What is impotence?
Impotence occurs when a man cannot achieve or maintain an erection. It is one of the most common sexual problems, affecting most men at some time during their lives.
What causes impotence and who is at risk?
The causes of impotence can be divided into two categories: psychological and physical . Only one man in 10 has a physical problem (such as a generalized illness or nerve disorder); the other 90 per cent have a psychological cause.
Psychological causes
There are many psychological conditions that can lead to impotence. They may be temporary (such as mental fatigue or stress) or long-standing (such as anxiety or guilt). Fear of sexual failure is a very common factor in impotence. This is self-perpetuating: a man is so concerned about not being able to get an erection that he cannot relax during sex and therefore the problem is compounded. Psychological causes include:
- Mental exhaustion
- Guilt
- Anxiety and worry
- Depression
- Stress
- Relationship problems
- Physical causes
The nerves and blood vessels of the penis may have been damaged by an injury, by radiotherapy (cancer-killing X-rays) to the pelvic area or by surgery on the rectum, prostate gland or bladder. Other physical causes include: Certain illnesses, such as diabetes which affects nerves and blood vessels High blood pressure Atherosclerosis (furring of the arteries) Neurological disorders, such as damage to the spinal cord Another major physical cause of impotence is drugs. Many (although not all) drugs prescribed to treat high blood pressure may impair erections. So do some diuretic drugs (sometimes called ‘water tablets’). Impotence may also be caused by the drugs used to treat disorders such as depression. As men get older, changes to the circulation or, very occasionally, lowered levels of testosterone, may cause impotence. Other physical causes include smoking, excessive alcohol consumption and drug abuse.
What are the common symptoms and complications of impotence?
Impotence can occur in any age group and has a wide variety of causes. The problem may occur every time sexual activity is attempted, or its occurrence can be very variable depending on the circumstances. For example, a man may have a good erection on awakening but fail to get one when he tries to have sex. A man experiencing impotence often responds by trying to hide the problem from his sexual partner. He may manipulate events to avoid situations in which sexual contact, and especially penetrative intercourse, may occur. This is a common response to the problem but usually only makes it worse. Examples of this avoidance behavior include: Staying up late to ensure the partner is asleep first Working longer hours than usual at work so he is ‘too tired’ for sex Going to bed early so he is asleep before his partner joins him Inviting friends home to reduce the amount of time alone with his partner Going out more at weekends to avoid being available for sex during the day Claiming to have a headache or be exhaus
ted at bedtime.
If the man can attain an erection but doubts that he can maintain it long enough for penetrative intercourse, he may reduce the time spent in foreplay or ejaculate quickly after penetration in case he loses the erection.
How do doctors recognize impotence?
Waking up in the morning with an erection almost certainly means that the problem is psychological rather than physical. A doctor will be able to make an accurate diagnosis from your medical history and knowledge of any drugs that you are currently taking.
What is the treatment for impotence? Self-care action plan
Most sufferers can be helped to resolve the condition and regain their potency. Often, the biggest problem to overcome is reluctance to seek help. Men experiencing impotence often feel so embarrassed and inadequate that they find it difficult to discuss it, but the first step to overcoming impotence is to face up to the problem and discuss it as openly as possible with your partner, a doctor or a qualified therapist. If a sexual partner can offer reassurance and understanding, this may go a long way towards overcoming the problem without recourse to outside help.
Changing sexual habits and discussing partners’ sexual needs can help. Many men think that only penetrative sex is satisfactory; they may therefore feel that if they cannot get an erection, all sexual contact must cease. If their partner reassures them that other forms of sex, such as foreplay or mutual masturbation, are enjoyable and satisfying, the man may be relieved of his feelings of inadequacy and guilt. Once he feels under no pressure to perform, his ability to get an erection may improve. When self-help measures fail, a man may decide to seek professional help. If he is in a long-term relationship, he should discuss this with his partner.
Medicines
The first stage is to discuss the problem with your doctor. The doctor can usually determine if there is a physical cause behind the condition and arrange any necessary tests. For example, the doctor may change a course of medication to see whether a specific drug is causing impotence. Depending on the cause, other treatments include vacuum pumps, vasodilator drugs, penile implants, and treatment for depression or alcohol and drug dependency.
However, the cause will most probably be psychological, and a referral to a qualified expert in the field may be made. There is a wide variety of psychiatric, psychological and psychotherapeutic counseling services to call on. The doctor may also refer impotence sufferers to a specialist sex therapist. Such counseling and therapy can successfully improve or cure the majority of long-term cases of psychological impotence.
The drug Viagra™ has been developed for the treatment of impotence has recently been a subject of much discussion in the media. It does not actually cause erections but increases the response of the penis to sexual stimulation. This allows for a more rapid and sustained erection. It is a highly effective treatment. However, there are some potentially serious complications due to interactions with other medicines such as glyceryl trinitrate used to treat angina. Before taking Viagra™ you must discuss all your current medication with your doctor.
Complementary therapy
Any therapies which reduce stress will almost certainly be of benefit if the cause of the impotence is psychological. Complementary therapies such as homeopathy are, however, of no known direct benefit.
What is the outcome of impotence? Although impotence is a very common problem, it is reassuring to know that up to 95 per cent of men suffering from impotence can be helped by a variety of different treatments. It is important, therefore, that men with impotence should not suffer in silence but should seek help.
