Impotence, also called erectile dysfunction, is considered to be a typically male problem, because it is generally expected that the penis should become sufficiently hard to enter the vagina and remain there long enough to provide pleasure, orgasm, and ejaculation. If occasionally this does not happen, most people do not worry: they blame drink or stress at work, and they do fine the next time. There are also older men who have no erections anymore and accept that. They can still be good sexual partners and enjoy orgasm and ejaculation without an erection.
In most other cases, however, erectile dysfunction or impotence is problematic. Situations differ, as do causes. Some are simple, others more complex.
In general, a distinction is made between ‘physical’ and ‘mental’ causes of erectile dysfunction. An example of the former: after an accident at work, a man’s spine or pelvis is injured, and this injury has damaged the nerve which stimulates the small penile artery that fills the penis with blood during arousal. If the nerve is damaged, it does not pass the signal to the artery, so that no erection occurs even though the man is aroused, with or without a partner.
In most other cases of erectile dysfunction the cause is (partly) mental, i.e. the man is quite capable of having erections when he is alone or in his sleep. But when he is with his partner, he cannot have a an erection that is strong enough or lasts long enough. This may also be called ‘situational’, because the man may have no problem when he is with another partner.
Old age is generally associated with erection problems. The general deterioration of physical and mental functions can be blamed, but only to some extent. There is, of course, a gradual decrease in the production of testosterone (the male hormone), an increase in prostate size, higher blood pressure and sugar levels. Life style probably also plays a part, such as excessive drinking and smoking, obesity, depression, or the use of drugs against depression, obesity or blood pressure). Men who live healthy and balanced lives (which may very well include a little drinking and smoking), who are successful and have attractive love partners, can retain good erectile function until death.
When young men are impotent with a partner, even though they have morning erections and no problem when masturbating, the situation is to blame. He feels inadequate. This may be due to an earlier experience: he dreads a repeat, is so concerned with himself and the possibility of failure that he is estranged from his feeling, becomes an observer of himself. This condition adversely influences his sexual competence, and so he ‘fails’ again. The behaviour of the partner plays an important part in the whole process. Although most are quite ready to say that ‘it doesn’t matter’, they often lack sufficient skill and self-confidence to convince him and themselves, so that it repeats itself the next time and causes a kind of despair mixed with irritation. If this happens, it is best to consult a sexologist, who will generally prohibit sexual intercourse (see great sex without intercourse) for some time to come, and in the meantime will set tasks and targets for the couple to help them improve their sexual communication.
Since 1998 a drug called sildenafil has come on the market under the name Viagra. It became a world famous remedy for erectile dysfunction. Sexologists stress that Viagra, and its several followers each with their own purported advantages, cannot be used to improve libido, or save a bad sexual relationship. But all things being equal, the erection pill can be a blessing if used properly.
Apart from the relational aspects which cause or contribute mainly to erectile dysfunction or impotence, a small number of males need other approaches to help them get erections long enogh to enjoy sessions of lovemaking and intercourse. Two main approaches are discussed, the medicinal and the mechanical.
Plant extracts like yohimbine, ginseng and papaverine, which used to be thought of as quack medicine, have shown their effectiveness in scientific trials, and are prescribed in sexological practice. Papaverine mixed with prostaglandins, on the market under the name Androskat, is injected into the penis. The doctor decides the dosage and demonstrates the injection technique. After that the man has to inject himself. He may think it’s a little scary at first, but after a while he gets used to it.
The most popular medicinal therapy since 1998 has been sildenafil (Viagra), It relaxes the smooth muscles round the small arteries of the penis, so that the blood can freely flow and fill the corpora cavernosa (hollow spaces) of the penis, making it hard. At the same tim, the veins which carry the blood off when the penis is flaccid are closed, so that the erection continues for a sufficiently long time to have sexual intercourse. Viagra cannot normally be had without a doctor’s prescription, and is not normally covered by health insurance.
Viagra is not an afrodisiac, although pleasure in sex obviously increases if a desired erection is attained and held. But if there is little or no appetite, Viagra does not help.
Because Viagra may pose a risk for people with high blood pressure or cardiac problems, other drugs have been developed which do not work directly on the blood flow, but on the nerve centre in the brain involved in bringing about an erection. Such other brand names are Uprima and Cialis. They have the advantage of working faster and Cialis especially has a longer effective period, even a whole weekend, whereas Viagra works only for four hours. The choice of different drugs is a good thing, for it widens the options for patients and doctors. Someone who gets no results from one may benefit from another.
No need to say, erection pills are sold through the internet. In some cases the sellers are bona fide, in most however, one can be almost certain to receive imitation drugs or food supplements.
For men who do not benefit from erection pills or are advised not to use them, there are still some mechanical means left whereby they can obtain and hold an erection.