Lack of libido and erectile dysfunction (Impotence)

Lack of libido is a loss of sexual desire leading to erectile dysfunction. Erectile dysfunction (ED) may be psychological, neurogenic, vascular, endocrine or related to drugs and often includes contributions from several causes.

ED is a common symptom in hypogonadism, but most patients with ED have normal hormones and many have no definable organic cause. The endocrine causes are those of hypogonadism and can be excluded by normal testosterone, gonadotrophin and prolactin levels, and the presence of nocturnal emissions and frequent satisfactory morning erections makes endocrine disease unlikely.


Vascular disease is a common aetiology, especially in smokers, and is often associated with vascular problems elsewhere.

Autonomic neuropathy,most commonly from diabetes mellitus, is a common partial, if not total, identifiable cause .

Many drugs can also produce ED .

The patient is assessed for any physical disease, related symptoms, stress and psychological factors, together with drug and alcohol abuse.

Psychogenic impotence is frequently a diagnosis of exclusion, though complex tests of penile vasculature and function are available in some centers.

Causes of Erectile Dysfunction:

Physiological
Neonatal
Pubertal
Old age

Hyperthyroidism
Liver disease

Oestrogen-producing tumours (testis, adrenal)

Human Chorionic Gonadotrophin producing tumours (testis, lung)

Starvation/ re feeding

Carcinoma of breast

Drugs

Oestrogen Producing

Oestrogens
Digoxin
Cannabis
Diamorphine

Anti-androgens

Spironolactone
Cimetidine
Cyproterone

Treatment of Erectile Dysfunction:

Offending drugs should be stopped. Phosphodiesterase type-5 inhibitors (sildenafil or Viagra, tadalafil, vardenafil) which increase penile blood flow are usually first choice for therapy. Other treatments include apomorphine, intracavernosal injections of alprostadil, papaverine or phentolamine, vacuum expanders and penile implants.

If no organic disease is found, or if there is clear evidence of psychological problems, the couple should receive psychosexual counselling.