Impotency and its Management
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Jul / Aug Vol V No 4.
Ardeshir Jagose.
Therapeutics. 

Introduction:

It is often a misnomer by the common man that impotency means failure to sustain a complete erection and / or inability to perform. In fact impotency can manifest in various ways-.

1. Loss of desire.
2. Inability to obtain or maintain an erection.
3. Premature ejaculation.
4. Absence of emission.
5. Inability to achieve orgasm.

Hence impotency in simple terms can be defined as "Male Sexual Dysfunction".

The complaint in a majority of cases is related to Psychogenic factors and only a small percentage of cases would be of specific organic disorders.

Causes of Impotency:

The normal sexual function can be divided into five events each of which is under diverse regulation: Libido, Erection, Ejaculation, Orgasm and Detumescence. Hence anything hampering the normal sexual functions will give rise to impotency as stated below:

1. Loss of desire--In a small percentage of organic cases, Pituitary or testicular disease gives rise to androgen deficiency which in turn causes a decreased libido.
   Hypogonadism also gives rise to such states.
2. Failure of erection--which may arise from the following conditions--
   1. Endocrine Causes--Pituitary tumors which give rise to hyperprolactinemia.
   2. Neurologic Causes--Lesions of anterior temporal lobe; Spinal cord disorders; Loss of sensory input in diabetics; neuropathies; tabes dorsalis and damage to parasympathetic nerves-following surgical procedures such as total prostate removal, retrosigmoid operations and aortic bypass surgery if autonomic nerve supply to penis to damaged.
   3. Vascular Causes--Leriche Syndrome.
   4. Penile Diseases--Peyronies disease, priapism and penile trauma
   5. Drug Induced--Prolonged use of antihistamines, antihypertensives etc, which are potentially correctable causes of impotency.
3. Premature Ejaculation--Always related to anxiety states or emotional disorder and unreasonable expectations about performance. It may rarely have an organic cause.
4. Absence of Emission--It may be due to the following conditions-
   1. Retrograde Ejaculation--Following surgery on the bladder neck or may develop spontaneously in diabetics.
   2. Sympathetic Denervation--May occur following sympathectomy.
   3. Androgen Deficiency--Results in a decrease in secretions of the prostrate and seminal vesicles and diminution of the volume of ejaculate.
   4. Drugs--Such as Guanaethidine, Phenoxybenzamine and Phenotolamine primarily impair ejaculation rather than erection or libido.
   5. Absence of orgasm--It is always almost due to psychological disorder if the libido and erectile functions are normal.
   6. Failure of detumescence--It is due to priapism but can be associated with sickle cell anaemia, chronic granulocytic
   7. leukaemia or spinal cord injury.

Evaluation of Impotency:

The central issue while "Evaluating Impotency is to separate those instances due to psychological factors from those due to organic causes. A good case-taking usually makes the separation possible.

The commonest cause is an anxiety or depressed state. Psychological factors like disinterest in sexual partner, martial discord etc. reduce sexual impulse.

However, if an organic cause is deduced, its aetiology should be well known.

Investigations and Examination:

1. Laboratory Investigation--Laboratory evaluation is probably of minimal value. Measurement of serum testosterone in the absence of evidence of feminization or hypogonadism in seldom helpful. If there is an indication from either history or physical examination of vascular aetiology, a Doppler procedure or arteriography may be indicated.
2. Physical Examination--Thorough genital examination to identify abnormalities of the penis; testicular size and abnormal masses. Evidence of feminization such as gynaecomastia and abnormal body hair distribution should be sought. All pulses should be palpated, including the penile pulse, to exclude the presence of deep cavernous arterial occlusion.
3. Systemic Examination--Neurological examination is necessary for detecting peripheral neuropathy and also to assess the peri anal sensation, anal sphincter tone and bulbo cavernous reflex.

PLAN OF TREATMENT:

It can be broadly classified as follows:

1. Ancillary of Extraremedial line of treatment.
2. Surgical line of treatment.
3. Treatment with Homoeopathic medicines like--mother tinctures, constitutional and intercurrent medicines, Organopathic, Rare medicines.

1) Ancillary of extra-remedial line of treatment:

1. Giving reassurance to the patients of anxiety states and corrective measures to depressive patients may restore sexual potency.
2. Sexual counselling, education and psychotherapy are also beneficial in alleviating psychogenic factors.

