Impotence

(Erectile Dysfunction)



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 most 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 and more time between erections than in the past.

Signs and Symptoms

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

Causes

Psychological causes include:

  • Guilt feelings.
  • A poor relationship with the sexual partner.
  • Psychological disorders, including depression, anxiety, stress and psychosis.
  • Lack of sexual information, including an understanding of the emotional aspects of sexuality and information about female anatomy and physiology.
  • Physical causes include:
  • Diabetes mellitus.
  • Atherosclerosis (hardening of the arteries).
  • Use of some antihypertensive medications.
  • 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, especially of marijuana, cocaine, narcotics, tranquilizers, sedatives, hypnotics and hallucinogens.
  • Decreased circulation to the penis from any cause.

Treatment

  • Medical tests as needed for diagnosis of any underlying disorder. Diagnosis in a special center to measure nocturnal erections.
  • Psychotherapy or counseling (alone or with your partner) from a qualified, professional sex therapist.
  • If medication is the cause, a change in medication or a change in dosage amounts may be helpful.
  • 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.

Medications

  • Medication is not helpful for impotence caused by psycho logical factors.
  • Medication may be prescribed to treat the underlying medical condition.
  • Medication for self-administered penile injections may be prescribed.

Newer therapies (tablets that dissolve in the urethra) are becoming available.

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