What is Impotence?

What happens under normal conditions?

Achieving an erection is a process that involves the circulatory and nervous systems with mental stimulation combined with the hormone testosterone and reliant upon adequate, functioning vascular tissue in the penis.

The process is quite straightforward. Stimulation of the brain starts the increase of blood flow through the arteries that supply the penis while at the same time restricting the outflow of blood in the veins from the penis.

This causes the penis to fill with blood and stay erect as long as the stimulation remains, allowing sexual activity to take place generally to completion. Once the sex act is completed the brain reverses the whole process, allowing greater outward blood flow and reducing the inward flow, resulting in the loss of the erection.

What are the risk factors for Impotence?

The first thought is generally that the male hormone testosterone is not sufficiently available, but this is very seldom the main reason, accounting for only about one in twenty cases. It may be a contributing cause in other cases.


There is a simple blood test that will identify a low testosterone level. It is indicated by a very low sexual desire coupled with poor energy levels and sometimes mood swings and depression symptoms. Replacement is easily accomplished by the application of patches or gels or even a simple pill.

What are some causes of Impotence?

Some of the most recognised causes are illness and conditions such as diabetes, high blood pressure, raised cholesterol levels or heart diseases.

All of these can cause restriction of and damage to the arterial blood flow and/or leakage at the venal end of the erection resulting in loss of pressure in the penis.

Some of the life choices we make for so-called pleasure, such as smoking or alcohol, can over time reduce the operation of these penile blood vessels, as can drug abuse especially if continued over an extended time

Exercise can often be a cure for mild impotence just as a lazy, inactive lifestyle can cause it.

Sometimes treatments for illnesses may cause or aggravate impotence and it is wise to check with a doctor that this is not the reason for your impotence.

Some surgery and treatments for cancer in the bladder, colon, rectum or prostate may result in impotence problems

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How do I know my Impotence is not in my head?

For almost all men there is an underlying physical cause. The "is it all in my head?" question does not arise, but many men experience performance failure at some point in their lives. And at any one time, 1 in 3 men have this problem and whether there is an underlying physical issue or not, psychological factors make matters worse.

There are companies that offer Cognitive Hypnotherapy treatments and one such company Sounds Positive offers the download of a course of treatment for home use.

How is Impotence diagnosed?

For most patients, the diagnosis can be made following a simple medical history.

Extensive testing is not necessary before treatment can begin and the choice of treatment depends on the goals of the individual concerned

If an erection is achieved that is sufficient for the completion of sex, with simple treatment like oral medication and the patient is satisfied, no further investigation is necessary.

If the initial treatment response is poor or the patient is not happy with the results obtained, then further steps can be taken. In general, as more complicated treatment options are chosen, testing may well become much more rigorous.

What are some non-surgical treatments?

It is usual in the first instance, if deemed suitable for the patient, to try out the oral medications known as phosphodiesterase-5 inhibitors (PDE-5). Current types are sildenafil citrate, vardenafil HCl or tadalafil.

These pills are taken before sexual activity (one recent version can be taken some while before) and they boost all the signals and responses to enable the man to achieve an erection sufficient for normal sexual activity to take place and be completed.

Provided there are no contra-indications (which would be assessed by a qualified doctor) these pills are safe in use and effective for almost 8 out of 10 men.

One of the main contra-indications is the use of nitrate medicines, which are commonly used for some heart complaints, and when combined with PDE-5 medicines can have very serious adverse effects. Heart patients not taking or likely to take nitrates can use PDE-5 inhibitors.

These medications sometimes have mild side effects but these generally lessen with continued use or are acceptable given the results they enable. Headaches, facial flushing, a stuffed up nose and sometimes muscle aches and pains have been reported.

In rare cases, some temporary visual distortion has been noticed and recently there have been a few reports of some temporary loss of hearing. However, these are very few in number when viewed in the context of the global use of these products. At present there are no reports of any long-term adverse effects.

As with all medications, it is important to follow the usage instructions carefully. Most cases when they do not work are caused by ignoring the advice regarding use to obtain the best results, that is included with the medications.

For those men who do not find oral medications satisfactory, the medication alprostadil can be given, either as an injection directly into the penis or as a urethral suppository.

Injection works best, giving success in over 80%, with suppository use only reaching about half this success level. Adverse effects of these treatments are a burning sensation in the penis or an erection that lasts too long. An erection that lasts for four or more hours may needs medical intervention.

If you prefer to avoid medications, a simpler method using an external vacuum device that may provide an acceptable result. This method simply creates a vacuum round the penis encouraging it to expand and fill to an erection, after which a constricting band at the base of the penis is used to keep the erection.

Some men cannot be treated by any of the above methods because of severe tissue damage as a result of disease, treatments of disease or deformities such as Peyronie's disease.

Prosthetic implants can be used and success rates are high for these most severely effected patients. This can be a fairly simple operation from the patient's point of view and is often an outpatient procedure.

Possible adverse effects include infection of the prosthesis or mechanical failure of the device.

What can be expected after treatment?

The surgical options provide the only permanent treatments with all the other options being on demand temporary fixes. The damage that has caused the problem is not cured. For this reason it is important to follow up with the prescribing or operating doctor if satisfaction is not achieved to see if some adjustment can improve results.

How do I know my Impotence is not in my head?

For almost all men there is an underlying physical cause. The "is it all in my head" question does not arise.

If I worry about my ability to get an erection can I make a bad condition worse?

For almost any action in life it is possible to suffer from performance anxiety. The brain is in charge and can easily be distracted by worry from a perfect performance.

Rather simply and pleasantly in this case - Practice makes Perfect - or as near as the average human can get.

Can I combine treatment options?

This is done but because of the risk of dangerously prolonged erections with medication therapy it should only be performed under a doctor's supervision.

I was fine until my doctor prescribed a new medication. What should I do?

If your doctor has recently changed a medication for some condition and it seems to have made you impotent, discuss the problem, as there are often other medications that will not have this side effect.

However it may be that you have to accept this side effect in order to benefit from the positive good that the medications gives you.

If you have to stay on the medication causing the problem, the treatments already outlined above can still help in many cases.