Impotence: What Can be Done

Every man has experienced some difficulty obtaining or sustaining an erection from time to time. Fatigue, nervousness with a new partner, having a bit too much to drink, jet lag, stress: all these can affect a man's ability to stay hard. But frequent or chronic impotence (or, as it is now called, "erectile dysfunction" or ED) is something affects at least ten percent of all men, making it a very common problem. It is especially common in elderly men, men who have experienced prostrate problems, chronic alcohol and drug users, and obese men.

Little Blue Pill: a Miracle?
The introduction of various drugs such as Viagra or Cialis have offered help to millions of men with this problem. But the "little blue pill" has one main function, which is to help the vascular region of the penis to pump blood more efficiently (it is engorgement with blood during arousal that makes the penis hard). This does not address the problems underlying impotence which may not have a physical cause. Although research now indicates that physical causes lie at the root of up to 70 percent of cases of ED; in the past it was believed to be a mostly psychological problem. Many men experience a combination of physical and psychological factors: obviously the physical cause can be overshadowed by the psychological, as stress and anxiety can worsen the condition.

And there lies the problem. Since most men realize that ED is not necessarily the result of physical causes, many are embarrassed at the prospect of discussing it with their doctors, and won't seek help. Sadly, a free sample of Viagra obtained at the doctor's office is not going to solve this problem, even if it provides temporary relief.

Men must come to terms with the fact that they are not expected to perform like machines, and that occasional ED is not a reflection of their masculinity, sexual prowess or physical strength. The more a man worries about this problem, the worse it can become, and this creates a cycle of anxiety and frustration. Chronic impotence within a committed relationship can often create tension and resentment between partners, especially if men are not willing to seek help or even discuss the problem. Fortunately, the introduction of these new drugs, while they are not effective or desirable for everyone, has at least made ED a common topic of conversation, so most people are more comfortable discussing it without the same stigma it had years ago. If a man can discuss it with his doctor and pinpoint the cause, he can follow the proper course of treatment, whether it involves a prescription drug, special exercises, therapy/counseling, or minor surgery in some cases.

Physical Causes
The following conditions can negatively affect erectile function, making erections difficult to obtain and/or maintain:

Diabetes
High blood pressure, angina or arteriosclerosis
Multiple sclerosis or other neurological disorders
Kidney problems
High cholesterol
Surgery affecting the pelvic region
Alcohol or drug abuse
Side effects of medications
Heavy smoking (which affects circulation)
Clinical depression

These conditions tend to affect erectile function at all times.

Psychological causes
If a man can achieve erections in some situations but not in others (for example, he has no trouble when alone and masturbating but has difficulty with a partner), the cause is very likely psychological. Here are some of the common factors:
Stress/anxiety caused by work or domestic problems
Relationship problems
Anxiety over sexual performance
Minor depression
Sexual boredom/lack of interest in partner
Issues of unresolved sexual orientation

This of course is just the tip of the iceberg and some men may experience a combination of factors. Once a man has been examined by a doctor and can rule out physical causes, he can discuss the options for treatment of these other factors. Sometimes just opening up communication with a partner can help. Sometimes individual or couple counseling is useful. It is important for partners to be sympathetic but not overly worried, because the man may pick up on this anxiety and, you guessed it, that can make things worse.

If depression is suspected, it may be wise to consider holistic ways of addressing the problem apart from prescribed antidepressants, because sometimes these drugs worsen ED. If depression is minor and temporary (i.e. stemming from an event like a death in the family, job loss or other problems), various non-pharmaceutical methods can be very helpful. These include: exercise, which produces endorphins that help elevate mood; a change in diet, which can provide important nutrients necessary for good circulation and production of hormones (try the new Mediterranean diets!); aromatherapy (citrus oils are great for improving the mood); herbs with mild effects like St. John's Wort which have no serious side effects; yoga or other deep-breathing exercises; meditation; or engaging in a new hobby or activity to help get your mind off your troubles.

Lifestyle changes are often at the heart of any course of therapy to improve general health, and since ED is a condition with both physical and psychological causes, a holistic approach (which looks at underlying causes and not just immediate symptoms) is best. If you are a heavy smoker or drink to excess, these factors alone may be the cause of the problem. Many programs exist for helping quit smoking or reducing alcohol use.

Treatments
There are many treatments available for ED which your doctor can discuss with you. Some are medication based, and some are physical. In some cases minor surgery can be performed which eliminates the problem. Chances are your doctor will try to determine if you need to address psychological causes as well. Make sure you take the time to educate yourself and discuss things with your partner, to make the best choice for you. Good luck!

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