Impotence affects about one out of every ten American men, yet many of them don’t seek help because they’re embarrassed, they think there’s no solution or they believe the problem is “all in their minds.” Unfortunately, these men are missing out on a wide variety of treatment options.
Impotence, the persistent inability to achieve and maintain an erection for intercourse, affects as many as 18 million men in the United States between the ages of 40 and 70. Until recently, doctors thought impotence was mainly rooted in psychological causes. Now it is believed that 50 to 70 percent of all cases are caused by physical problems.While erection difficulties increase with age, that is not the only or even the most important factor. A man’s general physical and psychological health as well as lifestyle habits and certain medications can all cause impotence. But the fact is, you don’t have to live with this problem. In most cases, impotence can be successfully treated.
In order to get an erection, several parts of the body must work together. The brain sends a message of sexual arousal through the nervous system to the penis. This message causes the muscles along the penis to relax. At the same time, the artery to the penis dilates to twice its diameter, increasing the blood flow sixteen-fold, and the veins which carry blood away from the penis are blocked. As a result, the two spongy-tissue chambers in the shaft of the penis fill with blood and the penis becomes firm. However, a breakdown in any of these systems makes getting or keeping an erection difficult.
| To Help Prevent Impotence: Exercise regularlyLimit the amount of fat and cholesterol in your dietDrink only in moderationDon’t smoke |
Virtually all men occasionally fail to get an erection. That’s normal. But if a man has trouble getting or maintaining an erection about 25 percent of the time, he should see a urologist. These physicians specialize in disorders of the kidneys, bladder, prostate, penis and urethra.
Usually, after asking questions about how the impotence developed, the urologist will give a patient a complete physical exam to determine if his hormone levels are normal and if the blood vessels, nerves and tissues of his penis are working properly. If this initial work-up doesn’t pinpoint the cause of the problem, a nocturnal penile tumescence test can be done.
Men with no physical abnormalities almost invariably have nightly erections during sleep. The patient may spend a few nights in a sleep laboratory where a gauge that measures the frequency and duration of nocturnal erections is attached to the base of the penis. A home version of this, the snap-gauge test, can also be used. Before going to sleep, the man attaches the gauge to the base of the penis. During the night, the gauge will break at different degrees of penile rigidity and show whether a partial or full erection has taken place while a man sleeps. If nocturnal erections do not occur, the impotence is most likely physical. Additional testing is then required to identify the precise cause of the problem.
What Are the Physical Causes of Impotence?
Physical impotence occurs when there is a problem with any of the systems needed to get or maintain an erection. The good news is that potency can usually be restored when a man is treated for underlying medical conditions, when medications are adjusted or when lifestyle habits are changed.
Here are some of the top causes of impotence:
- Cardiovascular Disease. Hardening of the arteries can affect the artery leading to the penis so that it cannot dilate enough to deliver all the blood necessary for an erection. Impotence can also occur if the nerves that control blood flow to the penis are damaged. diabetes. One out of every four impotent men has diabetes, which can cause nerve deterioration (diabetic neuropathy). Impotence may result if nerves or blood vessels that control the flow of blood to the penis are affected. In some cases, keeping the diet and blood sugar under control can decrease impotence. But permanent nerve damage can result in a chronic problem.
- Disease of the Nervous System. Some conditions, such as multiple sclerosis, Parkinson’s disease and spinal cord injuries, can affect or cause a problem with impotence.
- Cancer Surgery. Surgery to remove cancer from the prostate, bladder, colon or rectal area can cause problems. Impotence may result if the nerves and blood vessels that control erections are damaged in the process of removing cancerous tissue.
- Medications. Some prescription medications for high blood pressure, depression, spinal cord injury, diabetes and other conditions can cause temporary impotence by interfering with the nerve impulses or blood flow to the penis. But doctors may be able to adjust the dosage of a drug or change the medication to reverse impotence.
- Smoking. A recent study at the New England Research Institute in Watertown, Massachusetts, found that impotence was equally common among smokers and non-smokers in general. But among men with certain health problems, those who smoked were much more likely to have potency problems. For example, 56 percent of smokers with heart disease were completely impotent compared with only 21 percent of non-smokers with the disease.
