Sexual Dysfunction – Male Impotence

A consistent inability to achieve or maintain an erection of the penis necessary to have sexual intercourse. (The occasional periods of impotence that occur in just about all adult males are not considered dysfunctional).

FREQUENT SIGNS AND SYMPTOMS

  • Inability to achieve an erection.
  • Inability to maintain an erection for the normal duration of intercourse (erection may be too weak, too brief, or too painful).

CAUSES
Psychological causes include:

  • Guilt feeling.
  • A poor relationship with the sexual partner.
  • Psychological disorders, including depression, anxiety, stress and psychosis.
  • Lack of sexual information, including an understanding of the emotional aspects of sexuality and information about female anatomy and physiology.

Physical causes include:

  • Diabetes mellitus.
  • Atherosclerosis (hardening of the areries).
  • Use of some antihypertensive medications.
  • Disorders of the central nervous system, such as spinal cord injury, multiple sclerosis, stroke or syphilis.
  • Endocrine disorders that involve the pituitary, thyroid, adrenal or sexual glands.
  • Alcoholism.
  • Drug abuse, especially of marijuana, cocaine, narcotics, tranquilizers, sedatives, hypnotics and hallucinogens.
  • Decreased circulation to the penis from any cause.

Situational causes:

  • Presence of other people in the home (such as mother-in-law).

RISK INCREASES WITH

  • Problems listed in Causes.
  • Recent illness that has lowered strength.
  • Recent major surgery (e.g., cardiovascular or prostate surgery).

PREVENTIVE MEASURES

  • Maintain good communication with your partner. Don’t be hesitant about discussing the problem, exploring your needs and asking for help. Your partner’s understanding is critical to solving the problem.
  • Don’t drink more than 1to 2 alcoholic drinks, if any, a day. Don’t use other drugs that can be abused.
  • If you have diabetes, adhere closely to your treatment program.
  • Maintain overall good health.
  • If any new medication you take changes your sexual function, talk to the doctor.

EXPECTED OUTCOME

  • Spontaneous recovery sometimes occurs. In cases with psychological origins, recovery frequently occurs after counseling (psychotherapy).
  • For cases with physical origins, treatment of the underlying disorder or changes in a medication therapy may improve sexual performance.
  • Other medical methods to improve erectile function have greatly improved the outlook.

POSSIBLE COMPLICATIONS

  • Depression and loss of self-esteem.
  • Marital problems or breakdown of close personal relationships.

MANAGEMENT
GENERAL MEASURES

  • Medical tests as needed for diagnosis of any underlying.
  • For some patients, studies are done at a special diagnostic facility to measure nocturnal erections.
  • Psychotherapy or counseling (alone or with your partner) from a qualified, professional sex therapist.
  • If medication is the cause, a change in medication or changes in dosage may be helpful.
  • Self-administered penile injection therapy may be prescribed.
  • Use of vacuum device may be recommended for some patients.
  • Surgery to implant an inflatable or noninflatable penile prosthesis will help in some cases.

MEDICATION

  • Medication is not helpful for impotence caused by psychological factors.
  • Medication as needed, to treat the underlying medical condition.
  • Medication for self-administered penile injections may be prescribed.

ACTIVITY

No restrictions. Sexual relations can be resumed when potency returns or any surgery performed.