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Impotence is when a man can't get or keep an erection long enough to have sex. It is also called erectile dysfunction.
Most men have impotence every once in a while or for short periods of time. Impotence is most common in men over the age of 65, but it can occur in middle-aged or younger men. Impotence isn't just part of aging. It often has a cause that can be treated.
Most men feel awkward talking about impotence. But the truth is that many men with impotence can be helped. Talk to your family doctor to find out what treatment may help you.
What causes impotence?
Impotence can occur when something gets in the way of the process your body goes through to get an erection. This process involves the brain, which controls what you see, hear, feel, smell and think; the nerves, which pass messages from your brain to your body; and the blood vessels in your penis, which open to allow blood to flow in.
Physical causes are at the root of the problem in more than half of the men who have impotence. Physical causes include diseases that damage the blood vessels and block the flow of blood into the penis. Diseases that damage the nerves that carry messages of arousal from your brain to your blood vessels can also lead to impotence. Other diseases can lower your level of testosterone or your levels of other male hormones, which can also lead to impotence. Some of the physical causes of impotence are:
- Alcoholism
- Fatigue
- Atherosclerosis (hardening of the arteries)
- Diabetes
- Brain or spinal-cord injuries
- Hypogonadism (which leads to lower testosterone levels)
- Liver or kidney failure
- Multiple sclerosis
- Parkinson's disease
- Radiation therapy to the testicles
- Stroke
- Some types of prostate or bladder surgery
Certain drugs may affect the flow of blood to your penis or the hormone levels in your blood. Drugs that may lead to impotence include some antidepressants, some high blood pressure medicines and most tranquilizers. If you think your impotence is related to a drug you're taking, talk to your doctor. There may be another drug you can take instead.
What about other causes?
How you're feeling about your life and about your relationship with your partner can add to impotence. Many men begin having impotence regularly after they have had it happen once. After it has happened to them once, they feel nervous about having sex. The more they worry about having an erection, the more trouble they may have getting one.
What you're doing during sex may also add to problems getting and keeping an erection. People's needs change over time or because of certain physical conditions. This can cause a man to need more touching of his penis during sex to get and keep an erection.
Feelings that can lead to impotence include:
- Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence
- Feeling stressed, including stress from work or family situations
- Being troubled by problems in your relationship with your sex partner
- Feeling depressed
- Feeling so self-conscious that you can't enjoy sex
- Thinking that your partner is reacting negatively to you
How is impotence diagnosed?
Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for signs of physical causes.
Other tests may also be needed. For example, your doctor may want to find out if you have erections during sleep. Some tests that can be done at home measure if you have erections while you're asleep. Normally, a man will have about 5 erections during sleep. If you do, your impotence may not have a physical cause.
How is impotence treated?
How impotence is treated depends on what things are causing it. Impotence with a physical cause may improve when the condition is treated or controlled. Impotence caused by a drug you're taking may improve when your doctor changes the drug or changes how much of the drug you're taking.
Counseling can be very helpful no matter what's causing your impotence, because impotence can affect how you feel about yourself and how you and your sex partner relate to one another.
What about devices that help a man get an erection?
Devices and implants designed to help a man get and keep an erection can be very helpful. These devices are mostly used when there is a physical cause of impotence and medical treatment doesn't help. Many types of devices are available. Implants require surgery. If a device or implant might help you, your doctor will talk with you about your options.
What does counseling involve?
Counseling will probably be most effective if your sex partner is included. Your counselor may recommend that you "start over" with sex to break the cycle you and your partner have.
Couples can learn new ways to please one another and to show affection. This can reduce the anxiety about having erections.
How do I deal with my partner's reaction to my impotence?
One of the most difficult things about impotence may be dealing with how it makes your partner feel. Your partner may feel at fault for your impotence or may think that it means that the relationship is in trouble or that you're involved with someone else. Your partner may feel unattractive, disappointed, hurt, angry, frustrated and concerned. These aren't easy emotions to deal with.
Counseling that involves both you and your partner is often the most effective way to deal with these issues. It can give you a way to reassure your partner about your feelings and the causes of your impotence.
AAFP, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 http://familydoctor.org/healthfacts/109/index.html
August 2001
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