Impotence

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Introduction

What is impotence?

Impotence, or erectile dysfunction, is the inability of a male to attain and keep an erection sufficiently firm to engage in or complete sexual intercourse. Although it is more common in older men, impotence can occur at any age. Impotence is not a normal consequence of aging. About 70% of erectile dysfunction is due to diseases such as diabetes and atherosclerosis, another 10% to 20% is due to psychological factors, and the remaining percentage is related to medications, lifestyle factors, and injury (Source: NIDDK).

Achieving an erection is a complicated process, requiring transmission of sensations from the genital area to the nervous system and the return of nervous impulses to the muscles and blood vessels of the penis. Anything that interferes with this interchange, such as disease or injury of the blood vessels, muscles, or nerves, can make achieving and maintaining an erection difficult. Psychological factors, such as anxiety and depression, can also interfere with erectile function. Anxiety and depression may also develop as a consequence of impotence.

Fortunately, impotence is usually treatable. A thorough evaluation starting with a history and physical exam is needed to help diagnose the underlying cause. Once the cause of impotence is determined, treatment can be tailored to target that cause and any other contributing factors. Treatments used for impotence may include medications, vacuum devices, surgery, and psychotherapy.

Because impotence can be due to health problems that can affect the whole body, and because it can interfere with one’s quality of life, it is important to talk with your doctor if you have trouble attaining or maintaining an erection. With increasing discussion of impotence in the media, coupled with advances in treatment, men are now much more comfortable talking with their doctors about impotence. It is currently estimated that between 15 and 30 million men in the United States are affected by impotence (Source: NIDDK).

It is very important to s eek prompt medical care if you are experiencing impotence, not only because impotence can be due to underlying health problems, but because treatment can improve your quality of life. Impotence is not a medical emergency, but it may be associated with diseases that can have serious complications.

Symptoms

What are the symptoms of impotence?

Impotence, or erectile dysfunction, is the inability of a male to attain and keep an erection sufficiently firm to engage in or complete sexual intercourse. Impotence manifests differently in different individuals. You may find you are unable to achieve an erection at all, or you may be able to achieve an erection, but only briefly.

Common symptoms of impotence

Common symptoms of impotence include:

  • Inability to achieve an erection
  • Inability to maintain an erection

Symptoms that might indicate a serious condition

In some cases, impotence can be associated with health problems that can lead to serious, even life-threatening, complications. Seek prompt medical care if you experience the new onset of, or recurrent symptoms of, impotence.

Causes

What causes impotence?

Most of the time, impotence has a physical cause. Achieving an erection is a complicated process requiring your body to transmit sensations from the genital area to the nervous system and return nervous impulses to the muscles and blood vessels of the penis. Anything that interferes with this interchange, such as disease or injury of the blood vessels, muscles, or nerves, can lead to impotence. Psychological factors such as anxiety and depression can also interfere with your erectile function.

Causes of impotence

A number of factors may cause impotence including:

  • Abnormally low testosterone levels

  • Atherosclerosis (buildup of plaque on the walls of arteries; atherosclerosis is a common cause of cardiovascular disease)

  • Depression or anxiety

  • Diabetes

  • Kidney disease

  • Medication side effects

  • Multiple sclerosis (disease that affects the brain and spinal cord causing weakness, coordination, balance difficulties, and other problems)

  • Obesity

  • Penile or testicular trauma or surgery of the bladder or prostate

  • Peripheral neuropathy (disorder that causes dysfunction of nerves that lie outside your brain and spinal cord)

  • Spinal cord injury or tumor

  • Trauma or structural injury (prolonged bicycling or bicycling accident)

What are the risk factors for impotence?

Many factors may increase your risk of developing impotence. Not all people with risk factors will develop impotence. Risk factors for impotence include:

  • Advancing age
  • Alcohol abuse
  • Cardiovascular disease
  • Cigarette smoking
  • Diabetes
  • Neurologic disorders
  • Overweight or obesity
  • Psychological conditions
  • Substance abuse

Reducing your risk of impotence

You can play an active role in lowering your risk of impotence by:

  • Controlling your blood pressure if you have high blood pressure
  • Controlling your blood sugar if you have diabetes
  • Discontinue illicit drug use
  • Decreasing or eliminating alcohol use
  • Eating a healthy diet
  • Increasing physical activity
  • Maintaining a healthy weight
  • Participating in counseling to address emotional or psychological issues
  • Quitting smoking
Treatments

How is impotence treated?

Treatment of impotence begins with a lifelong program of regular medical care, which allows your health care professional to provide early screening tests. Regular medical care also provides an opportunity for your health care professional to promptly evaluate symptoms and your risks for developing impotence. Treatment of impotence is based on its cause.

Common treatments of impotence

Common treatments of impotence include:

  • Alprostadil urethral pellets (MUSE) to relax blood vessels of the penis

  • Couples therapy to develop techniques that improve intimacy 

  • Injectable medications such as alprostadil (Caverject, Edex), papaverine, and phentolamine to relax blood vessels of the penis

  • Oral phosphodiesterase (PDE) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) to improve blood flow to the penis

  • Psychotherapy to decrease anxiety

  • Surgery to improve blood flow to the penis

  • Surgery to prevent blood leakage from the penis

  • Surgical implants to cause erection

  • Testosterone replacement if a low testosterone level is a contributing factor

  • Vacuum devices to pull blood into the penis and cause engorgement

What you can do to improve your impotence

There are steps you can take that may mitigate your impotence. These steps include:

  • Decreasing or eliminating alcohol use

  • Discontinue illicit drug use

  • Eating a healthy diet

  • Increasing physical activity

  • Maintaining a healthy weight

  • Participating in counseling to address emotional or psychological issues

  • Taking medications as prescribed to control blood sugar and high blood pressure

  • Quitting smoking

What are the potential complications of impotence?

Complications of untreated diseases that contribute to impotence can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of impotence include:

  • Anxiety
  • Depression
  • Infertility
  • Relationship difficulties
  • Unfulfilling sex life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 10
  1. Erectile dysfunction. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). http://kidney.niddk.nih.gov/kudiseases/pubs/ED/.
  2. Erectile dysfunction. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/erectiledysfunction.html.
  3. McVary KT. Clinical practice. Erectile dysfunction. N Engl J Med 2007; 357:2472.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  5. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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