Overview

Impotence can first emerge in men as early as the age of 40. It is estimated that between 18 and 30 million men could be affected by this problem. The risk of becoming impotent increases as one ages. It is more frequent in men who are in their 60s compared with men who are in their 40s. Men with less education are likely to experience the problem because they tend to have less healthy lifestyles, exercise less, drink more, and eat a less healthy diet.

Impotence or erectile dysfunction specifically refers to the problems of achieving or maintaining an erection. Poor libido and ejaculation problems are associated with male sexual dysfunction or impotence.  Men with impotence could have a healthy libido, but their bodies do not respond in a sexual encounter by producing an erection. There is usually a physical basis for impotence.

Having a problem achieving an erection from time to time should not be a cause for concern among men. If it becomes an ongoing issue, it can result in stress, which affects your self-confidence and contribute to the deterioration of a relationship. The inability to get or maintain an erection can be a sign of an underlying medical condition that needs treatment. It is also a risk factor for heart disease.

Men who have problems getting and maintaining an erection should not be embarrassed about talking to their doctor. At times, the treatment of the underlying condition is enough to reverse impotence. In other cases, your doctor may prescribe medications and other treatments.

Mechanics behind impotence

An erection occurs when blood fills two chambers, known as the corpora cavernosa, an erection occurs, causing the penis to expand and stiffen, similar to a balloon that is filled with water. This process is triggered by nerve impulses coming from the brain and the genital area. The moment something interferes with these impulses or when there are restrictions to the blood flow to the penis, sexual dysfunction occurs.

Causes of Impotence

A man’s sexual arousal is an intricate process that involves the brain, emotions, hormones, muscles, nerves, and blood vessels. Impotence can result from any of these. Also, stress and concerns on mental health can cause or make worse existing cases of impotence. 

At times, a combination of psychological and physical issues may cause impotence. For instance, a minor physical condition, such as an injury, could slow your sexual response, which might cause anxiety about maintaining an erection. the resulting anxiety may lead to or worsen impotence.

Physical causes of impotence

In many cases, impotence has a physical cause. The common causes of impotence include:

• Atherosclerosis or clogged blood vessels
• Heart disease
• High blood pressure
• High cholesterol
• Obesity
• Diabetes
• Multiple sclerosis
• Parkinson’s disease
• Metabolic syndrome – A condition that involves high blood pressure, high insulin levels,  high cholesterol, and body fat around the waist
• Tobacco use
• Certain medications
• Alcoholism and other forms of substance abuse
• Peyronie’s disease – This involves the development of scar tissue inside the penis
• Sleep disorders
• Surgeries or injuries affecting the pelvic area or spinal cord
• Treatments for enlarged prostate or prostate cancer

Psychological causes of impotence

The brain has a very important role in triggering the series of physical events that cause an erection, beginning with feelings of sexual excitement. A number of things may interfere with sexual feelings, causing or worsening impotence, including:

• Stress
• Anxiety, depression, or other mental health conditions
• Relationship problems caused by poor communication, stress, or other concerns.

Impotence-causing lifestyle choices

Many lifestyle choices, such as alcohol abuse, smoking, and obesity can impair the circulation of blood that leads to impotence. Excessive drinking, smoking, or drug abuse can damage the blood vessels, reducing the blood flow to the penis. Men with atherosclerosis who smoke are more vulnerable to impotence. Smokers have twice the risk of becoming impotent compared with nonsmokers. Being obese or overweight and getting very little exercise may also contribute to impotence. Men who exercise regularly have a lower risk of becoming impotent.

Surgery

Surgical or radiation treatments for prostate enlargement, prostate cancer, or bladder cancer may damage blood vessels and nerves near the penis. The nerve damage may be permanent resulting in the patient requiring treatment to achieve an erection. There are times, though, when surgery causes temporary impotence that improves on its own after several months.

Medications

Many medications can cause or contribute to impotence, such as blood pressure drugs, tranquilizers, and antidepressants. Men with erectile problems must talk with their doctor if they have the suspicion that a prescription or over-the-counter medication may be causing erectile problems.

Cycling

Avid cyclists are more prone to impotence than other athletes because the shape of bicycle seats can cause pressure on the nerves that are important to sexual arousal. Cyclists who regularly ride for many hours can benefit from seats that are specially designed to protect the perineum.

