The causes of impotence and how to treat them

By Adam Rowden  

Reviewed by Alana Biggers, MD, MPH

Common causes | Treatments | Preventing impotence

Impotence is the inability for
a man to get and maintain an erection. It is also known as erectile dysfunction
and can impact a person’s ability to have satisfactory sexual intercourse.
Impotence is a very common
condition and can occur at any age. However, it is most common among older men.
According to the University of
Wisconsin, around 5 percent of men in the United States that are over 40 years
old have complete erectile dysfunction (ED). Around 15 percent of men over the
age of 70 have complete ED.

Common causes

A man’s ability to achieve an
erection is based on a number of factors and can result from a variety of
physical problems.
Mental health issues and other
psychological problems can also cause ED or make it worse.
Physical causes

Erectile dysfunction is most
commonly caused as a result of a physical factor. The most common causes

  • heart disease
  • high cholesterol
  • clogged blood vessels
  • injury to the penis
  • diabetes
  • obesity
  • metabolic syndrome
  • Parkinson’s disease
  • multiple sclerosis
  • smoking and other tobacco use
  • alcoholism
  • other forms of substance abuse
  • sleep disorders
  • prostate cancer treatments or
    treatments for an enlarged prostate
  • spinal cord injuries
  • Peyronie’s disease
Psychological causes

There are also a number of
psychological causes for impotence. These are the most common psychological

  • stress
  • depression
  • anxiety
  • other mental health conditions
  • relationship problems due to
    stress, poor communication, or other concerns
Some men may suffer from a
combination of physical and psychological issues that can lead to or worsen ED.
For example, a physical injury, which may slow a person’s sexual response, may
lead to anxiety about achieving an erection. This anxiety can then worsen the
The British National Health
Service (NHS) also state that some men may only experience ED in certain
situations. For example, a person may be able to achieve an erection during
masturbation, or may find that they wake up with an erection.
If a person is unable to get
an erection with a sexual partner, the cause of their impotence is most likely
to be psychological.
If a person is never able to
get an erection, the cause of their impotence is most likely to be physical.

Firstly, a doctor will ensure
that the individual is receiving the correct treatments for any other health
conditions they may have. It may be that these conditions are causing the ED,
or making it worse, so they must be treated properly.
The doctor will then treat the
erectile dysfunction directly. There is a range of treatments available for
impotence, but they vary according to the cause of the impotence.
Oral medications

There are a handful of oral
medications that can be prescribed to people with erectile dysfunction. They

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Spedra)
These medications will not
automatically cause an erection. The person must still feel some sexual
stimulation for them to work. They do not cause sexual excitement and are not
These drugs may cause some
side effects, including headaches and facial flushing. Less commonly, a person
may experience indigestion, a stuffy nose, and a blue tint to their vision.
These medications should be
avoided if a person has the following conditions:

  • severe heart problems
  • severe liver problems
  • has recently suffered a stroke
  • has recently suffered a heart
  • low blood pressure
  • certain rare inherited eye

If a person’s erectile
dysfunction does not respond to treatment, they may be offered alprostadil.
This is a man-made hormone that can help stimulate blood flow to the penis.
A person can either inject the
hormone directly into their penis, or place a pellet of alprostadil into their
urethra. The urethra is the tube that carries the urine from the bladder to the
top of the penis.
According to the NHS, a person
taking this hormone will usually experience an erection after 5 to 15 minutes.
However, the length of time the erection lasts will vary depending on the dose
of alprostadil taken.
Men who have sickle cell
anemia and are at risk of priapism, which is a long-lasting painful erection,
should avoid alprostadil. People with other disorders and those who are using
other treatments for ED should not take alprostadil.
Some side effects of this
treatment include:

  • changes in blood pressure
  • headaches
  • dizziness
  • pain in the penis
  • urethral burning
  • urethral bleeding
  • reactions at the location of
    the injection
Vacuum pumps

Another alternative treatment
for impotence is the vacuum pump. This can either be hand operated or battery
A person places a tube over
their penis and then pumps all of the air out of the tube, creating a vacuum.
This vacuum causes blood to fill the penis making it erect. Placing a rubber
ring around the base of the penis holds the blood in place, allowing the person
to maintain an erection.
A vacuum pump can allow a man
to maintain an erection for around 30 minutes. The NHS call these pumps
“effective,” stating that 9 out of 10 men are able to have sex after
using them.
A man should not use a vacuum
pump if he has a bleeding disorder or if he has taken medicines to reduce the
clotting ability of his blood.
Less than a third of men will
experience pain and bruising as a result of using a vacuum pump.

Surgery procedures may be
recommended but only if all other treatment methods fail.
These surgical treatments
involve placing implants, which can be semi-rigid or inflatable, inside the
Psychological treatments

If erectile dysfunction is
caused by stress, anxiety, or other psychological reasons, a doctor will advise
the person to visit a psychologist or counselor.
If the condition causes
tension and stress within a relationship, both partners may be advised to
attend the appointments together. This can be helpful in resolving any issues.
Preventing impotence

There are a number of ways in
which a person can reduce their chance of developing impotence. These include:

  • not smoking
  • not abusing alcohol or other
  • pelvic floor exercises
  • losing weight if obese
  • taking steps to avoid stress
  • getting treatment for
    depression, anxiety, or any other mental health issues

The outlook for a person who
has impotence is very good. There is such a range of treatments available that
it is highly likely a person will be able to find one that works for them.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.