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ImpotencePublished by Bupa's health information team, healthinfo@bupa.com, June 2007. This factsheet is for men with impotence, or people who would like information about it. 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 are a variety of treatment options available and for the majority of men these are successful. What is impotence?Impotence occurs when a man has difficulty with either getting an erection or keeping one for long enough to allow satisfactory sexual activity. It's one of the most common sexual problems and affects around 2.3 million men in the UK. Half of all men over the age of 40 will experience it at some point in their lives. It becomes more common and severe as men get older. However, only about 10 percent of affected men seek help. CausesThere are a number of reasons why you may have impotence. In around three-quarters of cases there are 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 healthA number of different conditions may cause impotence, including:
PsychologicalPsychological problems can influence your ability to get and keep erections. These include:
LifestyleIf you drink too much alcohol, this can affect your ability to get and keep an erection (often called brewer's droop). In the longer term, it interferes with the production of the male hormone testosterone, which can reduce your sexual drive and desire (libido). Smoking damages your blood vessels and so increases your risk of erection problems. Similarly, being physically inactive, which contributes to poor cardiovascular fitness, may raise the chances of you having impotence. Impotence may be an early warning sign that you are at risk of coronary heart disease (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. MedicinesThe side-effects of some medicines such as those for high blood pressure and certain antidepressants can lead to impotence. Medicines can also affect your libido, or cause problems with ejaculation and orgasm. These can also have an effect on erections. DiagnosisYou may decide to see your GP if you are 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. You may feel embarrassed when you first go to discuss the issue with your GP or practice nurse. However, talking about impotence is routine for GPs and nurses. Your GP will ask about your general health and your erections. This will include whether or not you wake up with an erection in the morning and the strength of erections compared with those in the past. Your GP will ask you if you are taking any medication, 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 request blood tests for conditions such as anaemia, diabetes, high cholesterol or hormone imbalances. 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 the man has a faltering erection, this may lead to further distress for you both. More specialised tests to assess blood flow and the way your nerves are working can be done in specialist hospital clinics. Your GP will refer you if this is necessary. TreatmentImpotence can nearly always be treated - 95 percent of men find a suitable treatment. The simplest are talking therapies, such as cognitive behavioural therapy, and medicines. If the cause is mainly because you are anxious or are having relationship difficulties, then talking to a counsellor or psychosexual therapist will probably be most helpful for you. You may also find this useful if you think you may have other psychological problems such as depression. Self-helpA healthier lifestyle may prevent your impotence getting worse. The following changes can help.
If your GP thinks prescription medicines are causing or contributing to impotence, it may be possible for you to switch to an alternative. MedicinesIn most other circumstances, the next step will be a trial with a medicine that will help you obtain and keep an erection. 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 if you have had major pelvic surgery, spinal injury or kidney failure. There are now three different types of medicine known as phosphodiesterase type-5 (PDE5) inhibitors. The most well-known of these is sildenafil (Viagra). There are two other similar medicines called tadalafil (Cialis) and vardenafil (Levitra) that work in the same way. All three medicines cause the blood vessels in your penis to relax 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. As with all medicines, you may have side-effects. With these treatments they are usually minor and include headaches, nausea, indigestion and flushing. However, 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 have not been shown in clinical trials to be safe for women. It's now possible for you to buy some of these medicines over the counter in pharmacies, following a consultation with a pharmacist. Be careful if you are considering buying medicines on the internet, particularly prescription medicines. If you buy medicines over the internet there is a risk that they are from unregulated and illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness of the medicines provided. It's illegal to sell medicines on the internet in the UK. To protect patient safety, the law is that they must be prescribed by a doctor, and dispensed by a pharmacist. If you do wish to purchase medicines online, speak to your GP about the provider first. AlternativesYou may be able to get an external vacuum pump device from a hospital impotence clinic or you can buy one. These pump out the air from the penis and so suck blood into it. You can use them with a constriction band to trap blood inside the penis. It may be an option for you to have surgery to increase the blood supply to your penis or to have a penile implant inserted. Your GP will be able to tell you more about these procedures. Further information
Sources
Related topicsThis information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Raj Persad MB BS ChM FRCS FRCS (Urol) FEBU, consultant urological surgeon, Bristol Urology Associates; Mr Tim Whittlestone, MA MD FRCS, consultant urologist, Bristol Urology Associates; and Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: June 2007. Expected review date: June 2009.
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