General Impotence Summary

Impotence is the inability of a man either to have an erection or to keep the penis erect long enough to have sexual intercourse. This is a common problem affecting as many as 10 million men in the United States. By the time most men are 40 they have already experienced impotence at some time in their lives.

When just a single incident occurs, the best thing to do is forget about it. Problems arise when this difficulty starts occurring regularly.

According to an article published in early 1993 (review: Morley, 1993), approximately 10 million men in the U.S. have problems with impotence.

Men afflicted with repeated impotence tend to be middle-aged and older, with such a condition most common in men 60 years of age and older. Regardless of the age, however, many men who have this problem can be treated successfully.

Impotence can result from a wide variety of problems. As with any other ailment, when a person begins having this problem repeatedly, he needs to see a doctor. The doctor will want to rule out the possibility of disease, injury, or side effects from medicine.

For example, cardiovascular problems, diabetes, injuries to the spinal column, and side effects from high blood pressure medicine are among the physical conditions that can lead to impotence.

If the problem is physical, there is a wide variety of treatment available depending upon the cause and severity of the problem. If the physician does not believe the problem is physical, he or she may suggest seeing a psychologist, marriage therapist or psychiatrist. In such therapy, the emphasis will probably be on explanation, education, and support, and the wife may be asked to participate as well.

Sometimes both medical and psychological treatment are used together. If medical and psychological therapy proves unsuccessful, a device can be inserted surgically that will assist in allowing the man to have intercourse. Although this may sound scary, such devices have been used successfully in thousands of men. It is important that all such steps be taken under a trusted physicianþs guidance.

Due to the many possible causes of impotence, it is impossible to provide a definitive description of its prevention, especially since some causes are unpreventable.

There are, however, a number of ways to minimize the possibility or frequency of it. When a physician prescribes medicine or recommends a surgical procedure, the patient should ask if there may be side effects or complications that could influence him sexually.

Smoking appears to have a negative effect on a man's erection, while exercise and good diet help to enhance anyone's sex life.

Since in perhaps half of the cases the cause of impotence is believed to be psychological, there are some guidelines that are useful in minimizing such problems. Generally speaking, psychologically based impotence results from the man's feeling unsure about his ability as a lover, is under some form of external pressure or emotional upset (for example, job stress or loss of a loved one), or finds that his partner is not providing the type or extent of sexual stimulation he wants.

Some men feel that they are under various pressures to "perform," or find that their partner takes a rather passive role in love making. If both parties can find a way to discuss such situations between themselves and remove the obstacles that can arise, such problems can be reduced and problems from impotence minimized.

Current Research

A number of research projects involving experimental treatments have been reported in current medical journals. Some of these treatments, or the drugs involved, may not yet be available, however.

Fortunately for those afflicted with impotence, it is curable in most instances. A simple test can help determine whether impotence is a physical problem or a psychological one.

Although usually unaware of it, most men have frequent erections while they sleep. Consequently, the patient can be given a specially designed plastic band to place on his penis at bedtime. If the band is found to have broken during the night, then the man is capable of having normal erections and the problem is probably a psychological one.

If medical treatment is required, there are a wide variety of treatments available. Certain medications when applied to the penis have been found to assist in enhancing erection, such as nitroglycerin ointment (Nunez and Anderson, 1993) and Minoxidil (Cavallini, 1991).

In some patients, the problem is found to result from obstructions in the blood vessels of the penis that prevent them from filling properly, leading either to partial erections at best or none at all. In such patients, success has been reported in the use of injections of papaverine hydrochloride, prostaglandin, phentolamine and atropine which the patient can inject himself (Montorsi and others, 1993).

Where surgery is required to correct such vascular problems, outcomes research indicates that almost 80% of patients can regain potency (Schramek and others, 1992).

Another treatment possibility is the use of vacuum constrictive devices. A survey sent to patients who had been provided such devices over a 5-year period showed that both patients and their partners were quite satisfied with the results of using them (Cookson and Nadig, 1993).

Penile implants are another therapy option. In one survey, 80-90% of persons who received penile implants were found to be satisfied with the results (Witherington, 1991).

Bodily Effects

In very simple terms, the penis is a tube composed of two spongy cylinders. An erection occurs when these cylinders fill with blood. Although frequently unaware of it, most men normally have erections when they sleep, in addition to those times when they are sexually stimulated.

Once the male has an orgasm or the stimulation subsides, blood drains out of the cylinders in the penis and the penis becomes limp again.

Impotence occurs when something goes wrong with this process, namely, that something interferes with the initial phase of excitement, or with the ongoing sexual arousal during the sex experience, or with the ability to have an orgasm.

Sources:

1 - Cavallini, 1991. Minoxidil versus nitroglycerin: a prospective double-blind controlled trial in transcutaneous erection facilitation for organic impotence. Journal of Urology (July 1991), volume 146(1), pages 50-53.
2 - Cookson and Nadig, 1993. Long-term results with vacuum constriction device. Journal of Urology (February 1993), volume 149(2), pages 290-294.
3 - Montorsi and others, 1993. Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction. Journal of Urology (May 1993), volume 149(5 Pt 2), pages 1291-1295.
4 - Morley, 1993. Management of impotence: diagnostic considerations and therapeutic options (review). Postgraduate Medicine (February 15, 1993), volume 93(3), pages 65-67 and 71-72.
5 - Nunez and Anderson, 1993. Nitroglycerin ointment in the treatment of impotence. Journal of Urology (October 1993), volume 150(4), pages 1241-1243.
6 - Schramek and others, 1992. Microsurgical arteriovenous revascularization in the treatment of vasculogenic impotence. Journal of Urology (April 1992), volume 147(4), pages 1028-1031.
7 - Witherington, 1991. Mechanical devices for the treatment of erectile dysfunction (review). American Family Physician (May 1991), volume 43(5), pages 1611-1620.

- Causes of Impotence