Impotence Called Often Organic and Treatable

WASHINGTON — Impotence, once believed to be largely psychological, often can be attributed to organic causes, including diseases and common medications, and is frequently highly treatable, researchers said Monday.

Sixteen of the 200 most prescribed drugs can cause sexual dysfunction, including many hypertensives and diuretics, tranquilizers and cimetidine--a medication used to treat ulcers and heartburn--according to Dr. John Morley, director of the geriatrics research education and clinical center at UCLA and the Sepulveda Veterans Administration Medical Center in Los Angeles.

Problem Widespread

Morley, one of several physicians who spoke at a meeting sponsored by the National Institute of Arthritis, Diabetes and Digestive and Kidney Diseases, estimated that one of every three men older than 40 has some form of sexual dysfunction, “usually organic and very treatable.”

Dr. William H. Masters, chairman of the Masters and Johnson Institute in St. Louis, Mo., said that only 18% to 20% of the patients he sees every year in his “own highly selective group” are impotent for organic reasons. Impotence suffered by the majority of his patients, he said, usually was caused by psychological factors. He said he could not estimate the nationwide incidence of impotence.

Dr. E. Darracott Vaughan Jr., director of the division of urology at Cornell University Medical College in New York, estimated that there are 10 million to 20 million males in this country “with sustained problems” of impotence.

sh Alcohol a Factor

The researchers said that non-psychological causes of the condition include illnesses such as diabetes or muscular dystrophy, alcohol, nicotine, zinc deficiency, drugs and a hardening of the vessels that supply blood to the penis, a condition Morley called “penile angina.”

In the latter cases, “impotence may be an early warning sign for a heart attack,” he said. “I think it’s very real. When I see males with impotence and vascular disease, I look for heart disease.”

However, all the researchers emphasized that, even when impotence is organically caused, the condition is often exacerbated by anxiety about continued failure to perform. “As soon as you get organic disease, psychogenic disease comes rushing through the door at the same time,” Morley said. “It’s a mixed attack.”

sh Methods of Treatment

Dr. Robert J. Krane, chairman of the department of urology at Boston University Medical School, described the three most successful treatments for organic impotence. They are self-injection of two drugs to increase blood flow to the penis; the surgical insertion into the penis of a prosthesis, in which, Krane said, “patient satisfaction is greater than 90% “; and microvascular bypass surgery, a procedure performed on younger patients, which, Krane said, “is the same as heart bypass surgery.”

Krane called the self-injection drugs, papaverine and phentolamine, “an incredibly good treatment” and probably “the most reasonable one to offer a patient first.”

He added: “Its appeal is that it is natural, it is not painful--the needles are very small--and it is a very simple maneuver to learn, and it has very few side effects. If you’re impotent and looking at options, it may be the best.”