin called the scrotum. The scrotum hangs outside the body in the front of the pelvic region near the upper thighs.

Structures within the testes are important for the production and storage of sperm until they’re mature enough for ejaculation. The testes also produce a hormone called testosterone. This hormone is responsible for sex drive, fertility, and the development of muscle and bone mass.

Anatomy and function of testes

The main function of the testes is producing and storing sperm. They’re also crucial for creating testosterone and other male hormones called androgens.

Testes get their ovular shape from tissues known as lobules. Lobules are made up of coiled tubes surrounded by dense connective tissues.

Seminiferous tubules

Seminiferous tubules are coiled tubes that make up most of each testis. The cells and tissues in the tubules are responsible for spermatogenesis, which is the process of creating sperm.

These tubules are lined with a layer of tissue called the epithelium. This layer is made up of Sertoli cells that aid in the production of hormones that generate sperm. Among the Sertoli cells are spermatogenic cells that divide and become spermatozoa, or sperm cells.

The tissues next to the tubules are called Leydig cells. These cells produce male hormones, such as testosterone and other androgens.

Rete testis

After sperm is created in the seminiferous tubules, sperm cells travel toward the epididymis through the rete testis. The rete testis helps to mix sperm cells around in the fluid secreted by Sertoli cells. The body reabsorbs this fluid as sperm cells travel from the seminiferous tubules to the epididymis.

Before sperm can get to the epididymis, they can’t move. Millions of tiny projections in the rete testis, known as microvilli, help move sperm along to the efferent tubules.

Efferent ducts

The efferent ducts are a series of tubes that join the rete testis to the epididymis. The epididymis stores sperm cells until they’re mature and ready for ejaculation.

These ducts are lined with hair-like projections called cilia. Along with a layer of smooth muscle, cilia help move the sperm into the epididymis.

The efferent ducts also absorb most of the fluid that helps to move sperm cells. This results in a higher concentration of sperm in ejaculate fluid.

Tunica: Vasculosa, albuginea, and vaginalis

The testes are surrounded by several layers of tissue. They are the:

  • tunica vasculosa
  • tunica albuginea
  • tunica vaginalis

Tunica vasculosa is the first thin layer of blood vessels. This layer shields the tubular interior of each testicle from further layers of tissue around the outer testicle.

The next layer is called the tunica albuginea. It’s a thick, protective layer made of densely packed fibers that further protect the testes.

The outermost layers of tissue are called the tunica vaginalis. The tunica vaginalis consists of three layers:

  • Visceral layer. This layer surrounds the tunica albuginea that shields the seminiferous tubules.
  • Cavum vaginale. This layer is an empty space between the visceral layer and the outermost layer of the tunica vaginalis.
  • Parietal layer. This layer is the outermost protective layer that surrounds almost the entire testicular structure.

What conditions affect the testes?

Many conditions can affect the testes. Here’s a list of some of the most common ones.

Hydrocele

A hydrocele happens when excess fluid builds up in the cavities around one of your testicles. This is sometimes present at birth, but it can also result from an injury or inflammation.

Hydrocele symptoms include:

  • testicular swelling that gets more noticeable as the day goes on
  • a dull ache in your scrotum
  • feeling heaviness in your scrotum

Hydroceles usually don’t require treatment unless they’re very large or painful. Most go away on their own, but more severe cases might require surgical removal.

Testicular torsion

Testicular torsion means that your testicle has rotated in the scrotum. This can wind up the spermatic cord, cutting off blood supply, nerve function, and sperm transport to your scrotum.

Symptoms of testicular torsion include:

  • severe scrotum pain
  • swelling of the testicle
  • lower abdominal pain
  • feeling nauseous
  • vomiting
  • feeling like the testicle is out of place
  • urinating more than usual

Several things can cause testicular torsion, including:

  • injury to the scrotum
  • exercising too long or hard
  • being exposed to cold temperatures
  • free movement of the testicle in the scrotum caused by a genetic condition

Your doctor can treat testicular torsion by moving the testicle by hand. Some cases might require surgery to untwist the spermatic cord.

Orchitis

Orchitis refers to a swollen or inflamed testicle. Like epididymitis, orchitis often results from an infection caused by an STI.

Orchitis symptoms include:

  • testicular pain and tenderness
  • a swollen testicle
  • fever
  • feeling nauseous
  • vomiting

Both bacterial and viral infections can cause orchitis. A combination of antibiotics or antiviral medication, along with nonsteroidal anti-inflammatory drugs or cold packs can help reduce discomfort and pain. Orchitis usually disappears in 7-10 days.

Hypogonadism

Hypogonadism happens when your body doesn’t make enough testosterone. It can result from a testicular issue or because your brain doesn’t properly stimulate hormone production.

You can be born with this condition. It can also happen due to an injury, infection, or other condition that affects testosterone production.

Symptoms of hypogonadism vary depending on age:

  • In infants. The genitals might not be clearly male, or both sets of genitals might be present.
  • In teenagers. Symptoms may include:
    • a lack of muscle development
    • little body hair growth
    • no voice deepening
    • unusual arm and leg growth relative to the rest of the body
  • In adults. Symptoms may include:
    • a lack of fertility
    • loss of body hair
    • growth of breast tissue
    • loss of bone density
    • an inability to get an erection

Hypogonadism is usually treated with hormone replacement therapy. It’s aimed at either the brain or testes, depending on the source of low testosterone production.

Testicular cancer

Testicular cancer happens when cancerous cells multiply within the tissue of your testicles. It commonly starts in the tubular testicle structures that help produce sperm.

The cause of testicular cancer isn’t always clear.

Symptoms of testicular cancer can include:

  • a lump in your testicle
  • feeling heaviness in your scrotum
  • fluids in your scrotum
  • testicular pain
  • abdominal or back pain
  • swollen or tender breast tissue

Sometimes, your doctor can surgically remove the affected tissue. In other cases, you may need to have an entire testicle removed. Radiation therapy or chemotherapy can also help destroy cancer cells.

What are common symptoms of a testicular condition?

See your doctor if you notice any of the following symptoms in one or both of your testes:

  • long-term pain that’s either dull or sharp
  • swelling
  • tenderness
  • a sensation of heaviness

Other symptoms of a problem with the testes include:

  • feeling sick
  • throwing up
  • abnormal abdominal or back pain
  • having to pee frequently
  • abnormal growth of breast tissue

Tips for healthy testes

Try the following to keep your scrotum in good health:

Do a monthly testicular self-exam

Roll each testicle around in your scrotum using your fingers. Check for lumps and swollen or tender areas.

Bathe regularly

Take a shower or bath every day to keep your entire genital area clean. This reduces your risk of infections that can cause other complications. Keep your penis and scrotal area dry after bathing. Moisture trapped in the area can quickly become a breeding ground for bacteria.

Wear loose, comfortable clothing

Try to avoid wearing tight underwear and pants. Allow your scrotum to hang naturally from your body to help keep the scrotal temperature low and prevent injury.

Wear protection when you have sex

Wear a condom when doing any kind of sexual activity involving your penis. This helps to prevent sexually transmitted diseases that affect your scrotum and testicles.

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