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Over the years men complain of two distinct sexual problems: lack of desire and impotence. Impotence or erectile dysfunction is the inability to hold an erection long enough to pursue in sexual intercourse. Erectile dysfunction (ED) can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only short erections.

Erection begins with sensory and mental stimulation. Under normal conditions, when a man is sexually stimulated, his brain sends a message down the spinal cord and into the nerves of the penis. The nerve endings in the penis release chemical messengers called neurotransmitters that signal the corpora cavernosa (the two spongy rods of tissue that span the length of the penis) to relax and fill up with blood. As the penis becomes congested with blood, it enlarges and stiffens, causing an erection.

Surgical operation can wound nerves and arteries close to the penis making man an impotent. Also, between 35 and 50 percent of men with diabetes experience impotence. Many common medicines produce impotence as a side effect. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa. Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone. Physicians believe that psychological factors cause 10 to 20 percent of cases of impotence. A small percentage of men experience sporadic and situational impotence.


Risk factors
Men with diabetes, smoking, taking drugs or older than 50 years of age are particularly at risk for impotence. For instance men with diabetes are at risk because of their high risk of both atherosclerosis and a nerve disease called diabetic neuropathy. Age seems to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above. Some medications can contribute to impotence, as can some operations and radiotherapy treatments.

Years ago, the standard treatment for impotence was a penile implant or long-term psychotherapy. Today there are these popular methods: vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED. Because ED can take a toll on a man's self-esteem, sex therapy is increasingly being recommended as a form of treatment on its own or in combination with other medical remedies. If your impotence problems are caused by low levels of testosterone then hormone therapy can be given in the form of injections or patches. Testosterone substitution therapy may improve energy, mood, and bone density, increase muscle mass and weight, and heighten sexual interest in older men who may have deficient levels of testosterone. Psychotherapy can also be valuable to men who are trying to overcome non psychological impotence. Hydrotherapy (cool showers, for instance) can also be effective for ED.
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