If impotence is due to physical factors, the latter should be treated accordingly. What methods are used in treating patients whose problem is physiological? Here's what to expect but remember that all these methods carry certain risks so it's important that your impotence is correctly diagnosed first.

Hormonal medications may be prescribed if impotence is due to a hormone deficiency. Low testosterone levels, for instance, can be treated with testosterone injections. However, this happens in very few cases.

If testosterone shots are given haphazardly, this could lead to liver damage, tumors, and stop sperm production. What's more, this therapy is not indicated for men with a history of prostate cancer, heart, kidney, or liver disease.

Impotence caused by obstructed arteries that block blood flow to the penis or a venous leak that allows excessive amounts of blood to drain from the penis can be remedied by surgery. This difficult and expensive procedure may include microscopic reconstruction of penile arteries or the removal of abnormal veins that cause blood to drain rapidly from the penis.

In the right candidate, surgery carries a 60 to 65 percent success rate. In others, it can result in infection, numbness, scar tissue formation with shortening or twisting of the penis, painful erections and swelling of the head of the penis. Some who opt for surgery may find that whatever improvement they have is temporary. Impotence may return in six months to a year.

Another surgical technique for impotence entails the use of prosthetic implants. The first penile implant taken from a man's rib was made in 1936 but technical difficulties forced the surgeons to abandon the idea. Modern implants are the brainchild of Dr. William Scott of the Johns Hopkins Medical School, Dr. Michael Small of the University of Miami Medical School and his associate Dr. H.M. Carrion.

Scott's device was operated by a scrotal pump which transferred fluid from a reservoir located in the lower abdomen to the flaccid penis, producing an erection. The Small-Carrion devices, on the other hand, produced a constant state of erection when implanted. This is good during intercourse but has to be concealed afterwards.

In 1989, implants were used by about 27,5OO men in America alone. Worldwide sales of five implant manufacturers have reached more than $60 million. At present, there are several models that can be classified in three basic categories: rigid, semi rigid, and inflatable.

The surgical success rate for penile implants is 9O to 95 percent but patient and partner satisfaction is only 6O to 75 percent. To make things worse, a large number of men will require another operation owing to some complications like infection, penile pain, and mechanical failure of the implant. So think twice before you have one.

For those who are afraid of surgery, there are several mechanical aids for impotence. We'll talk about this in the fourth part of our series.

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