Impotence

Alternative names:

decreased sexual interest; male impotence; sexual dysfunction in males

Definition:

The inability to achieve and maintain penile erection sufficient to complete satisfactory intercourse; ejaculation may or may not be affected.

Considerations:

Occasional impotence occurs in about half of adult men in the U.S.; chronic impotence affects about 1 in 8 American men.

Impotence can be classified as primary or secondary. A man with primary impotence has never had successful intercourse with a partner but may achieve normal erections in other situations. This rare condition is difficult to treat.

Treatment of secondary impotence is more successful than that of primary impotence because, despite current impotence problems, there is some history of success with completing intercourse in the past.

Male infertility is quite different from impotence. A man who is unable to maintain an erection may be perfectly normal in every other way and very capable of fathering a child.

Except for impotence caused by injury or sudden illness, secondary impotence usually comes on gradually.

Aging alone does not cause impotence.

Premature ejaculation, when orgasm comes on too quickly to satisfy either partner, is different from impotence. The couple should seek counseling for this problem.

There are several components required for an erection:

• a responsive emotional state of mind
• a normally functioning pituitary
• adequate testosterone
• intact brain and nervous system
• adequate penile blood supply

Common causes:

• medication use (especially antihypertensives)
• smoking
• hormonal deficiency caused by disease (diabetes) or injury
• liver disease, usually caused by alcoholism
• circulation problems (arteriosclerosis, anemia, or vascular surgery)
• neurological problems (injury, trauma, disease)
• urological procedures (prostatectomy, orchiectomy, radiation therapy)
• penile implants (or prostheses) that are not functioning properly
• depression, anxiety, fatigue, boredom, stress, fear of failure
• mood-altering drugs, alcohol, medications
• fear of infection
• fear of recurring heart problems
• deep-seated psychological problems

Note: There may be other causes of impotence. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for impotence, occurring alone or in combination with other problems.