Impotence is the inability to achieve and maintain a penile erection. While it may be embarrassing to talk about this condition, it actually affects almost 7-15% of Asians, with the prevalence increasing each decade.
Impotence is the inability to consistently obtain firm erections or ejaculate; it is also known as erectile dysfunction. Various physical and emotional factors can cause this disorder. It can cause stress, depression, and low self-esteem in men, and even contribute to relationship issues due to dissatisfaction.
Problems getting or keeping an erection may also be a symptom of other underlying health conditions, and needs to be addressed and treated accordingly.
Symptoms
The common misconception is that one cannot get an erection when impotent. In fact, impotence includes the following symptoms:
- Inability to hold a firm erection
- Premature or delayed ejaculation
- Inability to have orgasm after sufficient stimulus
- Reduced sex drive
Having these issues from time to time is usually not a cause for concern. However, if the symptoms persist, it may point to a medical condition.
Causes of Impotence
Male sexual arousal involves many parts of the body, including hormones, emotions, nerves, muscles and circulatory system. Hence, impotence can be caused by an issue with any part of these processes. It can also be a result of a combination of issues.
Some common causes of impotence includes:
1. Endocrine Diseases
The endocrine system helps regulate the body’s sexual function, metabolism and reproduction, among other functions of the body.
Diabetes is the most common cause; it damages the penis nerve and causes impaired blood flow to the penis and unusual hormone levels. Overall, it is a high-risk factor. Hypogonadism is a condition where the male gonads (testes) produce little to no hormones (testosterone). Reduced testosterone levels can impact a man’s sexual drive and cause some symptoms of impotence. In hyperprolactinemia, excess levels of prolactin interferes with secretion of gonadotropin-releasing hormone (GnRH), resulting in decreased testosterone and hence symptoms of impotence.
2. Neurological and Nerve Disorders
Several neurogenic disorders can cause impotence and nerve disorders that can affect the brain’s ability to link with the sexual organ, causing the erection to be affected. Here are some conditions:
- Parkinson disease
- Brain and spinal cord tumour
- Multiple sclerosis
- Temporal lobe epilepsy
The causes of nerve damage that can result in impotence can include:
- Prostate surgery
- Spinal cord injuries
- Stroke
- Riding bicycles for a long period of time, causing excess pressure on the genital area
3. Drugs
Many drugs can potentially cause impotence as a side effect.
- Antidepressants
- Anxiolytics
- Muscle relaxants
- Diuretics
- Antihypertensives
- Selective serotonin inhibitor
- Chemotherapy drugs
4. Vascular diseases
Vascular diseases are conditions that affect the circulatory system, or the system of blood vessels. When blood flow is affected, the blood vessels in the penis are also affected, resulting in erectile dysfunction. Vascular diseases include atherosclerosis, high cholesterol and hypertension (high blood pressure).
Furthermore, men with heart and vascular diseases also present with other risk factors such as diabetes and obesity, which leads to a high prevalence of erectile dysfunction in this population. Vascular diseases account for 70% of physical-related causes of erectile dysfunction.
5. Psychological
Psychological causes account for about 10-20% of cases of impotence. This is because the brain also plays a role in sexual arousal and sexual feelings. There is not one single psychological cause that can trigger impotence in men, a variety of issues can contribute to the condition
Stress arising from money, job woes, or mental health conditions including depression, anxiety can affect both sexual desire and sexual function. As previously mentioned, some medications used to treat psychological issues, such as antidepressants, can also contribute to the condition.
Treatment
Before treating impotence, the treating doctor will assess the condition to tackle any underlying medical problems that could be causing or worsening the erectile dysfunction. Depending on the causes and the severity of the condition, there are different treatment options available.
Medication
Oral medication
The Phosphodiesterase-5 (PDE5) Inhibitor is a common class of medication used to treat erectile dysfunction. It works by bringing about a vasodilating effect on the penis, by inhibiting PDE5 enzymes that reverse the erection process.
These include: Sildenafil, Tadalafil, Verdenafil
Others
If the pills are not suitable or ineffective, other medical therapies also exist.
Alprostadil is a medication that can be administered via injections or as urethral suppositories (also known as MUSE, medicated urethral system for erections). Like PDE5 inhibitors, Alprostadil also has a vasodilating effect on the blood vessels in the penis, increasing blood flow and promoting erections.
Vacuum devices, or penis pumps, can be an option. These devices help to pump blood to the penis to create a firm erection. A constrictor ring at the base of the penis can help to maintain the erection long enough for sexual intercourse.
Surgery
If other treatments have failed, surgery may be recommended. Implants can be surgically placed within the penis to aid in erection firmness.
Lifestyle changes
While lifestyle changes may not completely address the condition, making good lifestyle choices and developing healthy habits can play a role in reducing erectile dysfunction and improving overall sexual function.
- Quit smoking: Cigarette smoking is associated with erectile dysfunction, as well as heart disease.
- Decrease alcohol use: Chronic and persistent alcohol use can induce sexual dysfunction.
- Exercise: There is research to suggest that exercise and physical activity is inversely associated with the development of erectile dysfunction.
- Eating a healthy diet: The Massachusetts Male Aging Study found that a diet high in fruits, vegetables, whole grains and fish, and low in red meat, processed meat and refined grains decreased the likelihood of erectile dysfunction developing.
- Psychological counselling: Addressing one’s mental state such as low self-esteem, stress or relationship issues may help to ease resulting erectile dysfunction symptoms.
- Get enough sleep: Poor sleep is associated with erectile dysfunction.
Alternative therapies
Many supplements in the market claim to help with erectile dysfunction. However, unregulated supplements may be contaminated with other medication which can be dangerous. If the claims sound too good to be true, be sure to practice caution.
Before using any supplement, check with your doctor and pharmacist to make sure it is safe and does not interact with any other medication.
Conclusion
Impotence is a very common condition, with many different possible causes. If you are concerned about symptoms, do not be embarrassed to approach a doctor. This is especially if you are also experiencing other sexual problems or have other chronic medical conditions. Appropriate treatments can then be tailored to the nature of the condition.
