Impotence,
the inability to have sexual intercourse, is common and although
it does become more common with age, 50% of 70 year olds are
still fully potent. The most common form of male impotence is
erectile failure, the inability to achieve or maintain a satisfactory
erection. Much less common, particularly in the younger, is
ejaculatory failure, where there is satisfactory erection but
ejaculation is not achieved. Erectile failure is, mainly, of
3 types. The man may be unable to get an erection at all. He
may be able to get some erection but insufficient to enable
vaginal penetration to take place. He may be able to achieve
an erection but it collapses before satisfactory sexual congress
is managed. Erectile failure can be due to either physical or
psychological causes, or both at the same time, one being made
worse by the other. One way to distinguish the two from each
other, by no means foolproof, is the early morning erection.
Many men have such an erection on waking and its presence, in
impotency, suggests a psychological cause rather than a physical
one, as does the ability to masturbate satisfactorily. The physical
causes are mainly those that either interfere with the blood
supply or the nervous supply to the penis. Diabetes can do both.
Other physical causes include atherosclerosis (hardening of
the arteries) and injuries to the spinal cord. Some medications
can produce erectile failure, particularly if taken every day,
as with some diuretics and blood pressure medication. Certain
drugs may seriously reduce the libido, the loss of the sexual urge, a common cause of psychological impotence. Loss of libido may be related to a particular partner or partners in general. Stress, anxiety, loss of self-confidence and depression may all be involved in psychological impotence. Ejaculatory failure is not uncommon amongst older men. It is also seen, sometimes in younger men as well, as a side effect to medication, particularly the SSRI ant-depressants (se Depression).
The actual type of impotence must be defined and reasonable expectations must be considered depending on the age of the man concerned. It is common for men with impotence to be referred to a multi-disciplinary unit where the causes may be sorted out and treated by the appropriate physicians. For the psychological cases reassurance, counselling and advice are essential. Medication, such as prostaglandin E, given by injection in to the penis or through a tube into the urethra can induce satisfactory penile engorgement in all types of impotency. Sildenafil (Viagra) can be taken by mouth and facilitates an erection. It is not, however, an aphrodisiac, and to work, some degree of psychological arousal must be present. Various physical devices are available to help maintain an erection. In some cases an erectile device can be surgically implanted. In some milder cases of psychological impotence, little more is often required than for the libido to be increased by the better management of stress, adequate rest and relaxation, a more stimulating love life (erotica etc). and the habit of making love, if possible, when one feels most active and alive “love in the afternoon”. All this will restore confidence. Smoking, drugs and the excess use of alcohol can all be potent anti-aphrodisiacs. |
