Impotence is the condition in which a man is unable to attain or maintain an erection sufficient for satisfactory completion of a chosen sexual activity. It is a common problem, affecting at least one in ten men across all ages in all countries. The problem can be global, in that it occurs in all situations when sexual activity is attempted, or it can be situational – where erections can occur in some situations but not in others. For example, the man may have good erections on awakening but fail to attain or maintain erections when he tries to have sexual intercourse with his partner. There are many different causes of impotence but fortunately, nowadays, as many as 90% of sufferers can be helped to regain their potency.

Tell-tale signs
A man who is experiencing impotence often feels embarrassed and guilty that he finds it difficult to talk about the situation, even with his partner. Instead, he may manipulate events so that he avoids situations in which sexual intercourse may occur.

Common examples of this include staying up late at night, so that his partner is asleep before he goes to bed, or working longer hours than usual at work, so that he is tired in the evenings, goes to bed earlier than his partner, and is asleep when she retires to bed. Another often-used play is to invite friends and relatives to the house frequently, so as to reduce the amount of ‘private’ time he has with his partner. He may also start going out more during the day, again to ensure that he is not available if his partner wants to approach him sexually. And of course, men can have the avoidance ‘headache’ when it comes to sex, just as women traditionally do.

These are all normal responses to the problem, but they can all make the problem worse. When the man can attain an erection but has doubts about maintaining it during sexual intercourse, he may reduce the time spent in foreplay and may ejaculate soon after penetration, before he loses his erection.

Partner’s reaction
The changes in the man’s behaviour as described above may make the partner think that the man is having an affair. When she thinks this, a woman sometimes reacts by trying to be more attractive and behaves more sexually to try to ‘win’ her man back. Obviously, this can make the situation worse as it will put more pressure on the man and he may then take more extensive steps to avoid physical contact with his partner, a reaction that will probably reinforce the woman’s mistaken idea that he is having an affair.

When a woman knows that her partner is having problems with erections, she may react in a number of ways. Some women feel responsible for the problem: “It must be my fault he is having a problem. Perhaps I’m no longer sexually attractive to him”; “Perhaps my dislike for a lot of sexual experimentation has made him lose interest”. Other women feel physically rejected, unsatisfied and resentful, feelings that can easily extend to other areas of their lives leading to arguments and bickering, often about trivial things. When a man can get an erection but loses it soon after penetration, some women blame themselves by thinking that their vaginas are too large to stimulate the penis sufficiently.

What causes impotence?
There are many causes of impotence. These can de divided broadly into physical or psychological causes.

Physical causes include conditions which damage the nerves or blood vessels that supply the penis, such as diabetes, high blood pressure, atherosclerosis (furring up of the arteries, such as occurs when the man has high cholesterol) and spinal injuries. The nerves and blood vessels can also be damaged as a result of surgery on the rectum, prostate gland and bladder, or by radiotherapy to pelvic organs. Another important physical cause of impotence is drugs. Many, but not all, drugs prescribed to treat high blood pressure and various drugs used for psychiatric conditions impair erections. Smoking and excessive drinking of alcohol can also lead to impotence. Rarely, impotence can be caused by having too little testosterone (male sex

Among the psychological causes of impotence, “fear of failure” is the most common. This is when the man is so pre-occupied that he will not be able to get or maintain his erection that he is unable to relax during sex. Other common psychological causes of impotence include tiredness, guilt, worry, depression and stress.

What can you do to help?
The conspiracy of silence that many couples maintain about impotence does nothing to help the problem. The first step to overcoming impotence is to face up to the problem and discuss it as openly as possible.

Women can often take a lead in this respect by broaching the subject in a non-judgemental and nonpressuring way. Mutual reassurance of continuing affection and love can go a long way in helping the couple discuss the problem. It is also helpful to discuss each others sexual needs. So many men hold the view that sex means full penetrative intercourse and anything less than this is not acceptable. Hence, if they are unable to have erections, they feel that all sexual contact must cease. For many women sexual intercourse is a means to have intimate contact with their partners; they find foreplay just as or even more enjoyable and satisfying than penetrative sexual intercourse. When an impotent man realises this, it can remove a considerable burden of guilt and feelings of inadequacy and this can sometimes have the effect of improving his erections because he knows he is not under such enormous pressure to perform. It is often helpful for the couple to agree that they will not try to have intercourse even if an erection occurs but instead just enjoy mutual caressing and close contact.

When these simple measures fail to overcome impotence the couple can mutually agree that professional help is needed. Women can sometimes take the lead in arranging such help. In the first instance this may involve discussing the problem with her general practitioner or the doctor at the Well Woman’s clinic. At other times it would be necessary for the man himself to attend his general practitioner and it might be helpful if his partner went along too.

Some general practitioners may have a special interest in impotence and are able to offer in-depth advice and a full range treatments. However, your GP may decide that a referral to a specialist is more appropriate.

Final Word
Fortunately it is now possible to treat up to 95% of impotent men by variety of different treatments. Not all the treatments are acceptable to all couples and it is therefore important that you discuss with your partner the treatments offered and come to a decision together which seems the most appropriate for you both.