IMPOTENCE, MALE SEXUAL

General Information

DEFINITION--A consistent inability to achieve or maintain an erection of the penis necessary to have sexual intercourse. (The occasional periods of impotence that occur in just about all adult males is not considered dysfunctional.) Impotence is not inevitable with aging. The capacity for erection is retained, though a man may need more stimulation to achieve erection. Sometimes, erections may be less firm or full.

BODY PARTS INVOLVED--Male reproductive system; central nervous system.

SEX OR AGE MOST AFFECTED--Male adolescents and adults, but most common in men over 45.

SIGNS & SYMPTOMS

• Inability to achieve an erection.
• Inability to maintain an erection for the normal duration of intercourse (erection may be too weak, too brief or too painful).

CAUSES

Physical causes include:

• Diabetes mellitus.
• Atherosclerosis (hardening of the arteries).
• Medications (antihypertensive, antipsychotics, antihistamines, anti-ulcer drugs, sedatives).
• Disorders of the central nervous system, such as spinal-cord injury, multiple sclerosis, stroke or syphilis.
• Endocrine disorders that involve the pituitary, thyroid, adrenal or sexual glands.
• Alcoholism; drug abuse.
• Decreased circulation to the penis.
• Hormone imbalance (rare).
• Surgery (prostate, back or genital surgery).

Psychological causes include:

• A poor relationship with the sexual partner.
• Psychological disorders, including depression, anxiety, stress and psychosis; guilt feelings.
• Lack of sexual information, including an understanding of the emotional aspects of sexuality and information about female anatomy.

Situational or environmental causes:

• Presence of visitors in the home.
• Rushed or routine lovemaking.
• Smoking; exposure to toxic chemicals.

RISK INCREASES WITH

• Problems listed in Causes.
• Recent illness that has lowered strength.
• Recent major surgery, especially cardiovascular or prostate surgery.

> Don't drink more than 1 or 2 alcoholic drinks--if any--

a day. Don't use other drugs that can be abused.

• If you have diabetes, adhere to treatment.
• Maintain overall good health.
• If any new medication is prescribed, ask your doctor if it can cause erection problems.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Medical tests as needed for diagnosis of any underlying disorder. Diagnosis at a special diagnostic center to measure erections.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Psychotherapy or counseling (alone or with your partner) from a qualified, sex therapist.
• If medication is the cause, a change in medication or in dosage may help.
• Self-administered penile injection therapy may be prescribed.
• Use of vacuum erectile device may be recommended for some patients.
• Surgery to implant an inflatable or non-inflatable penile prosthesis (sometimes).

POSSIBLE COMPLICATIONS

• Depression and loss of self-esteem.
• Marital problems or breakdown of close personal relationships.

PROBABLE OUTCOME--Spontaneous recovery or recovery after brief counseling in many cases with psychological origins. For other cases with physical origins, treatment and improvement in the underlying disorder may improve sexual performance.

How To Treat

GENERAL MEASURES--

• Don't be hesitant about discussing the problem, exploring your needs and asking for help. Your partner's understanding is critical.
• See Resources for Additional Information.

MEDICATION--Medication is not helpful for impotence caused by psychological factors. Be wary of cures using shots or pills.

ACTIVITY--No restrictions. Resume sexual relations when potency returns or surgery heals.

DIET--Eat a well-balanced diet and take vitamin and mineral supplements.

Call Your Doctor If

You have symptoms of impotence, especially if you take medications or have disorders listed as causes.