Impotence guide

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Created: Monday, November 12, 2007

Published by BUPA's health information team, June 2007.

This factsheet is for men with impotence, or people who would like information about it.

Impotence is also known as erectile dysfunction and is the inability to achieve or sustain an erection for sexual activity to take place. It affects around one in 10 men and has a number of causes, both physical and psychological. There are a variety of treatment options available and for the majority of men these are successful.

What is impotence?

Impotence occurs when a man has difficulty with either getting an erection or keeping one for long enough to allow satisfactory sexual activity.

It's one of the most common sexual problems and affects around 2.3 million men in the UK. Half of all men over the age of 40 will experience it at some point in their lives. It becomes more common and severe as men get older. However, only about 10 percent of affected men seek help.

Causes

There are a number of reasons why you may have impotence. In around three-quarters of cases there are physical problems affecting the blood supply. However, there is a complex relationship between the physical and psychological aspects of sexual function. For instance, you may have physical health problems that cause psychological distress and this may have an additional effect on erection problems.

Physical health

A number of different conditions may cause impotence, including:

diabetes
multiple sclerosis
Parkinson's disease
if you have had surgery in your pelvic area
hormone imbalances
Hypothroidism
Hypo-testosterone

Psychological

Psychological problems can influence your ability to get and keep erections. These include:

feeling anxious, guilty or depressed
work
conflicts with your partner
unresolved issues about your sexual orientation

Lifestyle

If you drink too much alcohol, this can affect your ability to get and keep an erection (often called brewer's droop). In the longer term, itinterferes

with the production of the male hormone testosterone, which can reduce your sexual drive and desire (libido).

Smoking damages your blood vessels and so increases your risk of erection problems. Similarly, being physically inactive, which contributes to poor cardiovascular fitness, may raise the chances of you having impotence. Impotence may be an early warning sign that you are at risk of coronary heart

disease (the arteries that go to your heart are narrowed).

Many men need greater tactile stimulation as they get older. You may want to consider a change in sexual foreplay and technique to ensure a sustained

erection.

Medicines

The side-effects of some medicines such as those for high blood pressure and certain antidepressants can lead to impotence. Medicines can also affect

your libido, or cause problems with ejaculation and orgasm. These can also have an effect on erections.

Diagnosis

You may decide to see your doctor if you are anxious about how reliably you can have an erection. This is often the initial problem in younger men. However, occasional episodes of impotence are common and don't mean that you will have persistent problems in the future.

You may feel embarrassed when you first go to discuss the issue with your doctor or practice nurse. However, talking about impotence is routine for doctors and nurses.

Your doctor will ask about your general health and your erections. This will include whether or not you wake with an erection in the morningand thestrength of erections compared with those in the past. Your doctor will ask you if you are taking any medication, and whether there have been any changes in your life recently that might have influenced your sexual health.

Your Doctor will take your blood pressure and check the pulses in your legs. This helps to indicate how healthy your circulation is. He or she will examine your penis and scrotum. Your doctor may request blood tests for conditions such as anaemia, diabetes, high cholesterol or hormone imbalances. He or she may also examine your prostate gland.

Your doctor may talk with you and your partner together about any physical or psychological factors that could be contributing to the problem.

For example, around the menopause, women may experience pain or discomfort during intercourse - if the man has a faltering erection, this may lead to further distress for you both.

More specialized tests to assess blood flow and the way your nerves are working can be done in specialist hospital clinics. Your doctor will refer you if this is necessary.

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