- Alcoholism. Excessive alcohol consumption disrupts hormone levels and can lead to nerve damage. This type of impotence may be reversible or permanent depending on the severity of the nerve damage. Some clinical studies suggest about 25 percent of all alcoholics become impotent–even after they stop drinking.
- Hormone Imbalance. Abnormal testosterone levels are rare, but they can cause impotence. In addition, other illnesses, such as kidney failure and liver disease, can disrupt the balance of hormones.
What Are the Psychological Causes of Impotence?
A man who is depressed, under stress, or worried about his “performance” during sex may not be able to have an erection. Qualified therapists or counselors who specialize in the treatment of sexual problems can often help diagnose and sort through these problems. Some impotence problems can be solved when a man understands the normal changes of aging and how to adapt to them. For example, as men get older they generally need more direct stimulation to achieve an erection. They may also have less firm erections, take longer to ejaculate and need more time between erections.
Relationship woes can interfere with potency and so can job stress, depression or financial worries. Impotence may also be the result of deep-seated emotional problems, such as having been sexually abused as a child. Qualified psycho-therapists can diagnose such problems and help men understand and overcome them.
Aging and Impotence
The chart below indicates the extent of impotence in men at verious ages.
| Age | Completely Impotent | Moderately Impotent | Minimally Impotent | Not Impotent |
| 40 | 5% | 17% | 17% | 61% |
| 45 | 7% | 21% | 17% | 56% |
| 50 | 8% | 23% | 17% | 52% |
| 55 | 10% | 26% | 17% | 47% |
| 60 | 12% | 28% | 18% | 43% |
| 65 | 13% | 32% | 18% | 37% |
| 70 | 15% | 34% | 18% | 33% |
What are the Treatment Options?
When treatment of underlying physical or psychological problems fails to restore potency, many men turn to injections or other devices. A man and his sexual partner can consider one of the following solutions to impotence.
1) Vacuum Device. This is one of the most common impotence treatments. First, the man slips a hollow, plastic cylinder over his flaccid penis. He then attaches a hand pump to draw air out of the cylinder, creating a vacuum that draws blood into the penis. Once the penis is erect, the man slips an elastic ring over the cylinder onto the base of his penis and removes the cylinder. The ring will keep blood from flowing out, allowing intercourse. Note: This device should only be used under a doctor’s care since mishandling can damage the penis.
2) Self-Injection. One or more drugs (papaverine, phentolamine and prostaglandin-E1) can be injected into the penis to increase blood flow. The injection is nearly painless and produces a more natural erection than a vacuum device or implant. But until the proper dose is worked out, a man might have a prolonged and painful erection. In rare instances, an erection that does not go down after ejaculation may require surgery.
3) Penile Implants. Surgical implants can be used as alternatives if the above treatments are unsatisfactory. Experts at the Mayo Clinic say there is a 10 to 15 percent chance that an implant will malfunction within five years, but the problem almost always can be corrected. Over 90 percent of patients are satisfied with these implants. The two major types are:
- Malleable Rods. Two long rods (also referred to as semi-rigid prostheses) are inserted into the outer channels of the penis through a small incision in the lower abdomen or scrotum. Each rod is one solid piece and so remains erect at all times. However, it can be bent close to the body for concealment. Because there are no moveable or inflatable parts, malfunctions are rare.
- Inflatable Cylinders. These devices consist of one or two inflatable cylinders, a finger-activated pump and an internal reservoir that stores liquid used to inflate the tubes. All components-the cylinders, pump and reservoir-are implanted within the penis, scrotum and lower abdomen respectively. When the pump in the scrotum is manually squeezed several times, the fluid from the reservoir is released into the cylinders. They expand and create an erection, which is maintained until the release valve on the pump is squeezed, returning the fluid to the reservoir.
Our thanks to David W. Keetch, M.D., Director, Male Diagnostic Center, Barnes West County Hospital, St. Louis, MO, for reviewing this article.
The Impotence Institute of America offers literature on impotence and doctor referrals.
800-669-1603
The American Foundation for Urologic Disease provides free information on impotence and how to assess treatment options.
800-242-2383
