Men’s Health: Impotence, Some Hard Facts

It is safe to say that every man experiences erectile dysfunction (ED) from time to time?

Who Becomes Impotent?

Medically speaking, impotence is defined as the inability to sustain an erection sufficient for at least 25% of attempts. Using this definition, experts have estimated that between 10 and 20 million men in the United States between ages 40 and 70 experiences erectile dysfunction. Some surveys report that 30% of all men experience at least temporary erectile dysfunction at some time.

Older Men. Aging is most often associated with impotence. About 5% of men at 40 report complete erectile dysfunction; by age 65, 15% to 25% of men are troubled by this problem, and over age 75, about 55% of men report being chronically impotent. Nevertheless, impotence is not inevitable with age. A recent survey of men of over 60 years old reported that 61% of them were sexually active, and nearly half derived as much if not more emotional benefit from their sex lives as they did in their 40s.

What Causes Impotence?

Over the past decades the medical perspective on the causes of impotence has shifted. Common wisdom used to attribute almost all cases of impotence to psychological factors. Now, investigators estimate that between 70% and 80% of impotence cases are caused by medical problems:

• Most often atherosclerosis (hardening of the arteries);
• Complications of diabetes;
• Prostatectomy (surgical removal of the prostate);
• And medications.

Many experts believe that negative emotional states occurring with the condition are more likely to be a reaction to the experience of impotence than its causes. Psychological problems are more apt to be the causes of erectile dysfunction in younger men, however, while physical problems are usually the cause in older men.

So many physical and psychological situations can bring about erectile dysfunction, in fact, that a man should consider brief periods of impotence to be as normal as having a cold. (Even a cold can, in fact, cause temporary impotence.) Oxygen deprivation is the most common cause of impotence and can occur from numerous conditions that deprive the penis of the blood. Nerve damage in the penis or the pelvic area and deficient levels of important hormones can also be responsible for erectile dysfunction.

How Serious is Impotence?

Impotence is not life threatening, of course. It can be symptomatic, however, of other serious problems, such as atherosclerosis, diabetes and hypertension. Impotence can also be indicative of an injury, age related changes in tissue, or the possible long-term effects of risky behaviors such as smoking, heavy drinking, or an unhealthy diet.

Psychological factors related to impotence can be significant. Erectile dysfunction can have a devastating effect on a relationship and can cause extreme depression, which may become chronic if the erectile dysfunction is not treated.

Specific Medical Conditions Contributing to Erectile Dysfunction

Diabetes. Diabetes may contribute to as many as 40% of impotence cases. Between one third and one half of all diabetic men report some form of sexual difficulty. Diabetics often develop atherosclerosis and nerve damage; when the blood vessels or nerves of the penis are involved, erectile dysfunction can result. (It should be noted that women with diabetes also suffer from sexual dysfunction due to damaged circulation and can also be helped by some of the drugs given to men for impotence.)
High Blood Pressure. In one study, 17% of men with high blood pressure experienced erectile dysfunction even before being treated. Many of the drugs used to treat hypertension may cause impotence as the side effect, although it is reversible when the drugs are stopped.

One study, in fact, suggested that impotence in men with hypertension actually usually occurs if they also have coronary artery disease, and that it is this dangerous combination – not the drugs – that causes erectile dysfunction in such men. More recent drugs, such as ACE inhibitors, in nay case, appear to be less likely to cause erectile dysfunction.

Multiple Sclerosis. Multiple Sclerosis (MS), which affects the central nervous system, also precipitates sexual dysfunction in as many as 78% of male patients. (Corticosteroids, which are common treatments for MS may improve sexual dysfunction.

Alternative Therapies and Remedies

Yohimbine. Yohimbine has been used as folk medicine for years; it appears to improve blood flow. Studies have been inclusive about its benefits, but a recent analysis of seven trials reported that between 34% and 75% of men achieved favorable results when taking 5 mg to 10 mg. Side effects include nausea, insomnia, nervousness, dizziness and high blood pressure.

Ginkgo improves blood flow in the brain and in one small study 78% of men who had impotence caused by impaired blood flow regained erections. More research is needed.

Ginseng root is a traditional Asian remedy for stimulating sexual function, although no studies have been conducted on its efficacy.

DHEAS. Dehydroepiandrosterone sulfate (DHEA) is a male hormone used in the production of testosterone; levels of this hormone falls as man ages. In one small study, those who took DHEA for 16weeks experienced some improvement in erectile dysfunction. It should be noted, however that the long-term effects of this potent hormone are unknown, particularly on the risks for prostate cancer.

Lifestyle Changes

Maintaining General Health. Because many cases of impotence are due to reduced blood flow from blocked arteries, it is important to maintain the same lifestyle habits as those who face an increased risk for heart disease. Such good habits include a diet rich in fruits and vegetables, whole grains and fiber and low in saturated fats and sodium. Men who drink alcohol should do so in moderation. A regular exercise program is extremely important. Quitting smoking is essential.

Frequent Erections. Staying sexually active can help prevent impotence. Frequent erections stimulate blood flow to the penis. It may be helpful to note that erections are firmest during deep sleep right before waking up. Autumn is the time of the year when male hormone levels are highest and sexual activity is most frequent.

Changing or Reducing Medications Causing Impotence. If medications are causing the problem, the patient and the physician should discuss alternatives or reduced dosages. In treating high blood pressure, for instance, ACE inhibitors are less likely to cause sexual dysfunction than any other medications.