IMPOTENCE PROBLEM
Published by Bupa's health information team, July 2009.
Impotence is also known as erectile dysfunction and is the inability to achieve or sustain an erection for sexual activity to take place. It affects around one in 10 men and has a number of causes, both physical and psychological. There is a variety of treatment options available and for the majority of men, one of these will be successful.
Impotence occurs when a man has difficulty with either getting an erection or keeping one for long enough to allow penetrative sex. It's one of the most common sexual problems and affects around 2.3 million men in the UK. Half of all men over 40 will experience it at some point in their lives. It becomes more common and severe as men get older. However, only about one man in 10 seeks help. If you have problems getting or maintaining an erection over several weeks, ask your GP for advice.
There are a number of reasons why you may have impotence. Around three-quarters of men who have it have physical problems affecting the blood supply. However, there is a complex relationship between the physical and psychological aspects of sexual function. For instance, you may have physical health problems that cause psychological distress and this may have an additional effect on erection problems.
Physical health
A number of conditions may cause impotence, including:
· high blood pressure · high cholesterol · diabetes · obesity · multiple sclerosis · Parkinson's · stroke · surgery (such as an operation to remove your prostate gland) or radiation in your pelvic area· hormone imbalances such as hypogonadism which causes low levels of testosterone · Peyronie's disease - a condition affecting the sheath that surrounds the erectile tissue of the penis · hypospadias - a condition causing the urethra and penis to develop abnormally
Psychological
Psychological problems can influence your ability to get and keep erections. These include:
· feeling anxious, guilty or depressed · stress at work · partner conflicts · sexual boredom
· unresolved issues about sexual orientation
Lifestyle
Drinking too much alcohol can affect your ability to get and maintain an erection (often called 'brewer's droop'). In the longer term, it interferes with the production of testosterone, which can reduce your libido.
Smoking damages your blood vessels, so if you smoke this will increase the risk of erection problems. Chewing tobacco such as gutka may increase the risk of impotence. There is also anecdotal evidence suggesting that regular cannabis use can cause impotence.
Being physically inactive contributes to poor cardiovascular fitness, and may increase your risk of impotence. Impotence may be an early warning sign that you're at risk of coronary heart disease (when the arteries that go to your heart are narrowed).
Many men need greater tactile stimulation as they get older. You may want to consider a change in sexual foreplay and technique to ensure a sustained erection
Medicines
The side-effects of some medicines such as treatments for high blood pressure and certain antidepressants can cause impotence. Medicines can also affect your libido or cause problems with erections, ejaculation and orgasm.
Cycling
If you cycle for more than three hours a week, you may be at risk of damaging nerves through contact with the saddle. Your GP may recommend that you stop cycling for a few weeks to allow the nerves to repair and see if there is any improvement. You can also buy saddles that reduce damage to the erectile nerves.
You may decide to see your GP if you're anxious about how reliably you can have an erection. This is often the initial problem in younger men. However, occasional episodes of impotence are common and don't mean that you will have persistent problems in the future.
Your GP will ask about your general health and your erections. He or she will ask if you're taking any medicines, and whether there have been any changes in your life recently that might have influenced your sexual health.
Your GP will take your blood pressure and check the pulses in your legs. This helps to indicate how healthy your circulation is. He or she will examine your penis and scrotum. Your GP may also take a blood sample to test for related conditions. He or she may also examine your prostate gland.
Your GP may talk with you and your partner together about any physical or psychological factors that could be contributing to the problem. For example, around the menopause, women may experience pain or discomfort during intercourse.
If necessary your GP may refer you for more specialised tests to assess blood flow and how your nerves are working.
Impotence can nearly always be treated - the vast majority of men are given a suitable treatment. The simplest are talking therapies, such as cognitive behavioural therapy, and medicines.
If the cause is mainly because you're anxious or having relationship difficulties, talking to a counsellor or psychosexual therapist will be most helpful for you. This may also be useful if you think you may have other psychological problems such as depression.
Self-help
A healthier lifestyle may prevent your impotence getting worse. The following changes can help.
· Try to stop smoking.
· If you're overweight, ask your GP for advice about losing excess weight.
· Take moderate-intensity exercise (so you feel warm and slightly out of breath) for half an hour on most days of the week.
· Eat a balanced diet, including at least five portions of fruit and vegetables a day. Cut down on salty foods and sugary drinks.
· Drink alcohol in moderation. Using illegal drugs may also cause impotence.
· Aim to reduce stress in your life.
· If you have diabetes, make sure that you control your blood sugar levels properly.
Medicines
If your GP thinks prescription medicines are causing or contributing to impotence, it may be possible for you to switch to an alternative.A trial with a medicine that will help you obtain and keep an erection is probably the next step. However, you will only be able to receive these medicines on the NHS if you have a specific medical condition, such as diabetes, multiple sclerosis or Parkinson's disease. You may also be eligible for them if you have had major pelvic surgery, spinal injury or kidney failure.
There are three different types of medicine known as phosphodiesterase type-5 (PDE5) inhibitors. The three most commonly used are sildenafil, tadalafil and vardenafil. They work in the same way to relax the blood vessels in your penis so more blood can flow into it, leading to an erection. They don't increase your libido so you will still need sexual stimulation. The medicines will enable you to have erections for several hours.
There are other medicines available and your GP will be able to advise which is most suitable for you.
These medicines may cause side-effects, including headaches, feeling sick, indigestion and flushing. There have been rare cases of more serious complications including heart problems. All of these medicines are only legally approved for use in men and haven't been shown in clinical trials to be safe for
Alternative treatments
An external vacuum pump device pumps out the air from the penis and so sucks blood into it. You can use these with a constriction band to trap blood inside the penis.
You may be able to have surgery to increase the blood supply to the penis, although this is very rarely done, or have a penile implant inserted. Ask your GP for more information.
Complementary therapies
You may see herbal remedies advertised that claim to cure impotence without any scientific evidence to prove this. Many contain ingredients that can affect other medicines and cause side-effects, so always speak to your GP before trying any herbal remedies.
However, there have been studies showing that yohimbine, a chemical found in the bark of an African tree, can improve erections.
A small trial showed that Korean red ginseng increased sexual desire and successful erections and intercourse compared with a placebo (dummy treatment).
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