MALE REPRODUCTIVE PROBLEM

1. MEDICAL SURGICAL NURSING-1
TOPIC: IMPOTENCE
Prepared by: SEIF SAID KHALFAN
(BSc.N STUDENT)

2. Nursing management of patients
(adults including elderly) with Male
Reproductive problems.

3. IMPOTENCE
Definition
Impotence, often called erectile dysfunction(ED), is
the inability to achieve or maintain an erection of
penis long enough to engage in sexual intercourse.
This problem may not cause much concern when
occurring intermittently. However it may affect a
relationship negatively and break a person’s self
confidence when the condition tends to be
ongoing.

4. CAUSES/PREDISPOSING FACTORS
Physical causes
There are four main types of health conditions
that can cause physical problems resulting in ED.
These are vasculogenic, neurogenic, hormonal
and anatomical.
Vasculogenic – conditions that affect the flow of
blood to the penis.

5. • Examples of vasculogenic conditions that can
cause ED include:
cardiovascular disease –such as atherosclerosis
(hardening of the arteries), high blood pressure
(hypertension)
diabetes – This can affect both the blood supply
and the nerve endings in the penis.

6. Neurogenic – conditions that affect nervous
system, which is made up of brain, nerves and
spinal cord .
• Examples of neurogenic conditions that can
cause ED include:
Multiple sclerosis (MS) a disease which causes
demyelination of the brain and spinal cord
nerve cells.

7. E.g. cont..
• Parkinson’s disease – a condition that affects
the way that the brain coordinates body
movements, including walking, talking and
writing
• a spinal injury or disorder
• a stroke – a serious medical condition that
occurs when the blood supply to the brain is
interrupted

8. Hormonal – conditions that affect hormone levels
Examples of hormonal conditions that can cause ED
include:
• hypogonadism – a condition that affects the
production of the male sex hormone,
testosterone, causing abnormally low levels
• an overactive thyroid gland (hyperthyroidism) –
where too much thyroid hormone is produced

9. • an underactive thyroid gland (hypothyroidism)
– where not enough thyroid hormone is
produced
• Cushing's syndrome – a condition that affects
the production of a hormone called cortisol

10. •Anatomical – conditions that affect the
physical structure of the penis .Example
Peyronie's disease, which affects the tissue of
the penis, is an example of an anatomical
condition that can cause ED.

11. Medicinal causes
In some men, certain medicines can cause ED, including:
• diuretics – medicines that increase the production of
urine and are often used to treat high blood pressure
(hypertension), heart failure and kidney disease
• antihypertensive – medicines, such as beta-blockers,
that are used to treat high blood pressure
• fibrates – medicines that are used to lower cholesterol
levels

12. • antipsychotics – medicines that are used to
treat some mental health conditions, such as
schizophrenia
• antidepressants – medicines that are used to
treat depression and some types of pain

13. Psychological causes
Possible psychological causes of ED include:
• depression – feelings of extreme sadness that
last for a long time
• anxiety – a feeling of unease, such as worry or
fear

14. There are many emotional issues that may also
affect your physical ability to get or maintain an
erection. These include:
• relationship problems, such as being unable to
talk openly about any problems that you have
• lack of sexual knowledge
• past sexual problems
• past sexual abuse being in a new relationship

15. Signs and Symptoms of impotence
Impotence manifests differently in different
individuals. You may find you are unable to
achieve an erection at all, or you may be able to
achieve an erection, but only briefly.
Common symptoms of impotence include:
• Inability to achieve an erection
• Inability to maintain an erection

16. If the dysfunction:.
• Develops gradually and persistently, there is
probably a physical cause; this is generally the
case with chronic impotence.
• Develops abruptly but you still have early-
morning erections and are able to have an
erection while masturbating, the problem is
likely to have a psychological component,
perhaps with an underlying physical factor.

17. Pathophysiology
Under normal circumstances, when a man is
sexually stimulated, his brain sends a message
down the spinal cord and into the nerves of the
penis. The nerve endings in the penis release
chemical messengers, called neurotransmitters,
that signal the corpora cavernosa (the two spongy
rods of tissue that span the length of the penis) to
relax and fill with blood. As they expand, the
corpora cavernosa close off other veins that would
normally drain blood from the penis.

18. As the penis becomes engorged with blood, it
enlarges and stiffens, causing an erection. Problems
with blood vessels, nerves, or tissues of the penis
can interfere with an erection. As can be
understood from the mechanisms of a normal
erection, impotence may develop due to hormonal
deficiency, disorders of the neural system, lack of
adequate penile blood supply or psychological
problems.

