The Psychology of Impotence

Psychological factors can, of course, cause impotence. These include:

• guilt
• depression
• losing interest in your partner
• a partner who finds intercourse painful
• low self-esteem
• fear of not performing well

Often both physical and psychological factors are involved. A physical problem impairs erections, and you then become so preoccupied with the question 'Can I maintain my erection this time?' that sexual arousal becomes impossible. Anxiety actually has the physical effect of contracting the muscles of the erectile tissue, preventing blood entering the penis and allowing the blood to drain away.

How to Approach Your Doctor

According to Men's Health magazine, 'on the Richter scale of embarrassment, impotence comes near the top'. The Viagra publicity has loosened the taboo to some extent, but this is still the problem men least like discussing with their family practitioner. But it is, of course, the one problem that the family practitioner will not be able to guess that you have, unless you mention it. When you do manage to discuss it, you will probably find that your family practitioner is surprisingly matter-of-fact about it. Impotence is a standard medical problem that doctors are now trained to deal with. It is also possible that you have a local specialist hospital clinic.

If you keep avoiding the issue with your family practitioner there are two other possible approaches. Your partner could have a preliminary discussion with the doctor to pave the way. Or you could write to your doctor, marking the envelope 'Confidential' and explaining that you have been too embarrassed to mention the problem but would like an appointment to discuss it, if possible, at the end of a surgery when the doctor would have more time.

Even if you convince yourself that the problem is due to stress, see your doctor. You may be wrong, and even if you are right your doctor should be able to help.

Questions to ask yourself

• Is it really an erection problem? Or is the actual problem premature ejaculation or a lack of sexual desire?
• Can you achieve an erection by masturbation but not with your partner, and do you still sometimes wake with an erection? If the answers are 'yes', a psychological reason, such as stress or depression, is likely.
• Did loss of erections come on suddenly, or have erections gradually been failing over a long period of time? Erectile failure which comes on suddenly is usually psychological; physical causes usually have a more gradual onset.
• Have you been under extra stress lately? If so, is there any way you can lessen the stress in your life?
• Are you taking any drugs that might be responsible? If so, ask your doctor for alternatives.
• Are you drinking too much? Blood alcohol concentrations of up to about 25 mg/100 ml improve erections slightly, but when the level reaches about 40 mg/100 ml erection is inhibited. In some people, only one or two drinks is enough to raise the blood alcohol to this level. Heavy drinking over a long period can cause erectile failure because of nerve damage.
• Have you noticed anything else wrong? For example: Peyronie's disease, where the penis develops a lump and often kinks (Penis - bending), can cause impotence; tightness of the foreskin (tight foreskin) can prevent full erections; enlargement of the breasts or loss of body hair might mean a hormonal problem.
• Who is really bothered by the problem - you or your partner? Talk to your partner about what each of you wants from sex. As sex counselor Susie Hayman says, "It's amazing how many people just lie there wishing their partner was a mindreader."
• Are you a smoker? If so, can you stop? Stopping smoking won't reverse the problem, but may stop it getting worse.

Impotence can also result from depression and from relationship problems, so be prepared for some talk along these lines. However, most doctors believe that there is no point in deep psychoanalytical-type discussions; they prefer to do a few simple investigations and then deal with the problem in a practical way.

Last updated: 8/05

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