Male Impotence

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Physical Causes of Impotence

The most common physical cause of impotence is tiredness, overwork and stress. It is perfectly normal to perform under par in these circumstances. Other physical causes include drug side-effects, hardening of the arteries (atherosclerosis), leaking valves that stop blood pooling within spongy tissues, fibrosis, hormonal imbalances and nerve damage.

Drug Side-effects

Drug side-effects are a common and reversible cause of impotence. Among the prescription drugs, the worst offenders are beta-blockers ­ which work by damping down the activity of certain types of nerve. Beta-blockers are excellent drugs which are frequently prescribed to treat high blood pressure, angina, heart attacks, anxiety, palpitations, migraine, glaucoma and an over-active thyroid, but if this side-effect becomes troublesome it is important to tell your doctor so you can be switched to a different type of drug.

Thiazide diuretics (water tablets) prescribed to lower high blood pressure or reduce fluid accumulation in the body can also trigger erectile failure. Patients taking diuretics are twice as likely to be impotent as those on no drugs. Again, tell your doctor; alternative treatments are available.

Anti-depressant tablets affect nerve endings in the nervous system and can also be at fault.

If you are taking any drugs at all it is worth asking your doctor or a pharmacist whether these are likely to affect your sex drive.

It is easy to forget that cigarette smoke contains a powerful drug, nicotine. Cigarette smoking is closely linked with erectile failure, and there is a clear dose-related effect: the more cigarettes smoked per day, the less rigid the erection. Cigarette smoking damages blood vessels and hastens 'furring up' of the arteries.

Atherosclerosis

Hardening and furring of the arteries is common in late middle age. Sometimes, the arteries leading to the penis become blocked and furred up with cholesterol deposits. This poor circulation means blood cannot flow into the penis in the volume required for a normal erection, and impotence results.

Tests that outline blood flow into the penis (using dyes that show up on X-ray) will show any narrowing of the arteries that may be the cause. Ultrasound is also sometimes used to measure changes to the blood flow after injection with an erection-inducing drug.

Slow Leaks

In some males, erection starts off rigidly and then slowly sags due to a slow leak of blood out of the corpora cavernosa and corpus spongiosum (see Chapter 1). This is due to a weakness in the mechanisms that constrict outlet veins and prevent pooling blood from draining away during erection. This problem can be detected by special tests using dyes that show up on X-ray (cavernosometry). Venous leaks are a common cause of impotence in older men. Some men suffer from both poor blood supply and a venous leak.

Fibrosiss

If the blood supply is normal, fibrosis or a build-up of scar tissue (e.g. Peyronie's Disease) can make the penis rigid on one side, rather than expansile. This stops the penis inflating fully, or makes it curve dramatically and painfully to one side. This can cause partial or total impotence. Surgical treatment to remove the scar tissue, or to take a tuck in the opposite side so erections become straight again, can help solve this problem.

Hormonal Imbalances

Occasionally, an hormonal imbalance may be the cause of impotence, especially if testosterone hormone levels are too low or prolactin hormone levels too high. If you suffer from impotence you will have blood tests to screen for hormonal problems. If an imbalance is found, this is usually easily treated once its cause is sorted out.

Diabetes

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Diabetes causes impotence for two main reasons: it encourages furring up of the arteries (atherosclerosis) and, if not well controlled, can lead to permanent nerve damage from the high levels of circulating sugar.

Nerve Damage

Diseases or injuries that affect the nerves can cause impotence. This includes men who suffer from severe multiple sclerosis, or who have sustained a spinal cord injury as a result, for example, of breaking their back. Sometimes reflex erections occur but ejaculation is not normally possible without electrical stimulation.

Next: Treatment of Physical Impotence

Last updated: 10/05

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