2) Surgical line of treatment:.

It is worth giving a thought on the following points:

1. In cases of hyperprolactinemia where prolactin secreting pituitary tumour is present; surgical removal usually results in return of potency.
2. Surgical therapy is also useful in treatment of decreased potency related to aortic obstruction.
3. Implantation of a penile prosthesis by a small, blunt, rod or alternatively by an inflatable prosthetic device, can advised by a Homoeopathic physician in refractory cases who are not improving with the allopathic mode of treatment (intracavernous injections of papaverine etc.) or patients who are skeptical about the Homoeopathic mode of treatment. However it should be remembered that these procedures are extremely costly and have a high risk of complications. Homoeopathic line of treatment

a) Repertorization:.

The important rubrics found from cases in day to day practice from various repertories will aid the Homoeopathic physician to select the remedy.

Rubrics from Kents Repertory:

Erection, wanting (impotency)--(page 696)
Erection, incomplete, coition during--(page 695)
Erection, incomplete, penis becomes relaxed--(page 695)
Erection, sleep during--(page 696)
Erection, sleep during, with impotency when awake--(page 696)
Erection, delayed--(page 695) Coition, aversion to, enjoyment absent--(page 693)
Seminal discharge, too quick--(page 710)
Seminal discharge, before it leads to ejaculation--(page 709)
Seminal discharge, intromission before--(page 710)
Seminal emissions, dreams without--(page 710)
Seminal emissions, night every--(page 710)
Seminal emissions, excitement of fancy, without--(page 710)
Sexual passion, wanting--(page 711)
Mental, sexual excess, mental symptoms from--(page 79)

Rubrics from Synthetic Repertory:

Sexual desire, diminished--(page 843)
Sexual desire, wanting--(page 843)
Enjoyment, absent--(page 380)
Ejaculation difficult--(page 375)
Sexual aversion, to coition, with impotence--(page 432 and 433)

Rubrics from Boerickes repertory:

Impotency--(page 822)
Masturbation--Ill effects--(page 822)
Genitals, relaxed, flabby, cold weak--(page 821)
Desire, increased in old men but impotent--(page 80)
Spermatorrhoea--(Sexual debility, deficient physical work, nocturnal pollutions) with all its subrubrics--(page 825)
Dreams, lascivious--(page 938)

Important rubrics from Phataks repertory:

Impotency--(page 191)
Erection--(of Penis), slow, delayed--(page 105)
Sexual affections, disturbance in general--(page 304)
Desire (males) decreased, weak--(page 304)

b) Treatment with Homoeopathic Medicines:.

MOTHER TINCTURES: Mother tinctures play an important part in prescribing especially in cases with paucity of symptoms, where the exact psychological cause is difficult to obtain from the life situation of the patient and in uncooperative patients and illiterate persons.

Many a times it is seen that along with the indicated Homoeopathic remedy, a mother tincture is also prescribed, which helps the patient immediately but temporarily.

Given below are list of mother tinctures with their indications:

a) Ashwagandha:

A / f exposure to syphilis and gonorrhoea. It acts very fast in impotency and all kinds of seminal deficiencies. In co-ordination of muscular power with spermatorrhoea and weakness of nerves and muscles. Impotency may be associated with deficient intellect, where the power of thinking, memory and expression is paralysed.

b) Avena-sativa:

A / f excessive indulgence in onanism and masturbation, opium or morphine addiction. It is a great stimulant, builder and nutrient to the nervous system. Mental nervousness and physical debility due to excessive indulgence in sex. Spermatorrhoea and nocturnal emissions marked. May be used alternatively with Salix Nigra.

c) Bufo:

A / f excessive masturbation. Patient always seeks a solitary place for masturbation. May be associated with epilepsy due to onanism, when the attacks come on during the night when asleep.

d) Camphor:

It is a great stimulant, but constant use of it causes impotency. It is similar in action to that of Cantharis.

e) Cantharis:

A / f exposure to gonorrhoea. It produces a furious disturbance in the sexual organs and produces a strong desire. Also useful for painful erection and priapism in gonorrhoea.

f) Damiana:

