Brief overview
- What is impotence? Penis does not stiffen sufficiently or long enough for satisfying sex act
- Causes: various physical and/or psychological reasons, e.g. cardiovascular diseases, diabetes, injuries to the corpus cavernosum, stress, inhibitions, depression
- Attending physician: urologist or andrologist
- Examination: discussion, possibly also with partner, examination of penis and testicles, if necessary also via the rectum (rectal examination), blood and urine tests, determination of hormone status
- Therapy: e.g. medication, vacuum pump, penile prostheses, surgery
- What you can do yourself: stop smoking, exercise regularly, cut down on alcohol, pay attention to healthy blood pressure and healthy cholesterol and blood sugar levels
Impotence: Description
Men with impotence are not isolated cases. Exact figures are not available because the number of unreported cases is very high. However, it is estimated that about five percent of men in the general population are affected. The risk of erectile dysfunction increases with age.
The extent of impotence can vary greatly from man to man. Some sufferers complain only of occasional potency problems (“It sometimes doesn’t work”), while others report a total loss of erectile function.
Only when a sufficient erection fails in around 70 percent of attempts and the problems last for at least six months do doctors call this “erectile dysfunction”.
Forms of impotence
Doctors distinguish between two forms of impotence:
Erectile dysfunction (impotentia coeundi).
Infertility (Impotentia generandi).
In this type of impotence, a normal erection does occur and sexual intercourse can be performed without problems. However, the man cannot father children. Usually, these men have ejaculation, but there are no intact sperm, too few sperm, or no sperm at all in the semen.
Impotence: causes and possible diseases
An erection is actually a miracle: it is created by the complex interaction of blood vessels, nervous system, hormones and muscles. And any of these players can “go slack.”
The reasons for impotence can thus vary greatly and be both physical and psychological. In about 70 percent of men with erectile dysfunction, physical causes (mostly diseases) are found. This is especially true in the age group of 50 and older. In other men, psychological reasons are responsible for impotence.
Impotence: Physical Causes
There are a number of conditions associated with erectile dysfunction. The most important are: Cardiovascular disease: Vascular calcification (hardening of the arteries, atherosclerosis) is the most common cause of impotence. Coronary artery disease (CAD), high blood pressure (hypertension) and high cholesterol (hypercholesterolemia) can also trigger erectile dysfunction. Peripheral arterial disease (pAVD), the main cause of which is smoking, can also trigger impotence. Obesity also has a negative effect on the vessels.
The connection between arteriosclerosis and impotence is as follows: if the arteries are calcified, not enough blood reaches the penis. Conversely, blood can also flow out of the penis too quickly, and sometimes both happen. But the result is always that the amount of blood in the erectile tissue of the penis is no longer sufficient for a satisfactory erection.
Hormonal disorders: Low testosterone levels are the main factor to be mentioned here. If not enough of the male sex hormone is produced or released, this weakens erectile function.
Neurological disorders: For an erection to occur, nerve signals from the brain must be sent to the penis. Nerve diseases such as multiple sclerosis, Parkinson’s disease, a stroke or tumors can disrupt the transmission of signals.
Damage to the spinal cord: In this case, disturbances of the reflex responsible for the erection can lead to impotence. This is observed, for example, in paraplegia. But a herniated disc can also impair the transmission of the nerve impulses necessary for an erection.
Surgical interventions: During operations in the pelvic region (for example, in the case of prostate cancer), the nerve pathways to and from the penis can be damaged. Impotence is then a frequent consequence.
Genital malformations: They can also be responsible for impotence.
Impotence: Psychological causes
In some patients, the cause of impotence is purely psychological, especially in younger men. Sexologists and psychologists see potency problems primarily as coded messages from body and soul. Thus, the following psychological factors can be behind it when the penis goes on strike:
- Depression
- Stress, pressure to perform
- Inhibitions, fears
- lack of self-confidence
- protest against having to be a strong man
- Partnership conflicts
- personality conflicts, e.g. unacknowledged homosexuality
Other causes
Certain medications can also cause erectile dysfunction, including drugs for cardiovascular disease such as beta blockers – they lower blood pressure.
