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Impotence is when a man cannot get an erection or keep an erection long enough for satisfying sexual intercourse. While this can happen to all men occasionally, if the erection difficulties interfere with your sex life, then you may have impotence. The term impotence is not really used that much anymore. Instead, the medical term most often used for this condition is erectile dysfunction (ED).
ED affects over 30 million men in the US (AUA, 2018). And this is not just a condition of older men—while your risk of ED increases with age, this condition affects one in four men younger than 40 years of age (Capogrosso, 2013).
- Impotence, more commonly known as erectile dysfunction (ED), affects over 30 million men in the United States.
- As you age, your risk of ED increases, but men can get ED at any age.
- Causes of impotence/ED include health issues (diabetes, high blood pressure, heart disease, etc.), medication use, lifestyle habits, and psychological factors.
- Phosphodiesterase-5 inhibitors are the most commonly used oral medications for ED treatment.
- Other treatment options include lifestyle changes (like a healthy diet and more exercise) injectable drugs, vacuum assist devices, penile implants, and herbal supplements.
How does impotence/ED work?
During sexual arousal, a complex interaction between several different body systems (blood vessels, muscles, nerves, hormones, etc.) occurs. First, the smooth muscles surrounding small blood vessels in the penis relax, allowing those blood to flow into the corpus cavernosa (spongy tissues in the penis). The spongy tissues then trap the blood, leading to an erection.
This process involves a compound called nitric oxide (NO), which is released by tissues and blood vessels in the penis (Sullivan, 1999). After orgasm and ejaculation, the brain sends signals to allow the blood to drain from the penis back into the body’s circulation, and the erection comes down.
ED is when this process does not happen as it should. This medical condition could be due to medications, stress, anxiety, or poor lifestyle habits. Scientists think that problems with NO can also lead to ED. Sometimes ED is a warning sign of another medical issue like hypertension, diabetes, or heart disease. Men with ED may be at significant risk of getting a heart attack or stroke (AUA, 2018).
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Risk factors and causes of impotence/ED
Age is one of the most well-known risk factors for ED. While the chance of having ED goes up as men age (over 50), aging does not lead to ED and ED can occur at any age. Health conditions, medications, psychological issues, and lifestyle habits can also increase your risk of developing ED (NIH, 2017).
- Diabetes: Men with diabetes are more than three times as likely to have ED and may develop it 10–15 years earlier than men without diabetes (Kouidrat, 2017).
- Low testosterone levels
- High blood pressure (hypertension)
- Atherosclerosis (hardening of arteries due to cholesterol plaques)
- Heart disease
- High cholesterol
- Chronic kidney disease
- Multiple sclerosis (MS)
- Peyronie’s disease (scar tissue in the penis)
- History of surgery or injury to the penis, spinal cord, prostate, bladder, or pelvis
- Blood pressure-lowering medications (e.g., beta-blockers, diuretics)
- Antiandrogens (medicines used for prostate cancer therapy)
- Antidepressants (e.g., selective serotonin reuptake inhibitors or SSRIs)
- Prescription sedatives (medicines that help you calm down or sleep better)
- Medications to treat acid reflux or stomach ulcers
- Anxiety about sexual performance or general anxiety
- Guilt or stress about sexual performance
- Self-esteem issues
- Life stressors
- Poor diet
- Alcohol overuse or abuse
- Illegal drug use
- Being overweight or obese
- Lack of physical activity
Signs and symptoms of impotence/ED
Occasional difficulties with getting an erection are not unusual for most men. However, if it is happening regularly or interfering with your sex life, then you should discuss your difficulties with your healthcare provider. Common symptoms of ED include (NIH, 2017):
- Difficulty getting an erection at any time
- Getting an erection sometimes, but not every time you want to have sex
- An inability to maintain the erection long enough to have satisfying sex
ED can also have psychological symptoms. Some men have less interest in sex because of their ED. Others may find that depression, anxiety, and relationship stressors both contribute to and stem from ED.
Treatment for impotence/ED
If you think you may have impotence or ED, talk to your healthcare provider. Treatments for ED may start with lifestyle changes to improve heart and blood vessel health. These changes include eating a healthier diet, exercising more, losing weight, smoking cessation, and mental health treatments. Treating ED directly usually involves medications, natural remedies, procedures, or some combination of these options.
The most commonly used treatment for ED is a class of medications known as phosphodiesterase-5 (PDE5) inhibitors. These are the only pills approved by the FDA for ED treatment and include:
- Sildenafil (brand name Viagra)
- Vardenafil (brand name Levitra)
- Tadalafil (brand name Cialis)
- Avanafil (brand name Stendra)
You take these medications an hour or two before sex, and they require sexual arousal to work. PDE5 inhibitors work by improving blood flow to the penis, thereby allowing for a more robust erection. According to the American Urology Academy, seven out of ten men will have better erections after using PDE5 inhibitors (AUA, 2018). You should NOT take PDE5 inhibitors if you are taking medications called nitrates (typically used to help treat heart conditions).
Other medications that your healthcare provider may recommend are testosterone therapy (if you have low testosterone levels in your blood) and drugs like alprostadil that are injected directly into the penis (AUA, 2018).
Natural remedies, while popular, are not all supported by clinical data, so it is essential to do your homework and talk to your healthcare provider before starting any supplements for ED. Some herbal supplements, like ginseng, show promising results in improving erections, but results are preliminary and more research is needed in these areas (Borrelli, 2018). Also, not getting enough folate and vitamin D may contribute to ED, but the data is limited (Farag, 2016; Yang, 2014).
Vacuum pumps may also be beneficial for some men. Lastly, surgical procedures are an option for some men. A bendable or inflatable implant can be surgically placed in the penis. A penile implant allows men to have more control over their erections. Most men (and their partners) are satisfied with the results (AUA, 2018).
Can impotence or ED be cured?
ED is treatable, but don’t go looking for a quick cure. It is important to remember that ED can be a sign of an underlying medical condition, so you should talk to your healthcare provider about your symptoms. Several effective treatment options are available; your provider can help you choose which one is right for you.
Be wary of herbal supplements, and make sure to research the active ingredients or ask your provider if you are uncertain. Lastly, talk to your partner about your issues so that they can help and support you.