Impotence

Impotence is a common problem, affecting one in ten men.

Impotence or erectile dysfunction is defined as the inability to achieve or sustain an erection that's hard enough or lasts long enough to complete sexual intercourse or another chosen sexual activity. It affects at least one in ten men, which means there are about 2.3 million sufferers in the UK.

Many men suffer for years without seeking treatment. This may be because they're too embarrassed to seek help or they're unaware that there are treatments available.

What causes it?
Most men will experience an occasional failure to get an erection. This can usually be put down to stress, tiredness, anxiety or too much alcohol. In these circumstances it's nothing to worry about.

In the past it was thought that more frequent impotence was caused by almost entirely psychological factors, but we now know that physical conditions are present in about 70 per cent of cases. However, the majority of men with erectile dysfunction experience a combination of psychological and physical causes.

Physical causes
Men whose impotence is due to a physical cause often find they gradually lose the ability to have an erection, and it tends to happen with all sexual activities. These physical causes may include:

* diabetes
* hardening of the arteries, which can lead to high blood pressure, angina or poor circulation
* kidney disorders
* multiple sclerosis or other neurological diseases
* high cholesterol
* side effects of prescribed drugs
* heavy smoking
* alcoholism and drug abuse
* pelvic surgery


Psychological causes
If you experience a sudden onset of impotence and can still achieve erections in some circumstances but not in others, the cause may be psychological. Psychological causes can include:

* stress and anxiety from work or home
* problems within your relationship
* worrying about poor sexual satisfaction
* depression
* sexual boredom
* performance anxiety
* unresolved sexual orientation


Sometimes the triggering factor can be easily identified, such as an argument or major disagreement with your partner. Or it might involve being interrupted while making love or excessive worry about areas such as work, family life or finances.

Treating impotence
It's important to remember that over the past few years there have been major advances in the treatment of impotence and the majority of sufferers can now be treated effectively.

Discuss the problem with your partner - a problem shared is a problem halved. For example, it may be your partner is unintentionally putting pressure on you to "perform". Discussing the problem with them may relieve this pressure and enable you to have an erection again.

Look at your lifestyle. Are you a heavy smoker? Do you drink a lot of alcohol? Do you suffer from stress and anxiety? Cutting down on your alcohol intake or giving up smoking could make all the difference. Try to reduce stress and anxiety by finding ways to relax.

If the problem persists, see your GP. You could also ask to be referred to a clinic that deals with sexual dysfunction. You can get a list of your local clinics from the Sexual Dysfunction Association. See related links.

Treatments available
* Psychosexual therapy. When psychological factors or relationship problems are considered to be the cause of your impotence, a course of sex therapy or couples therapy might be recommended. Therapy's very useful in helping you to re-establish a sexual relationship with your partner when there's been a long period without sex.
* Vacuum pumps. A device involving a plastic cylinder and pump is used to make blood rush to your penis, enlarging it in a similar way to an erection. When you remove the pump, the erection is sustained by slipping a tension ring around the base of the penis.
* Injections. You or your partner will be taught by a nurse or doctor to inject a drug directly into the shaft of the penis when you want an erection. An erection usually follows within 15 minutes. The procedure is easy to learn.
* Transurethral therapy (Muse). This involves taking a small pellet of a drug, about half the size of a grain of rice, via the urethra (the tube through which urine is passed) using a special disposable applicator. The drug is absorbed through the urethra directly into the erectile tissue of the penis, giving an erection within five to ten minutes.
* Viagra. This drug is taken in tablet form one hour before sexual activity. It then remains active for three to four hours. Viagra won't work without sexual stimulation. It's not an aphrodisiac and doesn't increase sexual desire.
* Uprima. Uprima is a tablet which is taken under the tongue. You place the tablet under your tongue and wait for it to dissolve, which can take about ten minutes. It acts within 15 to 25 minutes and can be effective for up to two hours. Uprima won't work without sexual stimulation.
* Cialis. This drug comes in tablet form and can be taken from 30 minutes before sexual activity. With sexual stimulation Cialis may be effective for up to 36 hours after taking the tablet. Like Viagra, it's not an aphrodisiac and doesn't increase sexual desire.
* Levitra. This tablet should be taken 10 minutes to one hour prior to sexual activity. With sexual stimulation Levitra can be effective up to 12 hours after taking the tablet. Like Viagra and Cialis it is not an aphrodisiac and does not increase sexual desire.
* Hormone treatment. Only a small proportion of cases of erectile dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of the male sex hormone testosterone which can be restored by appropriate hormone replacement. It's unwise to take testosterone preparations unless you've had tests that confirm a deficiency.
* Penile prosthesis. You shouldn't consider a prosthesis (implant) until other forms of treatment have been tried. There are two types of implant. The semi-rigid type keeps the penis rigid all the time but lets you bend it downwards when you're not having sex. The hydraulic type is more sophisticated and causes the penis to stiffen when a pump (implanted in the scrotum) is activated.
* Surgical treatment. A few cases of impotence are caused by abnormalities in blood flow in and out of the penis and can be treated with surgery.