What is Impotence?
Impotence is the inability to achieve or maintain penile erection sufficient to complete satisfactory intercourse or any other chosen sexual activity; ejaculation (coming) may or may not be affected. Impotence is also known as Erectile Dysfunction (ED).
Impotence can be classified as primary or secondary.
Primary Impotence: a man has never had successful intercourse with a partner but may achieve normal erections in other situations.
Secondary Impotence: despite current impotence problems, there is some history of success with completing intercourse in the past.
How Common Is Impotence?
Most men will experience occasional impotence, usually resulting from stress, tiredness, anxiety or excessive alcohol or other drug consumption. Worrying about impotence may then set the scene for a more persistent problem due to “fear of failure” known as performance anxiety. Research has established that prevalence of ED among Australian men ranges from:
- 13.1% of 40-49 year olds
- 33.5% of 50-59 year olds
- 51.5% in 60-69 year olds
- 69.2% of 70-79 year olds
Unfortunately, many men do not receive treatment or wait a long time before seeking treatment. Erections can change over time, sometimes stronger or weaker than other times. When men are in their teens they often have little control over their erections and obtain erections when not in a sexual situation. For most men this stops in their late teens to early twenties. As men get older, erections may not always be obtained when they want one. Almost every man has the occasional time when their erection is less strong than they would like but sometimes it becomes a problem.
What Causes ED?
The cause may be physical or psychological. For most men the cause is both physical and psychological. In 75% of cases of impotence there will be a physical cause.
Physical causes of ED include:
- High cholesterol
- Heart disease
- Post prostate cancer
- High blood pressure
- Alcohol or other drug use
- Some prescribed drugs
- Disease of the liver and kidney
- Surgery to the bladder, prostate gland, lower bowel and spine
- Poor blood flow to the penis resulting from blocked arteries
Psychological causes of ED include:
- anxiety or stress
- anxiety about sexual performance or sexual identity
- fear of sexual contact (from issues such as pregnancy or HIV/Sexually Transmitted Diseases)
- psychological trauma or abuse
- sexual problems with partner
- sexual boredom
- lack of communication in the relationship or other relationship issues
- grief or the effects of illness of self or family member
A general practitioner will complete a medical assessment (including testing blood sugars, cholesterol and blood pressure) Depending on the findings; they may refer the patient for specialist care.
The old saying that sex is natural is not true. Some men experience impotence because of lack of sexual education, in other words, they do not know what to do. Usually, once the man is given correct sexual information and any concerns have been discussed then this difficulty is overcome.
Help is available for both psychological and physical causes. Having psychological problems with sex does not mean that there is anything wrong with your mental health.
Approximately 75% of Impotence cases will have physical causes. A general doctor will complete a medical assessment; depending on the findings, they may continue management with you on their own or may refer you for specialist care. The medical assessment would include testing blood sugars, cholesterol and blood pressure. Doctors will also check hormone levels, examine you for signs of circulation or neurological (nerves) disorders as well as check your genitalia. It is also important to disclose all medications you are taking, including recreational and herbal. Drugs, oral or injections, to help obtain and maintain an erection are available from your doctor.
For further care, your doctor will refer you to either a Urologist or Sexual Health Physician. Raelene Stokes is WA Coordinator for Impotence Australia and specialises in Men’s Sexual Health. If you would like to make an appointment with Raelene please email: firstname.lastname@example.org.
1Reference: Chew KK, et al. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. International Journal of Impotence Research 2000; 12: 41-45. Prevalence figures are based on questionnaire responses from 1240 Australian men of various age distribution.