20. DIAGNOSTIC MEASURE
• Clinical interview to explore the nature of the
problem, sexual behaviors and attitudes,
relationship with a partner, personal and family
history, psychiatric history and current therapy or
medication.
• Physical assessment including examination of
penis, testis, prostate and seminal vesicles,
neurological examination, vascular examination.
• Blood screen for evidence of endocrine
imbalance, diabetics mellitus, renal failure

21. • Assessment of penile blood flow by Doppler
study and angiography
• Assessment of neurogenic factors by
monitoring nocturnal penile
tumescence(NPT),response to visual erotic
stimuli, assessment of autonomic nerve
function and neurological studies
• Psychological testing.

22. Treatments for Impotency
Impotence is one condition which can be
treated successfully provided a person is ready
to discuss the problem with the health expert.
Most of the males feel embarrassed while
discussing the problem with the expert and feel
that the condition is untreatable. However, the
fact is various advance treatments are available
that treat the condition successfully.

23. Medication treatment
Viagra is one of the most widely used medications
for treating erectile dysfunction. It starts working
effectively within an hour and remains effective for
3 to 4 hours. Cialis and Levitra are two other
medications which are recommended by health
experts. It is necessary to consult with experts
before taking the medication and they should be
taken in the manner as prescribed by them.

25. Vacuum pump treatment
A vacuum pump or penis pump is a hollow tube
having battery-powered or hand-powered pump.
After placing the tube over the penis, pump is used
for sucking out the air inside the tube. This will help
in creating a vacuum which pulls blood into the
penis. At the base of the penis, a ring is applied on
temporary basis to hold the blood. This further
helps in sustaining the erection.

27. Psycho sexual therapy
It is believed that in 90% of cases, psychological
factors are responsible for causing impotency. In
such situation, seek the help of experienced
counselor or therapist.

28. Hormone treatment
Hormonal problems rarely cause impotency.
Reduced level of male hormone testosterone is
one of the common hormone abnormalities
which can be restored with hormone
replacement therapy. It is advised that if the
tests confirm deficiency in male sex hormone
testosterone, then only the therapy should be
taken.

30. Penile prosthesis treatment
This is one of those forms of treatments which
are opted when other forms of treatments have
been tested and tried. This is also called as
penile implants. In this, semi rigid rods are
placed within the penis surgically. Penis remains
rigid all the time. It can bend downwards when
a person is not having sex.

32. NURSING MANGEMENT
1) Sexual dysfunction
Assess client's sexual history and previous level
of satisfaction in sexual relationship. Assess
client's perception of the problem Assess client's
level of energy Review medication regimen,
observe for side effects Provide information
regarding sexuality and sexual functioning Refer
for additional counseling or sex therapy if
required.

33. 2) Ineffective sexuality patterns.
• Take sexual history, noting client's expression
of areas of dissatisfaction with sexual pattern.
• Assess areas of stress in client's life and
examine relationship with sexual partner. Note
cultural, social, ethnic, racial, and religious
factors that may contribute to conflict
regarding variant sexual practices.

34. • Be accepting and non judgmental Assist
therapist in plan of behavior modification to
help client decrease variant behaviors.
• Teach client that sexuality is a normal human
response and is not synonymous with any
sexual act. Client must understand that sexual
feelings are human feelings.

35. NURSING CARE PLAN

36. Problem N. Diagnosis Goal Intervention Evaluation
Importance Inability to
perform to form
sexual activity
related to anxiety
as manifested
by unable to
erect
Risk of divorced
marriage related
to importance as
manifested by
inability to
maintain sexual
intercourse
Patient(Pt) will
be free from
anxiety after 3
months
Patient will
maintain
marriage through
the life
Give counseling
About disease
condition
Give medication
as prescribed by
physician
Give
psychological
support to
couple concern
with ED as
condition can be
cured
Inform his wife
about condition
of her husband
Patient
understand
diseases
condition and
being free from
anxiety
Couple
understand and
marriage
maintained

37. Knowledge
deficit related to
sexual
dysfunction as
manifested by
maintaining
sexual act
Risk of Infertility
related to
impotence as
manifested by
inability to
perform sexual
intercouse
Pt will be
knowledgeable
after 3 days
Pt be able to
born children
Make follow up
of the case
Educate the pt
on the topic of
importance i.e
definition, signs
and symptoms
and
management.
Give prescribed
medication as
ordered
Teach and
demonstrate rule
and style of
sexual intercouse
Pt understand
and being
knowledgeable
Pt able to have 2
children after
6yrs

38. References
 Heidelbaugh JJ. Management of erectile
dysfunction. Am Fam Physician. 2010;81:305-312
 Erectile dysfunction glossary - MUSC Health
 Health.am. 2006. Retrieved 2007-10-07.
 Tom F. Lue, MD (2006). "Causes of Erectile
Dysfunction". Erectile dysfunction. Armenian
Health Network, Health.am. Retrieved 2007-10-
07.
 "Erectile dysfunction". Erectile dysfunction. Mayo
Clinic. 2006. Retrieved 2007-10-07.

39. The end