Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction.

Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects 10 to 15 million American men. In 1985, the National Ambulatory Medical Care Survey counted 525,000 doctor-office visits for erectile dysfunction.

Impotence usually has a physical cause, such as disease, injury, or drug side-effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging.

Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence--especially complications of impotence.

How does an erection occur?

The penis contains two chambers, called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.

Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.

What causes Impotence?

Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence.

Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Also, many common medicines produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug).

Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

How is Impotence Diagnosed?

Patient History

A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.

Physical Examination

Laboratory Tests

Other Tests

Psychosocial Examination

How is Impotence Treated?

The number of treatment options has increased in recent years and below we have listed a few.

VIAGRA: The most common treatment used now for impotence is the drug sildenafil (Viagra) and is effective in about 7 out of 10 men who use it. The pill is taken one hour before intercourse and, when effective, allows a normal erection with stimulation. It is not to be used by men who take any kind of nitroglycerin or nitrate drugs because the combination can result in severely low blood pressure.

SELF INJECTIONS: An erection can also be produced by self-injection of papaverine or prostaglandin before sex; these drugs may also improve long-term potency and penile blood flow. Prostaglandins can also be inserted directly into the urethra to produce erections. Medically administered testosterone shots help some men, but no specific level of the hormone guarantees potency.

PENILE IMPLANTS: When none of these therapies work, some men choose a penile implant. The least expensive is a semi-rigid type that produces a permanent erection. More-sophisticated and expensive implants are inflated by a pump mechanism placed beneath the skin of the scrotum.(See Figure 3)

PENIS PUMP: Another option for the treatment of erectile dysfunction is a vacuum inflation device (See Figure 2). This instrument draws blood into the penis by creating negative pressure around it; a rubber ring is then slipped over the base of the penis to maintain erection. The ring should be removed after 30 minutes to restore circulation.

PENIS PILLS: Many of the companies selling penis pills are using a combination of herbs that are known to improve blood flow to the penis, enhance sex drive by increasing the production of sex hormones such as testosterone or act as stimulants that boost energy levels. Several are used as effective treatments for impotence. Most penis pills will enable the erections to be harder and with more frequency depending on the quality of herbs. Many companies use the same ingredients but the qualities of herbal extracts are quit different. This is the key when dealing with Penis Pill products.

Points to Remember