Diagnosis and Treatment of Impotence

A doctor can diagnose erectile dysfunction by asking a patient questions about his symptoms and medical history. A complete physical examination may be necessary to detect nerve trouble or poor circulation. The doctor will also look for abnormalities of the genital area that may have caused the problems with erection.

A doctor may also review the symptoms that an individual experiences in diagnosing the underlying cause of impotence. 

The common symptoms of impotence include:

• Trouble getting an erection
• Trouble keeping an erection
• Reduced sexual desire

If you have chronic health conditions or when your doctor suspects that there could be an underlying condition involved in your erectile problem, you might need further consultation and tests with a specialist.

The tests for underlying conditions include:

• Physical exam – The exam might include a careful examination of your penis and testicles, and checking the nerves for sensation.
• Blood tests – A sample of your blood will be sent to a lab to check for signs of heart disease, low levels of testosterone, diabetes, and other health conditions.
• Urine tests – The test will look for signs of diabetes and other underlying health conditions.
• Ultrasound – This test is performed by a specialist in an office. It uses a wand-like device called a transducer held over the blood vessels supplying the penis. It creates a video image that allows your doctor to see if there is any problem with blood flow. This test may be done in combination with an injection of medication into the penis to stimulate the flow of blood and produce an erection.
• Psychological exam – Your doctor might screen you for depression and other possible psychological causes of your impotence.

Treatment for Impotence

Your doctor will ensure that you receive the right treatment for any health conditions that may have caused or worsened your impotence.

Depending on the cause and severity of your impotence and the underlying health conditions, your doctor can recommend various treatment options. Your doctor will explain the risks and benefits of each treatment and will ask you for your preferences. Your partner’s preference will also be considered in making your treatment choices.

Oral medications

Many men successfully resolve their erection problem by taking oral medications including:

• Sildenafil or Viagra
• Tadalafil or Cialis and Adcirca
• Vardenafil or Levitra and Staxyn
• Avanafil or Stendra

These four medications enhance the effects of nitric oxide, the natural chemical in the body that relaxes the muscles in the penis, increasing blood flow and allowing you to get an erection in response to sexual stimulation.

Taking any of these tables do not automatically produce an erection. You still need sexual stimulation to cause the release of nitric oxide from your penile nerves. These medications amplify the signal, which allows some men to sexually function normally. Oral erectile medications are not aphrodisiacs that cause sexual excitement and allow men to get normal erections.

These medications vary in dosage, how long do they work, and their side effects. Possible side effects include nasal congestion, flushing, visual changes, headache, stomach upset, and backache.

Your doctor will consider your situation in determining which medication will work best for you. These medications might not treat your erectile problem immediately. You might need to work with your doctor to determine the right medication and dosage for you.

Implants and penis pumps

If medication does not work, your doctor may recommend a different treatment such as:

• Penile implants – This treatment involves the surgical placement of devices on both sides of the penis.
• Penis pumps – It is a vacuum erection device that sucks out the air inside the tube to create a vacuum that pulls blood into your penis.

Exercise

Studies have shown that moderate to vigorous aerobic activity can improve impotence. 

Psychological counseling

Psychological counseling works especially when the impotence is caused by anxiety, depression, or stress. 

Lifestyle changes

Many men become impotent because of their lifestyle choices. The following lifestyle changes might help:

• Quit smoking
• Lose excess weight
• Be physically active
• Get treatment for drug or alcohol problems
• Work through relationship issues

Risks of Having Impotence

Men with the following health conditions are at a higher risk of becoming impotent:

• Smokers
• Alcohol and substance abuse
• Men with diabetes
• Obese or overweight individuals
• High blood pressure
• High cholesterol
• Heart problems

When to Seek Medical Attention

Seeing your primary care physician is the first step when you have erectile problems. See your doctor if:

• You have heart disease, diabetes, or another known health condition that might be linked to impotence
• You have concerns about your erections or you are experiencing other sexual problems such as delayed or premature ejaculation
• You have other symptoms along with impotence

Table of Medications

• sildenafil
• Cialis
• Viagra
• Staxyn
• tadalafil
• Levitra
• Caverject Impulse
• vardenafil
• alprostadil