What is this Condition?

Impotence refers to a man’s inability to reach or maintain erection of the penis sufficient to complete intercourse. It’s called primary impotence if he has never achieved a sufficient erection or secondary impotence if he has successfully completed intercourse in the past despite present inability. Secondary impotence is more common and less serious than primary impotence.

In response to stress, a man may have situational impotence, a temporary condition. About half of adult men probably experience temporary periods of impotence, which aren’t considered dysfunctional.

Impotence affects all age-groups but becomes more common with advancing age. The prognosis depends on the severity and duration of impotence and on the underlying cause.

What Causes it?

Emotional and mental factors account for at least half of all cases of impotence; physical factors account for the rest. In some men, all of these factors coexist, so it’s hard to isolate the main cause.

Emotional and mental causes fall into two main categories. Personal sexual anxieties generally involve guilt, fear, depression, or feelings of inadequacy resulting from previous traumatic sexual experience, rejection by parents or peers, exaggerated religious orthodoxy, incest, or homosexual experiences. Interpersonal sexual anxieties reflect a disturbed sexual relationship and may stem from differences in sexual preferences between partners, lack of communication, ignorance of sexual function, or nonsexual personal conflicts.

Physical causes of impotence include chronic diseases, such as heart and lung disease, diabetes, MS, or kidney failure; spinal cord injury; complications of surgery; drug or alcohol use; and genital or central nervous system defects.

What are its Symptoms?

The man with partial impotence can’t achieve a full erection. The man with intermittent impotence sometimes is potent with the same partner. The man with selective impotence is potent only with certain women.

Some men become impotent suddenly; others, gradually. If the underlying cause isn’t physical, the man may still be able to achieve an erection through masturbation.

When impotence stems from emotional or mental factors, the man may experience anxiety, sweating, and palpitations, or he may lose interest in sex. He may also suffer extreme depression (this may cause the impotence or result from it).

How is it Diagnosed?

Typically, the health care professional takes a detailed sexual history to help distinguish between physical and nonphysical factors that may be causing impotence. The health care provider also must rule out other disorders, such as diabetes and problems involving the blood vessels, nervous system, or urinary and genital structures.

How is it Treated?

Sex therapy, which should include both partners, may cure impotence stemming from emotional or mental factors. This type of therapy usually includes exercises that restrict the couple’s sexual activity while encouraging foreplay. It also includes improving verbal communication skills, eliminating unreasonable guilt, and reevaluating attitudes toward sex and sexual roles.

When impotence results from physical factors, treatment aims to reverse the underlying cause, if possible. If it can’t be reversed, psychological counseling may help the couple deal realistically with their situation and explore alternatives for sexual expression. Some men who are physically impotent may benefit from penile implants.