Impotence is the inability to achieve and maintain an erection, which is necessary for the penis to penetrate the vagina during sexual intercourse. The corpora cavernosa of the penis normally fill with blood during sexual excitement, which causes the penis to become rigid and erect. Impotence is a partial or total impairment of this function.
Types
There are two types of impotence: primary impotence, in which a man is never able to have an erection adequate for sexual intercourse; and secondary impotence, in which a man quite often fails to complete intercourse to the satisfaction of both partners. Secondary impotence is the more common type.
Many men experience temporary impotence at some point in their lives, but chronic (recurring) impotence can lower a man's self-esteem and put a strain on his marriage or social relationships.
Causes
Impotence can be caused by either physical or psychological problems. Impotence may be brought on by stress related to a job, fear of causing pregnancy, unresolved conflicts about sexuality, or fear of sex after a heart attack or major surgery. Drug and alcohol abuse are also among the leading causes of impotence.
Physical factors known to trigger impotence include the following: an imbalance in the hormonal system that causes a decrease in production of testosterone (the male hormone necessary for an erection); the use of certain drugs, particularly diuretics and beta-blockers for the treatment of high blood pressure; diseases of the nervous system, such as multiple sclerosis; structural abnormalities of the penis; injury to the penis; and malfunctioning of the circulatory system, which can interfere with the blood flow to the penis. Vascular problems (including those from diabetes) may also be associated with symptoms.
Symptoms
The major symptom of impotence is inability to attain or maintain erection of the penis for sexual intercourse. This may be accompanied by a lack of interest in sex, but it does not necessarily mean infertility (the inability to father a child).
Diagnosis
Several tests can help to diagnose the cause of impotence. A blood test will show whether adequate levels of testosterone are present. With a blood pressure cuff specially designed to wrap around the penis and an ultrasound study (a technique that uses sound waves to create images of internal structures), blood vessel problems in the penis can often be detected. Another test registers the size of erections that naturally occur during sleep; if erections do not occur during sleep, a physical cause, rather than an emotional one, is likely.
Treatment
To determine if certain medications might be the cause of impotence, prescription drugs may be replaced or eliminated one at a time. If impotence has a physical basis, a number of treatments are available. The drugs sildenafil (Viagra) and varenafil (Levitra) are often used for impotence treatment. Injections of testosterone and other hormones may relieve some problems. Surgery may be necessary to repair the arteries and veins that carry blood to and from the penis.
The use of penile implants is a successful new treatment for impotence, with several varieties now in use. One is a silicone rod that is implanted in the corpora cavernosa, resulting in a permanent partial erection. Another is a flexible silver wire surrounded by silicone, which allows manipulation of the penis to an erect position for intercourse. A third model consists of balloonlike cylinders implanted in the corpora cavernosa and connected to a container of fluid; with the use of a hand pump, the cylinders may be filled with the fluid, in much the same way that blood normally fills the penis during an erection.
Counseling by a psychologist or trained sex therapist may be recommended for men whose impotence seems to stem from emotional problems. Counseling may also help those with physical disorders learn to deal with their impotence.
Prevention
Avoiding drug and alcohol abuse, as well as eliminating or coping with stress, should help prevent at least some episodes of secondary impotence.
