Impotence

Alternative names:

decreased sexual interest; male impotence; sexual dysfunction in males

Home care:

Treatment varies depending on the cause and the significance of the problem for the individual man and his partner. The cause should be treated. For example, if the impotence is caused by a medication, consult your health care provider about changing medications. ALWAYS CONSULT YOUR HEALTH CARE PROVIDER BEFORE CHANGING A PRESCRIPTION MEDICATION.

Counseling may be advised. Rest and an active imagination are often effective measures. For impotence caused by fear of infection use safe sex practices, and abstinence should be considered if in doubt. Talk to your health care provider if impotence is related to fear of recurring heart problems; sexual intercourse is usually safe.

For impotence caused by smoking: stop smoking. For impotence caused by liver disease, alcohol consumption must be stopped.

Call your health care provider if:

• the problem is persistent or if there are other associated and unexplained symptoms.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting impotence in detail may include:

• QUALITY
  • Have you been able to achieve and maintain erections in the past?
  • Is the difficulty in achieving erections or maintaining the erection?
  • Do you have erections during sleep?

• TIME PATTERN
  • How long have you had difficulty with erections?

• AGGRAVATING FACTORS
  • What medications are you taking (include both prescription and over-the-counter medications, as well as mood-altering recreational drugs)?
  • Do you smoke?
    • Cigarettes, cigars, or pipes?
    • How much each day?
  • Do you use alcohol?
    • How much?
    • How frequently?
  • Have you recently had surgery?
  • Have you ever had surgery or treatments for your blood vessels?
  • Have you noticed changes in your emotional state?
    • Are you depressed?
    • Are you afraid or worried about something?
    • Are you experiencing a lot of stress?
    • Has your energy level decreased?
  • Are you sleeping well each night?
  • Are you afraid of sexual activity because of physical problems?
  • What changes in your life have recently occurred?

• OTHER
  • What other symptoms are also present?
  • Have you noticed changes in sensations in your penis?
  • Do you have any problems with urination?

Diagnostic tests that may be performed include:

• evaluation of nighttime penile erection using NPT (nocturnal penile tumescence test)
• hormone levels
• nerve conduction tests
• physiological screening
• voiding studies (voiding cystourethrogram)
• blood glucose or other tests for diabetes
• thyroid function tests
• testosterone level
• psychological tests

Intervention:
Treatment depends on the cause. If impotence is caused by a hormonal deficiency, testosterone supplements may be prescribed. However, in cases NOT caused by hormone deficiency, testosterone supplementation may aggravate the situation by increasing the libido (sex drive) without improving the erectile ability of the penis. Counseling may be advised. In some cases, a penile implant (penile prosthesis) may be advised.

After seeing your health care provider:
You may want to add a diagnosis related to impotence to your personal medical record.