Impotence

Q:  For the last three weeks, I have been unable to have intercourse with my wife because of impotence. I've been diagnosed with Lupus and am taking Cardizem, prednisone, Plaquenil, and ketoprofen. I used to drink pretty heavily but haven’t touched a drop for the last three weeks. I’d like to do something about this and would appreciate your help.

A:  In order for an erection to occur, a matrix of blood vessels in the penis must be able to sufficiently fill with blood at a pressure necessary to maintain the erection. This requires normal blood vessels and blood flow, as well as a properly functioning nervous system.

There is a multiplicity of causes for impotence and often, the identified cause may still not lead to satisfactory resolution of the problem. Although I can find no link between lupus and impotence, other problems causing blockages in small blood vessels can cause impotence including diabetes and peripheral vascular disease.

The next place to look is medications. Drugs to treat high blood pressure like Cardizem are one of the most common causes for impotence. It would be useful to check the side effect profile of all your medications for others that may cause this problem.

Alcohol use is a known cause of impotence. Spinal cord injury or other kinds of trauma to the nerves that supply the genitals may also be a factor to consider. Problems causing a decrease in the production of the male hormone testosterone can be addressed by a blood test and ought to be considered.

When these medical causes are excluded, impotence should be a considered as a response to stress or depression. The presence of early morning erections is a clue that there may be a non-medical component.

Solutions range all the way from modifications in medications, to counseling, various assistive devices, and, on occasion, surgery. You would best be best served by a visit to your family doctor who can begin the process of finding a solution.

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.