Although impotence is not a necessary consequence of aging, its incidence increases with age because the condition is often a side effect of other medical problems that come with age, such as vascular disease or diabetes. Recently it has been recognized that women may also experience sexual dysfunction, but problems regarding diagnosis remain, and the field is in its infancy. Only male impotence is addressed here. There are many causes and treatments, and the listings below, organized alphabetically, do not necessarily cover all of them. If you think you suffer from impotence, you should seek medical advice from a primary care physician or a urologist. It is estimated that 30 million men in the United States suffer from impotence, and that 95% of those cases can be treated.
Chronic tobacco use: Smoking has been shown to affect arterial blood flow and may also affect the arteries in the penis, reducing the blood flow necessary to maintain an erection.
Hormonal Imbalance: Only a small percentage of cases of impotence are due to hormonal problems, such as insufficient testosterone.
Neurologic Impairment: Injuries to the spinal cord or brain, or neurological diseases, such as Alzheimer's Disease, can lead to impotence. Erectile dysfunction is commonly associated with multiple sclerosis and Parkinson's disease.
Pelvic Surgery: Surgery or radiation to the prostrate, bladder, rectum or colon can cause nerve damage in the surrounding area. The damage may interfere with signals that must pass between the brain and the sexual organs to allow erection and orgasm.
Pelvic Trauma: Injuries caused by accidents, particularly accidents associated with bicycle riding, water sports, gymnastics and horseback riding, can cause impotence.
Prescription Drugs: Many prescription drugs, especially blood pressure or anti-depressant medication, can cause impotence, as well as some over-the-counter medications.
Psychological: Depression, anxiety, problems with self-esteem, anger, fear, and other mental conditions may lead to impotence.
Vascular Disease: Vascular diseases such as hardening of the arteries, or heart disease, can lead to reduced blood flow, thereby impairing the ability of the penis to become sufficiently engorged to maintain an erection.
NOTE: For up-to-date information, visit this page, sponsored by the National Institutes of Health: http://health.nih.gov/topic/Impotence
Intra Urethral Pellets: The patient uses an applicator to insert a small pellet of medication into the opening at the end of the penis (the urethra). The medication causes blood vessels to relax, so the penis fills with blood and becomes erect.
Common Side Effects: Pain, burning sensation
Oral Medications: The FDA-approved medication Viagra works directly on the blood vessels, allowing the arteries to expand. It will only cause an erection when the man is sexually aroused. For information about other oral medications, see the NIH website listed above.
Common Side Effects: Headache, facial flushing, backache, upset stomach, bluish tinge to vision
Penile Implants: This is an irreversible surgical intervention. Two inflatable balloons are implanted into the penis, a pump into the scrotum, and a reservoir near the bladder. When inflated by the pump, fluid from the reservoir flows into the inflatable balloons, creating an erection.
Common Side Effects: Swelling, potential infection/malfunction
Penile Injections: The patient or his partner uses a small needle to inject a powerful muscle relaxant into the base of the penis. The relaxation of muscle tissue allows blood to flow into the erection chambers in the penis, creating an erection.
Common Side Effects: Pain, bleeding, scarring, and rarely, prolonged erection
Vacuum Therapy: By placing a cylinder over the penis and withdrawing air, a vacuum is created, mechanically enhancing the flow of blood into the penis. A rubber ring placed on the base of the erect penis traps the blood inside the penis and maintains the erection.
Common Side Effects: Bruising, pain, diminished ejaculation