A / f sexual excess, gonorrhoea with syphilis or injury to spine. Serviceable from physical exertion and mental overwork. Spermatorrhoea in weak and exhausted subjects. Sexual neurasthenia. It is a good remedy to increase the sperm count.

g) Dioscorea-villosa:

Relaxation and coldness of organs with offensive sweat from genitals. Night emissions with weakness of knees without amorous dreams. Impotency may be associated with gall -stone where there is relief of pain on standing erect or bending backwards.

h) Panax ginseng:

It is said to be a great sexual stimulant. It is useful in cases of frequent emissions with weakness of genital organs.

i) Sabal-serrulata:

Sexual weakness and neurosis, organs feels cold. Spermatorrhoea marked. Impotency may be associated with prostatic enlargement where there is frequent painful micturition with urging especially at night.

j) Salix-nigra.

A / f masturbation. Excessive sexual desire with erotomania. Spermatorrhoea with lascivious dreams. It cures nocturnal emissions.

k) Yohimbinum:

As an aphrodisiac, when used in physiological doses, but contraindicated with all acute and chronic inflammation of the abdominal organs. It produces strong and lasting erections.

Role of Constitutional and intercurrent remedies:

1. a) Constitutional remedies like Acid-phos, Baryta-carb, Calc-carb, Fluoric-acid, Graphites, Lycopodium, Nat-mur, Nux-vomica, Phos, Staph and Sepia are found to be useful according to symptom similarity of the case.
2. b) Intercurrent remedies like Medorrhinum, Syphilinum, Tuberculinum etc. play an important role in eradicating the fundamental cause of the disease which might be an obstacle for cure.

Role of rare remedies:

At times it has been observed that remedies which exhibit-

1. An "Expression Block" due to use of allopathic drugs producing suppression.
2. Paucity of symptoms.
3. Maze of symptoms and
4. Very few peculiar symptoms pertaining to the disorder. Agnus-castus, Eupatorium-perf, Baryta-phos, Bufo, Caladium, Conium Ginseng, Nuphar luteum, Onosmodium, Selenium and Sarsaparilla come to the rescue in such cases.

Role of rare remedies:

At times it has been observed that remedies which exhibit very few peculiar symptoms become handy in the case (Aphorism 164), namely-

1. Eryngium-aquaticum--General debility, seminal emission without erection.
2. Digitalis--Barch recommends Digitalis in 3rd trituration and spermatorrhoea and claims that it usually suffices, especially when given early in the morning. Dickson claims better results from this remedy than from any other. Its symptoms being involuntary emission during sleep without dreams, followed by great weakness.
3. Kobalt--has backache following seminal emissions.
4. Kali-brom--A / f sexual excesses, especially loss of memory, impaired coordination, numbness and tingling in limbs. Sexual excitement during partial slumber.
5. Plumbum phos--Loss of sexual power. May be associated with locomotor ataxia.
6. Strychnine--It is perhaps better than Nux-vomica, where there is great spinal exhaustion, spermatorrhoea arising from plethora, irresistible desire to masturbate. The higher attenuation acts better than the lower.

BIBLIOGRAPHY:

1. Principles of Internal Medicine--Harrisons
2. Principles and Practice of Medicine--Davidsons
3. Textbook of Medical Physiology--Guyton
4. Short Practice of Surgery--Bailey and Love
5. Principles of Gynaecology--Jeffciates
6. Practical Homoeopathic Therapeutics--W A Dewey
7. Homoeopathic Therapeutics--S Lilienthal
8. The Prescriber--J H Clarke
9. Miracles of Mother Tincture--Dr Y Sinha
10. Study of Materia-Medica--N M Choudhuri
11. Tips by Masters of Homoeopathy--S R Wadia
12. Bogers Synoptic Materia Medica--C M Boger
13. Clinical Materia Medica--E A Farrington
14. Materia Medicas--Boericke, Kent Tyler, Allen.
15. Repertories--Boericke, Boenninghausen, Kent, Phatak
16. Synthetic Repertory--Barthel and Klunker
17. HOM Repertorium--Dr Schwabe
18. Approved Pharmaceutical Specialties--Dr Schwabe
19. Swiss Nature Doctor--A Vogel
20. Your Guide to Health--C R Anderson
21. Organon of Medicine (6th Edition)--Dr S Hahnemann.

There is no better aphrodisiac than love.

-- Dr Prakash Kothari.

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