Overcoming Impotence

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Causes, diagnoses and treatments

What is impotence?

A man who is impotent is persistently unable to get or keep an erection that is firm enough for sexual intercourse. He usually still has the ability to have an orgasm and father a child, but he often has difficulty doing these things. Impotence is not normal and is by no means an inevitable consequence of ageing.

Most men at one time or another are unable to get or keep an erection. This is normal and does not indicate a problem. However, millions of men of all ages experience this inability as a continuing problem. Impotency is frequently associated with feelings of inadequacy or hopelessness, but in most cases it can now be overcome.

What causes impotence?

The causes of impotence can be psychological or physical. At least half of the men suffering from impotence can trace its origin to a physical problem. For most men, the cause of impotence can now be fairly easily identified. Once identified, proper treatment can be recommended to help them return to a satisfying sexual life.

Most physical impotence is the result of permanent, physical damage and requires more extensive treatment. For example, diabetes and hardening of the arteries are causes of impotence in a significant number of men and successfully treatment of the impotence frequently requires an operation for a penile implant. Smoking can also increase the chances of becoming impotent.

How is the cause of impotence determined?

The first step toward overcoming impotence is to determine whether the problem is psychological or physical. Doctors who are experienced in the evaluation of impotence can often learn a great deal about the cause through general conversation about the problem. Many men prefer to consult with their physician alone, but more and more couples are seeing their doctors together and sharing their sexual concerns. If counselling doesn’t provide an answer then a special ultrasound examination can provide further information.

What is psychological impotence?

Psychological impotence is impotence caused by a man’s anxiety or fear that he will not be able to perform well sexually. This is often referred to as “performance anxiety” or “fear of failure”. A man who is worried about getting an erection cannot relax and probably will not be able to get an erection.

How is psychological impotence treated?

The preferred treatment for most men with psychological impotence is counselling or sex therapy. Such counselling can be sought from a clergyman, psychologist, licensed marriage or family counsellor, psychiatrist, or other physician experienced in dealing with sexual problems. Psychological impotence that has lasted for less than a year is generally more easily overcome that that which has existed longer, so the earlier the treatment is sought, the sooner the impotence can be overcome.

What is physical impotence?

Physical impotence is impotence caused by a physical disorder such as an injury, a disease, a hormone imbalance or an operation. Examples of physical disorders that can cause impotence include arteriosclerosis, or hardening of the arteries, high blood pressure, diabetes, brain or spinal cord injuries, surgical removal of the prostate gland, bladder or rectum for cancer, and radiation treatments to the pelvis. Substances such as alcohol, tobacco, drugs and certain medications can also interfere with erections and cause physical impotence.

How is physical impotence treated?

Treatment for physical impotence depends on the underlying cause. Hormone problems or adverse effects from medication can often be corrected quite easily. The use of pills or injections will usually restore normal erections in hormone-related cases. If the impotence is a side effect of medication, the substitution of another drug under the supervision of a physician will allow normal erections to return.

What is a penile implant?

Penile implants are commonly used to treat impotence caused by diabetes or arteriosclerosis. The implant is surgically placed into a man’s body and is designed to help him get an erection. It can help restore a healthy sex life and is a relatively simple operation.

There are two basic types of penile implants: inflatable implants and flexible rod implants. Both enable the impotent man to achieve a satisfactory erection for sexual intercourse and to experience the joys of sex again. The primary difference between the two types is that the flexible rods produce a permanently firm penis, while the inflatable types produce a controlled more natural erection.

Who can have an implant?

The primary reason for implanting a penile prosthesis is to enable a man to get an erection satisfactory enough for intercourse. For many men, a penile implant offers the only possible solution to the problem. The choice is whether to remain impotent and unable to have intercourse or to undergo a surgical procedure that return to normal sexual activity.

Prof Colin Moore