Sexual & Reproductive Health

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Impotence is when a man can't get or keep an erection long enough to have sex. It is also called erectile dysfunction. Most men have impotence every once in a while or for short periods of time. Impotence is most common in men over the age of 65, but it can occur in middle-aged or younger men. Impotence isn't just part of aging. It often has a cause that can be treated. Most men feel awkward talking about impotence. But the truth is that many men with impotence can be helped. Talk to your family doctor to find out what treatment may help you.


Impotence takes three forms.

  • There is primary impotence when the man’s erectile dysfunction is there from the very beginning of sexual activity and he simply cannot have any erection.
  • Secondary impotence is the commonest and this implies that the man can normally attain an erection but fail on one or more occasions in between normal activity.
  • The third form is associated with advancing age.


Sexual impotence may result from phychological illness such as depression which lowers both sexual drive and erectile function, tiredness, alcohol abuse, the therapeutic use of oestrogens, paralysis of parasympathetic nerves by drugs or permanent damage to them, and diabetes. Other causes of impotence include a devitalized condition of the system in general. The main problem of secondary impotence is the apprehension created by an earlier failure, which generates a good deal of anxiety for the next time.

Impotence can occur when something gets in the way of the process your body goes through to get an erection. This process involves the brain, which controls what you see, hear, feel, smell and think; the nerves, which pass messages from your brain to your body; and the blood vessels in your penis, which open to allow blood to flow in.

Physical causes are at the root of the problem in more than half of the men who have impotence. Physical causes include diseases that damage the blood vessels and block the flow of blood into the penis. Diseases that damage the nerves that carry messages of arousal from your brain to your blood vessels can also lead to impotence. Other diseases can lower your level of testosterone or your levels of other male hormones, which can also lead to impotence. Some of the physical causes of impotence are:

  • Alcoholism
  • Fatigue
  • Atherosclerosis (hardening of the arteries)
  • Diabetes
  • Brain or spinal-cord injuries
  • Hypogonadism (which leads to lower testosterone levels)
  • Liver or kidney failure
  • Multiple sclerosis
  • Parkinson's disease
  • Radiation therapy to the testicles
  • Stroke
  • Some types of prostate or bladder surgery

Certain drugs may affect the flow of blood to your penis or the hormone levels in your blood. Drugs that may lead to impotence include some antidepressants, some high blood pressure medicines and most tranquilizers. If you think your impotence is related to a drug you're taking, talk to your doctor. There may be another drug you can take instead.


Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for signs of physical causes.

Other tests may also be needed. For example, your doctor may want to find out if you have erections during sleep. Some tests that can be done at home measure if you have erections while you're asleep. Normally, a man will have about 5 erections during sleep. If you do, your impotence may not have a physical cause.


How impotence is treated depends on what things are causing it. Impotence with a physical cause may improve when the condition is treated or controlled. Impotence caused by a drug you're taking may improve when your doctor changes the drug or changes how much of the drug you're taking.

Counseling can be very helpful no matter what's causing your impotence, because impotence can affect how you feel about yourself and how you and your sex partner relate to one another.

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