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Question
Posted by: micksmixxx | 2003/01/23

Impotence

Greetings CyberDoc,

Is there any hope for me? I'm Diabetic (and have been for over 20 years, now) with various complications, such as Peripheral Neuropathy and Proliferative Retinopathy. I've been impotent since the age of 27 (I'm now 44), which, you no doubt, appreciate, took me a while to confide in a doctor. Unfortunately, the first doctor that I told, laughed, believing that I was joking. He did apologise later, when he realised that I was serious, but it was too late, the damage was done. I couldn't bring myself to speak to anyone else about it for a couple of years. I referred myself to a psycho-sexual counsellor, having been in a position to do so by way of my job as a Social Worker. (I believed, initially, that my problem may have been stress related.) After various sessions with the counsellor, she felt that I was not suffering from stress, but did write to my G.P. (doctor) asking him to try me with a course of 'B' vitamins. This, of course, did not remedy the situation.

My G.P. very kindly wrote to a Genito-urinary specialist at the local hospital about my problem. After various courses of treatment, including Papavarine Sulphate injections, Muse tablets, and Viagra tablets, I have come to the conclusion that it needs something else.

During the investigations via the Genito-urinary specialist, it was found that I have 'leaking' blood vessels. An offer was made for me to receive an operation in an attempt to repair the blood vessels. After two years of waiting, I got a little fed up of waiting and spoke to the secretary of the specialist, wishing to know how much longer I'd have to wait. It turned out that I'd actually been removed from the waiting list, without being informed of this. I arranged to see the specialist, who informed me that I was removed purely for the reason of the risks involved with infection and diabetes control. As you can imagine, I wasn't too happy about this.

At the moment I'm using a vacuum therapy device, which I do not feel is doing an adequate job. I'm using progressively tighter and tighter constriction rings, so tight, in fact, that they're agonising to remove.

I'd just ask your opinion on whether there are any other routes that I could try.

Thank you for your time and expertise.

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Our expert says:
Expert ImageCyberDoc

Mick, there are still some options available to you including drugs like Uprima® (apomorphine), repairing the defect and of course a penile prosthesis
FYI:
· Another oral drug called Vasomax (phentolamine) is still being tested, but it does not seem to have the effectiveness of Viagra with a 40% response in men tested. At higher doses, a lowering of blood pressure may be problematic.
· All of the oral drugs have different modes of action and if one does not work, the others may. Combinations of drugs, (e.g. Viagra and ?) and other techniques may also be possible.
· In recent European studies, a new injectable drug called VIP is being tested. VIP stands for vasoactive intestinal peptide. When mixed with phentolomine (Regitine), an older injectable drug, 80% of men had successful erections, even if they had failed other injectables. Studies are underway in the US.
· Two other injectables being researched abroad are called moxislyte and forskolin Initial success rates of 80% are being reported. No US studies are yet completed.
· North American studies of creams containing nitroglycerin that are applied to the penis have shown modest success in mild to moderate erectile dysfunction. Plans to study this drug in the US are planned.
· South American studies of creams containing prostaglandin (Alprox-TD) that are applied to the penis have shown modest success in mild to moderate erectile dysfunction. No plans to study this drug are planned in the US for now.
Good luck.

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