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Impotence. The word strikes at the bedrock of a man's worth. Its implications far exceed the inability to have a penile erection. The man is without power-inef fectual. Ancient statues represented with an oversized erect penis attest to the his toric conscious meaning of the phallus. Magnificent spires, memorial monuments, and the awe generated by the sight of rockets and missiles attest to the unconscious meaning. At the medical-superstitious level, men have invoked countless strategies for improving or restoring potency. They have included ritualistic dances, concoctions, and mechanical aids. Some survive to the present. More recently, verbal therapies have taken their place, ranging from simple exhortation to the uncovering of complex unconscious symbolic conflicts. Other therapies borrow from theories of learning, based on experiments with mice and men. The growth of modern endocrinology, with the isolation of "sex steroids," heralded another treatment strategy: hormones. Later, engineers entered with sur gically implantable mechanical devices. And, most recently, the technology of microsurgery has offered the possibility of physiological restoration of a compro mised vascular supply, a necessary component of erection.
Sommario
Case Vignettes: Presenting Syndromes.- 1. Erection: Anatomy.- 2. Erection: Physiology and Endocrinology.- 3. General Medical Disorders and Erectile Failure.- 4. Diabetes Mellitus and Erectile Failure.- 5. Arteriosclerosis and Erectile Failure.- 6. Psychological Theories of Erectile Failure.- 7. Alcohol and Erectile Failure.- 8. Methods for Differential Diagnosis of Psychogenic and Organic Erectile Failure.- 9. Psychotherapy of Erectile Failure.- 10. Endocrine Therapy of Erectile Failure.- 11. Penile Dysfunctions due to Local Disorders.- 12. Surgical Treatment of Erectile Failure.- Case Vignettes: Clinical Management and Outcome.- Conclusion.
