Overview Of Impotence

Impotence is synonymous with the term Erectile Dysfunction. An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at all. Or, you may lose the erection during intercourse before you are ready. Erection problems do not usually affect your sex drive.

Erection problems are common. Almost all adult men have trouble getting or keeping an erection at one time or another. Often the problem goes away with little or no treatment. But for some men, it can be an ongoing problem. This is called Erectile Dysfunction (ED).

If you have trouble getting or keeping an erection more than 25% of the time, you should see your health care provider.

Commonly Associated With

Erectile dysfunction; Sexual dysfunction – male

Causes Of Impotence

To get an erection, your brain, nerves, hormones, and blood vessels all need to work together. If something gets in the way of these normal functions, it can lead to erection problems.

An erection problem is usually not “all in your head.” In fact, most erection problems have a physical cause.

Below are some common physical causes.



  • Antidepressants
  • Blood pressure medicines (especially beta-blockers)
  • Heart medicines, such as digoxin
  • Sleeping pills
  • Some peptic ulcer medicines

Other physical causes of impotence:

  • Low testosterone levels. This can make it difficult to get an erection. It can also reduce a man’s sex drive.
  • Nerve damage from prostate surgery.
  • Nicotine, alcohol, or cocaine use.
  • Spinal cord injury.

In some cases, your emotions or relationship problems can lead to ED, such as:

  • Poor communication with your partner.
  • Feelings of doubt and failure.
  • Stress, fear, anxiety, or anger.
  • Expecting too much from sex. This can make sex a task instead of a pleasure.
  • Erection problems can affect men at any age but are more common as you get older. Physical causes are more common in older men. Emotional causes are more common in younger men.

If you have erections in the morning or at night while you sleep, it is likely not a physical cause. Most men have 3 to 5 erections at night that last about 30 minutes. Talk with your provider about how to find out if you have normal nighttime erections.

ED can result from health problems, emotional issues, or both. Some known risk factors are:

  • Being over age 50
  • Having high blood sugar (Diabetes)
  • Having high blood pressure
  • Having cardiovascular disease
  • Having high cholesterol
  • Smoking
  • Using drugs or drinking too much alcohol
  • Being obese
  • Lacking exercise

Symptoms Of Impotence

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, The primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man’s vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke, or circulatory problems in the legs. ED also causes:

  • Low self-esteem
  • Depression
  • Distress for the man and his partner

If ED is affecting a man’s well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health, and help the quality of a man’s life.

Exams & Tests

Your provider will perform a physical exam for impotence, which may include:

  • Taking your blood pressure
  • Examining your penis and rectum to check for problems
  • Your provider will also ask questions to help find the cause, such as:
  • Have you been able to get and keep erections in the past?
  • Are you having trouble getting an erection or keeping erections?
  • Do you have erections during sleep or in the morning?
  • How long have you had trouble with erections?

Your provider will also ask about your lifestyle:

  • Are you taking any medicines, including over-the-counter medicines and supplements?
  • Do you drink, smoke, or use recreational drugs?
  • What is your state of mind? Are you stressed, depressed, or anxious?
  • Are you having relationship problems?
  • You may have a number of different tests to help find the cause, such as:
  • Urinalysis or blood tests to check for health conditions such as diabetes, heart problems, or low testosterone
  • A device you wear at night to check for normal nighttime erections
  • Ultrasound of your penis to check for blood flow problems
  • Rigidity monitoring to test how strong your erection is
  • Psychological tests to check for depression and other emotional problems

Treatment Of Impotence

There are several different ways that erectile dysfunction can be treated. For some men, making a few healthy lifestyle changes may solve the problem. The urologist will help determine the most effective course of treatment for the condition.

Treatment options for ED include:

  • Avoid nicotine, alcohol, and other drugs.
  • The doctor may change the prescriptions if a medication has caused erectile dysfunction.
  • Psychological counseling may be recommended when erectile dysfunction has an emotional or psychological cause.
  • Testosterone injections or skin patches are given if blood testosterone levels are low.
  • Hyperthyroidism or hypothyroidism is treated if necessary.
  • Bromocriptine therapy is given to correct elevated prolactin levels.
  • Three oral medications are currently available for treating erectile dysfunction: Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil). All three drugs treat erectile dysfunction by permitting blood to flow into the penis during sexual stimulation – the drugs do not produce erections in the absence of sexual stimulation. Viagra and Levitra improve erections for about four hours; Cialis is effective for 24 to 36 hours. The side effects of the three drugs are slightly different. The drugs are not recommended for men who take nitrate-containing medication (such as nitroglycerin) or men who have recently had a stroke, heart attack, or life-threatening arrhythmia.
  • A special vacuum device may be used to produce an erection. Air is pumped out of a plastic tube placed securely over the penis, and the resulting vacuum pulls blood into the corpora cavernosa within a few minutes. The device is removed and a rubber band is placed at the base of the penis to maintain the erection.
  • Self-administered injections of alprostadil, a vasodilator drug, dilate the blood vessels in the penis to produce an erection. The doctor will instruct you on the correct injection technique.
  • Surgical implants for the penis are available. In one procedure, an inflatable device with a small fluid reservoir is inserted. In another, flexible rods are implanted that can be either bent upward to produce an erection or tucked close to the body.
  • In rare cases of erectile dysfunction, the doctor may advise vascular surgery to improve blood flow to the penis.