Alternate Names: Male impotence; Sexual dysfunction; Erectile dysfunction
Considerations:
Occasional impotence occurs in about half of adult men in the U.S., and chronic impotence affects about 1 in 8 American men. The chances of impotence increases with age.
Impotence can be classified as primary or secondary. A man with primary impotence has never had an erection sufficient for intercourse. Secondary impotence is the loss of erectile function after a period of normal function. Except for impotence caused by injury or sudden illness, secondary impotence usually comes on gradually.
Treatment of secondary impotence is usually more successful than that of primary impotence because, despite current impotence problems, there is some history of normal penile function in the past.
AGING ALONE DOES NOT CAUSE IMPOTENCE!
There are several components required for an erection:
- A responsive emotional state of mind
- A normally functioning pituitary
- Adequate testosterone
- Intact brain and nervous system
- Adequate penile blood supply
Premature ejaculation (when orgasm comes on too quickly to satisfy either partner) is different from impotence. The couple should seek counseling for this problem.
Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly normal in every other way and very capable of fathering a child. An infertile male may be able to have intercourse normally, but he may be unable to father a child.
Common Causes:
- Medication use (especially antihypertensives)
- Smoking
- High blood pressure
- Hormonal deficiency caused by disease (diabetes) or injury
- Liver disease, usually caused by alcoholism
- Circulation problems (arteriosclerosis, anemia, or vascular surgery)
- Neurological problems (injury, trauma, disease)
- Urological procedures (prostatectomy, orchiectomy, radiation therapy)
- Penile implants (or prostheses) that are not functioning properly
- Depression, anxiety, fatigue, boredom, stress, fear of failure
- Mood-altering drugs, alcohol, medications
- Deep-seated psychological problems
Home Care: Treatment varies depending on the cause and the significance of the problem for the individual man and his partner. The cause should be treated. For example, if the impotence is caused by a medication, consult your health care provider about changing medications. ALWAYS CONSULT YOUR HEALTH CARE PROVIDER BEFORE CHANGING A PRESCRIPTION MEDICATION.
Counseling may be advised. Rest and an active imagination are often effective measures. For impotence caused by fear of infection use safe sex practices, and abstinence should be considered if in doubt. Talk to your health care provider if impotence is related to fear of recurring heart problems -- sexual intercourse is usually safe.
For impotence caused by smoking: stop smoking. For impotence caused by liver disease, alcohol consumption must be stopped.
Call If:
If the problem is persistent or if there are other associated and unexplained symptoms, call your health care provider.
What To Expect: The medical history will be obtained and a physical examination performed.
Medical history questions documenting impotence in detail may include:
- Quality
- Have you been able to achieve and maintain erections in the past?
- Is the difficulty in achieving erections or maintaining the erection?
- Do you have erections during sleep?
- Time pattern
- How long have you had difficulty with erections?
- Aggravating factors
- What medications are you taking (Include prescription medications, over-the-counter medications, mood-altering recreational drugs)?
- Do you smoke?
- Do you use alcohol?
- How much?
- How frequently?
- Have you recently had surgery?
- Have you ever had surgery or treatments for your blood vessels?
- Have you noticed changes in your emotional state?
- Are you depressed?
- Are you afraid or worried about something?
- Are you experiencing a lot of stress?
- Has your energy level decreased?
- Are you sleeping well each night?
- Are you afraid of sexual activity because of physical problems?
- What changes in your life have recently occurred?
- Other
- What other symptoms are also present?
- Have you noticed changes in sensations in your penis?
- Do you have any problems with urination?
Diagnostic tests that may be performed include: Intervention:
Treatment depends on the cause. If impotence is caused by a hormonal deficiency, medication may be prescribed. Consult your health care provider to see if these medications are right for you.
Oral medications are also available for treatment of impotence. If oral medications fail, injectable medications are also available. In some cases, a penile implant (penile prosthesis) may be required. Consult your health care provider to see if one of these treatments is right for you.