Impotence: When should you see a doctor?
Men who suffer from impotence for several weeks should definitely see a doctor. This is because potency problems can be an early sign of a chronic disease, such as diabetes. If left untreated, these can become a serious health hazard. Therefore, overcome your shyness and go to the doctor early in case of a potency disorder!
Impotence: What does the doctor do?
The first port of call for erectile dysfunction is a urologist or andrologist. To clarify the impotence, a detailed discussion of the medical history (anamnesis) is first necessary. The doctor must also ask you very personal questions, including questions about your sex life. Sometimes this is followed by a discussion with your partner. You should also tell your doctor about all the medications you are taking – regardless of whether they are prescription drugs or not. This is because some medicines can cause impotence.
The next step is to clarify the underlying causes of erectile dysfunction. The first step is an examination of the penis and testicles. In addition, a manual examination via the rectum (digital rectal examination) is recommended. This can detect prostate enlargements, which can also cause Erectile Dysfunction.
Diagnosis of impotence further includes blood pressure and pulse measurement, as well as blood and urine tests. Among other things, the doctor will determine your hormone status. In special cases, he will also neurologically examine the nerves of the pelvic floor. In men with impotence who are older than 45, the blood may additionally be examined for signs of prostate cancer.
Ultrasound examinations of the blood vessels of the penis at rest – and sometimes after the injection of an erection-promoting drug – are important for the reliable diagnosis of erectile dysfunction.
Treatment
There are a number of individual treatment options for impotence. Which method is right for a particular case depends on the cause of erectile dysfunction and the man’s attitude to various forms of therapy. However, men must be aware that most treatment approaches only treat impotence, but do not eliminate its causes. In principle, the chances of success of impotence treatment are higher the earlier it is started. The decisive factor is whether or not the disease underlying the impotence can be treated.
If PDE-5 inhibitors do not help or must not be used (e.g., in the case of severe cardiovascular disease or taking antihypertensive drugs), the preparation yohimbine can increase potency under certain circumstances.
Hormone administration: The male sex hormone testosterone can help in some cases of impotence. When such therapy is appropriate depends on the individual case and should be decided by the doctor and patient together.
Vacuum pump: A vacuum is created in the vacuum pump that draws blood into the penis and temporarily resolves erectile dysfunction. A ring striped around the base of the penis prevents blood from draining too quickly from the erectile tissue once an erection is achieved.
Penile prostheses: Penile prostheses should be implanted in men with impotence only when all other methods have failed – because the procedure is permanent.
Surgeries: Vascular impotence can also be treated surgically. However, such interventions are risky and not very promising.
Dubious and dangerous potency aids
Don’t try to manage impotence yourself with drugs or dubious aphrodisiacs from the sex store. Erectile dysfunction is often an important early warning sign of serious diseases that are otherwise easily overlooked. Only a doctor can find out the cause of impotence and treat it effectively.
Be especially careful with net offers! Keep your hands off illegal internet offers that supply prescription drugs to treat impotence even without a prescription. Such products are often not effective because they contain, for example, only baking powder or flour. Then you have thrown your money out the window. Some illegal sexual enhancers are even dangerous because they contain toxins. You are not only harming your wallet, but also your health!
If side effects occur after using illegally distributed prescription drugs, you also have no liability claims against the manufacturer. In the case of orders from abroad, the package may also be confiscated by customs – and you will be left empty-handed.
What you can do yourself
In the case of potency disorders, it is always advisable to first improve your lifestyle habits:
- Stop smoking
- weight reduction in case of excess kilos
- regular physical exercise and sports
- normalization of elevated blood sugar levels
- normalization of elevated blood pressure and cholesterol levels
- reduction of alcohol consumption
There is now increasing evidence that such measures can have a positive effect not only on general health, but also on erectile function, and thus help against impotence.