Are the nerves in my penis damaged?
Impotence due to diseases
Diseases such as diabetes or cardiovascular diseases but also nerve disorders can be the cause of impotence.
Impotence from nerve diseases & injuries
In order for an erection to occur, nerve signals must be sent from the brain to the penis.
The signals are conducted via nerve tracts that run from the brain over the spinal cord, from which they emerge at about the level of the sacrum. Then they run together with the blood vessels as a so-called vascular-nerve bundle behind the bladder and prostate (prostate gland) to the penis. At every station on the long way there can be disturbances and interruptions in the signal transmission, which impair the erectile function.
Signal transmission error
The first problems can already arise in the "control center" when the corresponding nerve centers in the brain are damaged. This can happen through pathological changes, for example through strokes, multiple sclerosis, Parkinson's disease, but also tumors and inflammations.
There are other problems with signal transmission when the nerves that transmit it are interrupted. This is the case, for example, with paraplegia when the nerve tracts are severed or torn out as a result of an accident.
Degenerative diseases such as a slipped disc or diabetes mellitus can also hinder the transmission of impulses. Excessive and permanently increased alcohol consumption plays a significant role in this context. It attacks the nerves in the brain and spinal cord and especially damages the nerve endings.
Another possible cause is that nerve tracts were injured during an operation, for example when the rectum (rectum or sigmoid surgery) or, in cancer patients, the prostate was removed.
Impotence from penile injuries
In addition to the nerve impulses from the brain, an intact penis and functioning cavernous bodies are necessary for an erection. Injuries in this area can prevent the penis from stiffening. For example, erectile tissue or nerves in the genital area can be permanently damaged in the event of a penile fracture, accidents, cuts or blows.
Cardiovascular diseases such as high blood pressure, hardening of the arteries (atherosclerosis) or heart rhythm disorders are often associated with erectile dysfunction.
A large US study found:
Around 39 percent of the men studied who were taking medication for cardiovascular disease had severe erectile dysfunction (Massachusetts Male Aging Study, Journal of Urology, 1994). The researchers also found that many risk factors for cardiovascular disease and ED are the same - including smoking and obesity.
Penis is "at risk of calcification"
Potency problems are often the first indication that the cardiovascular system is damaged. Because the fine plexus of veins in the penis is particularly "at risk of calcification": If a tough layer of plaque made of blood lipids and other substances is deposited on the inner walls of the blood vessels (atherosclerosis), these are no longer able to expand and the erection remains out.
Another potential cause of potency problems is certain cardiovascular medications. For example, beta blockers, which are prescribed to lower high blood pressure, can prevent an erection in individual cases.
Fear for the heart as a pleasure killer
The psyche also contributes to the disturbed love life: Many cardiovascular patients fear that they will overtax the weakened pumping organ during sex. Most of the time, however, this concern is unfounded, as sexual activities do not place excessive stress on the heart and circulation. If you can climb stairs at a normal pace without getting out of breath, you don't need to worry.
Less fit men with heart problems should gently get their circulation going again. Overall, while sudden intercourse deaths are extremely rare, fear can be a significant obstacle to sexuality. Anyone who has had a heart attack may find a pleasurably increased pulse threatening.
The World Health Organization estimates that more than 150 million people worldwide suffer from diabetes. For Austria, the estimates go up to 600,000 people affected - many of whom do not even know about their illness.
Erectile dysfunction (ED) is one of the most common sequelae in men.
Diabetics not only have erectile dysfunction more often than non-diabetics, the first dropouts also tend to occur at a younger age. The likelihood of problems with potency increases in diabetics with the duration of the illness, the age and the extent of the consequential damage. As for the numbers, studies come to different results: Between 30 and 50 percent of affected men are said to suffer from erectile dysfunction.
Destructive blood sugar
Especially long-term elevated blood sugar levels endanger potency. The sugar molecules are deposited on the walls of the blood vessels and lead to the destruction of the outer cell layers. Because of the inflammation that this triggers, the blood vessels constrict, there is no longer enough blood to flow into the erectile tissue and the penis remains flaccid.
The nerve cells can also suffer from the increased sugar levels because they are not supplied with enough blood. The sugar molecules also attach themselves directly to the nerve endings. The result: the erection-triggering signals from the brain are not passed on and an erection does not occur. In addition, many diabetics suffer from high blood pressure and take so-called beta blockers. These drugs are also known to cause erectile dysfunction in individual cases.
++ More on the topic: Drugs as a cause of ED ++
ED therapy for diabetes
The best protection against diabetes-related ED is of course a long-term, well-controlled blood sugar - which is not the case with many diabetics. Potency disorders as a result of diabetes can initially be treated with medication. However, if the nerve tracts and blood vessels are already severely damaged, the only remaining therapeutic measure is surgical intervention, for example the implantation of a mechanical erectile tissue.
++ More on the topic: penile prosthesis ++
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Jochen Niehaus (doctor), NetDoktor.at
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