Most men experience a failed erection at some time in their lives, but if you find that you can’t achieve and maintain an erection in at least 3 out of 4 attempts, you should ask your doctor about impotence.
In the past, doctors considered impotence to be a mainly psychological problem, caused by performance anxiety or stress. Now, however, doctors know that most cases of impotence have a physical cause, which can be treated. In fact, according to Impotence Australia, physical causes contribute to about 75 per cent of cases of impotence.
Physical causes of impotence include damage to the arteries and veins that allow blood to flow into and out of the penis, damage to the nerves that send signals from the body’s central nervous system to the penis, and, more rarely, a deficiency in testosterone or other hormones. Some medicines can contribute to impotence, as can some operations and radiotherapy treatments.
A very common cause of impotence is when blood flow to the penis is impaired due to atherosclerosis, also known as hardening of the arteries. In atherosclerosis, the arteries are clogged and narrowed, resulting in reduced blood flow. High cholesterol, high blood pressure obesity, diabetes, and smoking are all risk factors for atherosclerosis.
If your erection problems are caused by atherosclerosis, there is a chance that the arteries in other parts of your body (e.g. the coronary arteries) are also affected by atherosclerosis. In fact, erection problems may be the first sign that you are at risk of coronary heart disease. Because the arteries to the penis are narrower than those to the heart, you may develop symptoms of erectile dysfunction before you experience any symptoms of heart disease, such as angina. So seeing your doctor about erection problems may be important for your overall physical health.
Impotence can also be caused by a blood clot that prevents enough blood from flowing into the penis to cause an erection.
In some men, blood can flow in to the penis easily, but the problem is that it leaks out again, so an erection cannot be sustained. This is called venous leakage. Doctors aren’t certain of the cause of venous leakage, but they can perform surgery to help repair it.
Many medicines can cause erection problems as a side effect, including: diuretics; high blood pressure medications; cholesterol-lowering drugs; some types of antipsychotics; antidepressants; cancer treatments; non-steroidal anti-inflammatory drugs (NSAIDs); and epilepsy medications.
If you experience impotence after starting a new medication, tell your doctor, who may be able to prescribe a different medicine for you. You should also tell your doctor about any over-the-counter medicines or complementary remedies you may be taking.
Both forms of diabetes, Type 1 and Type 2, are common causes of impotence: men who have diabetes are 3 times more likely to have impotence than other men. Diabetes contributes to impotence because it can damage blood vessels and cause a type of nerve damage known as peripheral neuropathy.
The advanced stages of prostate cancer can affect the nerves and arteries that are vital for an erection. Radiation treatment for prostate cancer can harm the erectile tissues of the penis, and surgery can cause nerve or artery damage to the penis. Treatment for advanced prostate cancer often includes drugs that counteract testosterone, and commonly cause erectile dysfunction as well as loss of sexual interest.
Peyronie’s disease is an uncommon condition that affects a man’s sex life because his penis curves abnormally and causes pain when he has an erection. He might also be unable to have a hard erection. The curvature of the penis is caused by a scar, called a plaque, that forms in the penis.
Multiple sclerosis (MS) and other degenerative diseases of the nervous system can impair the nerves involved in erections.
Many men find that when they’re suffering from depression, they lose interest in sex and can’t get or keep an erection. Asking your doctor for treatments for depression may help alleviate your erection problems as well.
Low levels of the male hormone, testosterone, are more commonly linked to a lowered sex drive, rather than impotence itself. Only a small percentage of cases of impotence are caused by hormone deficiency.
Low testosterone levels may be the result of a condition called hypogonadism, in which the testicles don’t produce enough testosterone. More rarely, low testosterone can be caused by the pituitary (a small gland at the base of the brain) not secreting sufficient hormones to stimulate the testes to produce testosterone. The pituitary is also sometimes affected by small benign (non-cancerous) tumours that secrete prolactin, another hormone that can cause impotence.
Mildly decreased levels of testosterone are often not due to specific testicular or pituitary problems, but rather stress or depression. In this situation, testosterone replacement is rarely of any benefit.
Impotence can be caused by spinal cord injury; injury to your sex organs; or a pelvic fracture, which can cause damage to the nerves to the penis, or damage the blood vessels, resulting in impairment of blood flow to the penis.
Surgery to organs near the nerve pathways of the penis, such as the bladder, rectum and prostate, can cause nerve or artery damage to the penis, resulting in the inability to have an erection.
Smoking contributes to vascular disease, so it can contribute to erectile dysfunction by affecting blood flow to the penis. Smoking cessation often has a beneficial effect on erectile function.
Alcoholism can cause permanent nerve damage, resulting in impotence. This nerve damage is called peripheral neuropathy. Long-term alcohol use can impair the liver’s ability to function, resulting in a hormone imbalance in which a man has too much of the female sex hormone, oestrogen. On a day-to-day level, alcohol dulls the central nervous system, impairing sexual response.
Illicit drugs such as marijuana, cocaine, heroin, barbiturates, and amphetamines act on the central nervous system, impairing the body’s ability to respond sexually.
Nerve and artery damage can be caused by cycling too hard, rodeo riding, or prolonged use of a rowing machine, resulting in the inability to get an erection. Often, minimising the use of hard bicycle seats and exercise machine seats will help restore sexual function.
Most cases of impotence have physical causes, but, in some men, psychological factors are the main contributors to impotence. Impotence that’s triggered by psychological factors is more likely to appear suddenly, and perhaps when you’re with just one particular person, than impotence that has a physical cause. You’re also more likely to have morning erections, and be able to have an erection when you masturbate, than men whose impotence has a physical cause. Here are some psychological factors that can have an impact on your erections.
When you’re stressed and focusing on other issues apart from sex, you might find that you don’t want to have sex as often and there might be a drop in your ability to perform when you do try. You might find that tackling the source of your stress can have benefits in the bedroom as well.
Anxiety about your sexual prowess (commonly called performance anxiety) can, in itself, contribute to failure. By putting pressure on yourself, you become too anxious to get an adequate erection. Most men experience isolated episodes of erectile failure. Even when the transient physical cause has passed, anxiety that it may recur is sufficient to prevent erection. Anxiety, whether about something specifically sexual or part of a wider anxiety syndrome, is never helpful to good sexual function.
Impotence may be a manifestation of a poor relationship, or a problematic time in a relationship. Sexual boredom, tension or anger among partners, and lack of intimacy and communication are all possible triggers of erectile dysfunction. In these cases, seeing a counsellor may help.
It’s worth remembering that impotence is a complex medical condition, which may have more than one cause. For example, if impotence is the result of a side effect of medication or an underlying disease, the anxiety caused by lack of performance may perpetuate the erectile dysfunction even after the physical cause has been tackled. Almost any chronic physical or mental health disorder, including those with no direct effect on penile nerves or blood supply, can have a powerful effect on sexuality, sexual self-image and erectile function.
If you’re worried about your sexual response or the quality of your erections, don’t be afraid to talk to your doctor, who has access to treatments that can help.
Last Reviewed: 05 August 2009