The causes of impotence and how to treat them

By Adam Rowden  

Reviewed by Alana Biggers, MD, MPH

Common causes | Treatments | Preventing impotence

Impotence is the inability for a man to get and maintain an erection. It is also known as erectile dysfunction and can impact a person's ability to have satisfactory sexual intercourse.

Impotence is a very common condition and can occur at any age. However, it is most common among older men.

According to the University of Wisconsin, around 5 percent of men in the United States that are over 40 years old have complete erectile dysfunction (ED). Around 15 percent of men over the age of 70 have complete ED.

Common causes

A man's ability to achieve an erection is based on a number of factors and can result from a variety of physical problems.

Mental health issues and other psychological problems can also cause ED or make it worse.

Physical causes

Erectile dysfunction is most commonly caused as a result of a physical factor. The most common causes include:

• heart disease
• high cholesterol
• clogged blood vessels
• injury to the penis
• diabetes
• obesity
• metabolic syndrome
• Parkinson's disease
• multiple sclerosis
• smoking and other tobacco use
• alcoholism
• other forms of substance abuse
• sleep disorders
• prostate cancer treatments or treatments for an enlarged prostate
• spinal cord injuries
• Peyronie's disease

Psychological causes

There are also a number of psychological causes for impotence. These are the most common psychological causes:

• stress
• depression
• anxiety
• other mental health conditions
• relationship problems due to stress, poor communication, or other concerns

Some men may suffer from a combination of physical and psychological issues that can lead to or worsen ED. For example, a physical injury, which may slow a person's sexual response, may lead to anxiety about achieving an erection. This anxiety can then worsen the ED.

The British National Health Service (NHS) also state that some men may only experience ED in certain situations. For example, a person may be able to achieve an erection during masturbation, or may find that they wake up with an erection.

If a person is unable to get an erection with a sexual partner, the cause of their impotence is most likely to be psychological.

If a person is never able to get an erection, the cause of their impotence is most likely to be physical.

Treatments

Firstly, a doctor will ensure that the individual is receiving the correct treatments for any other health conditions they may have. It may be that these conditions are causing the ED, or making it worse, so they must be treated properly.

The doctor will then treat the erectile dysfunction directly. There is a range of treatments available for impotence, but they vary according to the cause of the impotence.

Oral medications

There are a handful of oral medications that can be prescribed to people with erectile dysfunction. They include:

• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra)
• avanafil (Spedra)

These medications will not automatically cause an erection. The person must still feel some sexual stimulation for them to work. They do not cause sexual excitement and are not aphrodisiacs.

These drugs may cause some side effects, including headaches and facial flushing. Less commonly, a person may experience indigestion, a stuffy nose, and a blue tint to their vision.

These medications should be avoided if a person has the following conditions:

• severe heart problems
• severe liver problems
• has recently suffered a stroke
• has recently suffered a heart attack
• low blood pressure
• certain rare inherited eye diseases

Alprostadil

If a person's erectile dysfunction does not respond to treatment, they may be offered alprostadil. This is a man-made hormone that can help stimulate blood flow to the penis.

A person can either inject the hormone directly into their penis, or place a pellet of alprostadil into their urethra. The urethra is the tube that carries the urine from the bladder to the top of the penis.

According to the NHS, a person taking this hormone will usually experience an erection after 5 to 15 minutes. However, the length of time the erection lasts will vary depending on the dose of alprostadil taken.

Men who have sickle cell anemia and are at risk of priapism, which is a long-lasting painful erection, should avoid alprostadil. People with other disorders and those who are using other treatments for ED should not take alprostadil.

Some side effects of this treatment include:

• changes in blood pressure
• headaches
• dizziness
• pain in the penis
• urethral burning
• urethral bleeding
• reactions at the location of the injection

Vacuum pumps

Another alternative treatment for impotence is the vacuum pump. This can either be hand operated or battery powered.

A person places a tube over their penis and then pumps all of the air out of the tube, creating a vacuum. This vacuum causes blood to fill the penis making it erect. Placing a rubber ring around the base of the penis holds the blood in place, allowing the person to maintain an erection.

A vacuum pump can allow a man to maintain an erection for around 30 minutes. The NHS call these pumps "effective," stating that 9 out of 10 men are able to have sex after using them.

A man should not use a vacuum pump if he has a bleeding disorder or if he has taken medicines to reduce the clotting ability of his blood.

Less than a third of men will experience pain and bruising as a result of using a vacuum pump.

Surgery

Surgery procedures may be recommended but only if all other treatment methods fail.

These surgical treatments involve placing implants, which can be semi-rigid or inflatable, inside the penis.

Psychological treatments

If erectile dysfunction is caused by stress, anxiety, or other psychological reasons, a doctor will advise the person to visit a psychologist or counselor.

If the condition causes tension and stress within a relationship, both partners may be advised to attend the appointments together. This can be helpful in resolving any issues.

Preventing impotence

There are a number of ways in which a person can reduce their chance of developing impotence. These include:

• not smoking
• not abusing alcohol or other substances
• pelvic floor exercises
• losing weight if obese
• taking steps to avoid stress
• getting treatment for depression, anxiety, or any other mental health issues

Outlook

The outlook for a person who has impotence is very good. There is such a range of treatments available that it is highly likely a person will be able to find one that works for them.

SOURCE: MEDICAL NEWS TODAY