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Impotence

What is it?

Impotence is a repeated problem with getting or keeping an erection (ee-REK-shun) of the penis. Impotence is also called erectile (ee-REK-tile) dysfunction or ED. An erection is when the penis gets hard, stiff, and raised so that sexual intercourse (sex) is possible. Impotence may or may not affect a man's ability to have an orgasm (sexual climax) and release semen. Semen (SEE-men) is the thick white fluid that comes out of the penis during ejaculation (ee-jak-u-LAY-shun). Impotence is a very common problem. It may be a long term condition or it may only occur once in a while. Impotence can often be helped with treatment.

What are the physical causes of impotence? More than one thing may cause impotence. Impotence is most often caused by a physical (body) problem. Physical problems that may cause impotence include:

  • Health conditions. A common cause of impotence is problems with the blood vessels of the penis. Certain conditions, such as hardening of the arteries (atherosclerosis), can reduce blood flow to the penis. Other diseases that may cause blood flow problems include high blood pressure and obesity. Some diseases cause nerve problems as well, which may also lead to impotence. Diabetes, alcoholism (abusing alcoholic drinks), and multiple sclerosis (MS) are examples. Some cancer treatments, such as surgery or radiation therapy, can lead to impotence. Deformities (growth problems) of the penis caused by disease or that are present at birth may also result in sexual problems.
  • Medicines. Some medicines used to treat other illnesses may decrease your desire for sex or make it difficult to have an erection. Medicines used to treat depression, blood pressure problems, and mental problems are just a few examples. If you think that your medicines are causing impotence, talk to your caregiver. Do not stop taking your medicine without your caregiver's OK.
  • Injury or surgical nerve damage. A brain injury, such as a stroke or a head injury, can affect normal sexual function. An injury to your back or groin area may damage the nerves that help cause an erection. Surgery of the prostate (PROS-tayt), bladder, or groin may also cause nerve damage. The prostate is a male gland that lies just below the bladder. The groin is the area where your leg and abdomen (belly) meet.
  • Hormone problems. Hormones are special chemicals that your body makes. Hormones act as messengers to help control how your body works. Impotence may happen if you have too much or not enough of certain hormones in your body. For example, a lack of the male hormone testosterone (tes-TOS-te-rohn) may cause problems with getting and keeping an erection. Having too much of the hormone prolactin (proh-LAK-tin) may also cause impotence problems. Diseases (such as thyroid disease) or certain injuries can cause hormone imbalances.
  • Aging. Impotence is more likely to happen as a man ages.
  • Lifestyle. Smoking, drinking alcohol, or using street drugs can cause or worsen erection problems. Lack of exercise may increase your chances of having impotence. Not getting enough rest may also cause sexual problems.

Can thoughts or emotions cause impotence? Emotional problems are problems with your mood or state of mind. These problems can cause impotence or make it worse, even if the original cause was physical. Sometimes impotence can lead to an emotional problem. For example, anxiety or depression may be caused or worsened by problems with your sex life. Emotional problems that may cause impotence or make it worse include:

  • Anger. You may be angry or upset with your sex partner. These emotions may prevent you from having an erection.
  • Anxiety. Fear or anxiety may keep you from having a normal response to sex. You may be nervous about pleasing your partner or be afraid of causing pregnancy. Fear of not being able to have or maintain an erection may actually cause those problems.
  • Stress. Being under stress can prevent you from focusing your mind on having sex. For example, worry over money problems or losing a job may cause sexual problems. Guilt about having sex or low self-esteem may also cause impotence problems.
  • Depression or other problems. You may feel depressed (very sad) during certain times in your life. During these sad times you may not have your usual desire to have sex. Some mental illnesses (and the medicines used to treat them) may also cause impotence.

Medical Care:

The treatment for impotence depends upon what is causing the problem. Your caregiver may suggest one or more of the following tests or treatments. You may have these tests and treatments in the hospital or caregiver's office.

Tests

  • Blood tests.
  • Emotional tests.
  • Nocturnal penile tumescence test. This is a test that may also be called a "NPT." During the NPT, caregivers will learn if you have erections while asleep. Caregivers attach small elastic bands to your penis. The bands are attached to a machine that records movement of the penis during sleep.
  • Urodynamic tests. These are tests to study the bladder, ureters, and urethra that are part of the urinary system. Problems in the urinary system may cause impotence.

Treatment

  • Counseling.
  • Medicines.
  • Surgery.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Damiana (Turnera diffusa) has been used for many years, but has not been studied in men with impotence.
  • Ginkgo (Ginkgo biloba) may be helpful for impotence, and has been studied in men.
  • Ginseng (Panex ginseng) has been used for many years, but has not been studied in men with impotence.
  • Yohimbe (Pausinystalia yohimbe) may be helpful for impotence, and has been studied in men.

Supplements:

  • Arginine , an amino acid, may be helpful for impotence, and has been studied in men.
  • DHEA (dehydroepiandrosterone) may be helpful for impotence, and has been studied in men. Even though DHEA is available over-the-counter, it is a hormone that may have dangerous side effects, if it is not used correctly. You should only use DHEA with your doctor's permission.

Complementary Therapies:

  • Acupuncture may help erectile dysfunction.
  • Hypnosis may help erectile dysfunction.

Other ways of treating your symptoms:

Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat impotence.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • You have a painful erection.
  • You pass urine that is a pink or red color.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Aydin S, Ercan M, Caskurlu T et al Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997; 31(3):271-274.

2. Chen J, Wollman Y, Chernichovsky T et al: Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized, placebo-controlled study. Br J Urol 1999; 83:269-273.

3. Reiter WJ, Pycha A, Schatzl G et al: Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study. Urology 1999; 53(3):590-595.

4. Sikora R, Sohn M, Deutz F-J et al: Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol 1989; 141:188A.

5. Ward WO: The hypnotherapeutic treatment of impotence. Va Med 1977; 104(6):389-392.


Last Updated: 12/4/2017
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