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Impotence
The word impotence is derived from the Latin impotentia, meaning lack of power. It was first used to describe loss of sexual power in 1655 in, of all places, a treatise entitled 'Church History of Britain' by Thomas Fuller.
Impotence is the inability to obtain or maintain an erection for the satisfactory completion of heterosexual vaginal intercourse. Satisfactory is usually taken to mean an adequate erection, of sufficient hardness, maintained for a sufficient length of time, that ends in a controlled ejaculation and provides sexual satisfaction for both partners.
Impotence is a common and distressing condition affecting 10 to 30 per cent of men on a regular basis. All age groups are involved, but due to embarrassment or a mistaken belief that nothing can be done, victims often suffer in silence and despair. Whatever the cause of impotence, 99 per cent of men can get their erections back by one of the many treatment options now available.
It is often assumed that impotence is a purely psychological problem, but in 40 per cent of cases a physical cause is involved. If a man awakes with a morning erection or can masturbate to orgasm when alone, the problem is more likely to be psychological rather than physical.
If a male never manages an erection, even on waking, a physical problem is likely and this must be carefully looked into by a doctor specializing in urology.
During a night's sleep, between four and eight erections occur naturally unless there is a physical blockage preventing them. A special device can be attached to the penis before going to sleep that regularly measures penile diameter and rigidity throughout the night. This is useful for differentiating between physical and psychological causes of impotence.
Often, however, both physical and psychological factors play a role as a vicious circle builds up that causes anxiety and negative feelings to set in.
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.
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