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Impotence & Heart Diseases in Men
or erectile dysfunction
, may indicate that a man is at increased risk for heart disease. Arterial disease is a common cause of impotence, and where impotence is in fact due to arterial problems, physicians should also screen patients for coronary artery disease. Erectile dysfunction may be the first clinical sign of vascular disease.
We should be more aggressive in looking for other evidence of vascular disease when a patient presents with erectile dysfunction… look at it as an opportunity to interact with a patient’s primary care physician. The study involved 57 men with erectile dysfunction who had no previous history of arterial disease or risk factors such as hypertension, diabetes, or high cholesterol or blood lipids. Between the ages of 23 and 60, these men were tested twice for blood cholesterol after fasting for 12 hours. Sixty percent of the men were found to have elevated cholesterol levels and 91% of the men showed signs of arterial insufficiency by doppler ultrasound. Of the 40% who showed normal cholesterol levels, Doppler ultrasound showed that 88% had signs of arterial disease.
As many as 40% of couples seeking vasectomy have experienced a failure with their previous method of nonpermanent birth control. Such failures can occur from misplacement of a diaphragm, an incorrectly implanted IUD, or noncompliance with an oral contraception regimen.
Some people contemplate vasectomy when use of a condom, diaphragm, or foam interferes with their enjoyment of sex. Freedom from distraction during sex is a secondary benefit of vasectomy, but should not be considered the primary motivation for the operation.
Can Vasectomies be reversed?
Although men should consider their vasectomy to be a permanent decision before undergoing the procedure, if they change their mind, there is a surgical procedure known as a vasovasostomy that may restore fertility. The main reasons for requesting a reversal are remarriage, the death of a child, or an improvement in finances. Reversal may also be performed to relieve postvasectomy pain, which occurs in a small percentage of men.
Causes of Vasovasostomy failure
The chances for pregnancy decrease the longer the duration between vasectomy and the reversal operation. The lower rates as time goes by is probably due to increasing chance for obstruction of the epididymis and the development of anti sperm antibodies. A successful reversal is more likely if the section removed during vasectomy was not long, if the original procedure was performed on straight sections of the vas, and if the joined pieces were of equal size.
If the sperm count does not recover within a reasonable period after vasovasostomy, secondary blockage of the epididymis is most often the cause, which may be corrected with a second procedure.
In the majority of cases, the reversal procedure reopens the epididymis, but fertility is not necessarily automatic. Autoimmunity is a condition in which the antibodies of the immune system attack specific cells in the body, mistaking them for micro foreign invaders. In the case of male infertility, such so–called auto antibodies target the sperm. Even if a procedure to reverse the vasectomy is performed, such antibodies often persist. Antibodies bind to specific parts of the sperm (e.g.., the head or tail) and cause problems depending on the site of attachment. Sperm may stick together (agglutinate), fail to interact with cervical mucous, or fail to penetrate the egg.