Impotence

Considerations:
Occasional impotence occurs in about half of adult men in the U.S.; chronic impotence affects about 1 in 8 American men.

Impotence can be classified as primary or secondary. A man with primary impotence has never had successful intercourse with a partner but may achieve normal erections in other situations. This rare condition is difficult to treat.

Treatment of secondary impotence is more successful than that of primary impotence because, despite current impotence problems, there is some history of success with completing intercourse in the past.

Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly normal in every other way and very capable of fathering a child.

Except for impotence caused by injury or sudden illness, secondary impotence usually comes on gradually.

Aging alone does not cause impotence.

Premature ejaculation , when orgasm comes on too quickly to satisfy either partner, is different from impotence. The couple should seek counseling for this problem.

There are several components required for an erection:
  • a responsive emotional state of mind
  • a normally functioning pituitary
  • adequate testosterone
  • intact brain and nervous system
  • adequate penile blood supply



Common Causes:

Note: There may be other causes of impotence. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for impotence, occurring alone or in combination with other problems.

Home Care:
Treatment varies depending on the cause and the significance of the problem for the individual man and his partner. The cause should be treated. For example, if the impotence is caused by a medication, consult your health care provider about changing medications. ALWAYS CONSULT YOUR HEALTH CARE PROVIDER BEFORE CHANGING A PRESCRIPTION MEDICATION.

Counseling may be advised. Rest and an active imagination are often effective measures. For impotence caused by fear of infection use safe sex practices , and abstinence should be considered if in doubt. Talk to your health care provider if impotence is related to fear of recurring heart problems; sexual intercourse is usually safe.

For impotence caused by smoking : stop smoking. For impotence caused by liver disease , alcohol consumption must be stopped.

Call Your Healthcare Provider If:

  • the problem is persistent or if there are other associated and unexplained symptoms.



What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting impotence in detail may include:

  • QUALITY
    • Have you been able to achieve and maintain erections in the past?
    • Is the difficulty in achieving erections or maintaining the erection?
    • Do you have erections during sleep?

  • TIME PATTERN
    • How long have you had difficulty with erections?

  • AGGRAVATING FACTORS
    • What medications are you taking (include both prescription and over-the-counter medications, as well as mood-altering recreational drugs)?
    • Do you smoke?
    • Do you use alcohol?
      • How much?
      • How frequently?
    • Have you recently had surgery?
    • Have you ever had surgery or treatments for your blood vessels?
    • Have you noticed changes in your emotional state?
      • Are you depressed?
      • Are you afraid or worried about something?
      • Are you experiencing a lot of stress ?
      • Has your energy level decreased?
    • Are you sleeping well each night?
    • Are you afraid of sexual activity because of physical problems?
    • What changes in your life have recently occurred?

  • OTHER
    • What other symptoms are also present?
    • Have you noticed changes in sensations in your penis ?
    • Do you have any problems with urination?

Diagnostic tests that may be performed include:

Intervention:
Treatment depends on the cause. If impotence is caused by a hormonal deficiency, testosterone supplements may be prescribed. However, in cases NOT caused by hormone deficiency, testosterone supplementation may aggravate the situation by increasing the libido (sex drive) without improving the erectile ability of the penis. Counseling may be advised. In some cases, a penile implant (penile prosthesis ) may be advised.

After seeing your health care provider:
You may want to add a diagnosis related to impotence to your personal medical record.