Impotence

It is believed that as many as 20 million men in the United States suffer from impotence, a condition that leaves them unable to have sexual intercourse (sex) because their penis does not become hard and, therefore, they are not able to have or keep an erection.

What causes impotence?

It can happen because of diseases such as diabetes or kidney disease, which affect hormone levels, blood circulation, and overall strength and energy levels. Problems that affect nerve function, such as multiple sclerosis or a spinal cord injury, also can cause impotence.

Drugs, especially certain high blood pressure pills, can cause you to have problems getting and/or keeping an erection. Other possible causes include surgery, drug abuse, alcoholism and emotional problems, such as depression (feeling down), anxiety, stress, marriage problems or fear that you may not be able to perform sexually.

Impotence may also be caused by a combination of physical and emotional problems.

How is impotence diagnosed?

You may be sent to a doctor, called a urologist, who treats problems of the urinary system. To find out if you have impotence, the doctor will take a medical history, do a complete physical examination, evaluate your emotional state and interview your sexual partner. Other tests that may be ordered for you are:

• measurement of the male sex hormone (testosterone) in your blood
• evaluation of the nerve and blood supply to your penis
• evaluation of nocturnal (nighttime) erections.

How is impotence treated?

The best treatment for you depends on the cause of your impotence. Your doctor will help you to choose. If your problem is emotional, counseling can be very helpful. This works best if both you and your partner go. If your problem is caused by a drug you are taking, the doctor may order a different medication.

Drugs: Sometimes, the doctor may inject a drug directly into the penis. This drug causes a large amount of blood to go into the tissues in the penis, resulting in an erection that lasts one to two hours. In a few cases, this treatment may lead to a long-lasting, painful erection.

You may be impotent because of a hormone problem. Drugs, such as testosterone, are sometimes used to correct this problem. These drugs may have some side effects, and you should discuss this with your doctor.

Some men report being helped by an oral medication called yohimbine, which comes from the bark of a tree that grows in India and Africa. This drug, which needs to be taken every day, has been reported to help about 20 to 25 percent of the men taking it. A relatively new but widely used oral medication called Viagra requires a careful medical evaluation by your doctor.

Vacuum Pump: Your doctor may try another treatment, called a vacuum pump, which helps to draw the blood into the penis. The erection caused by this treatment can be continued by using a special elastic ring around the penis. The ring may cause occasional bruising.

Surgery: If neither drugs nor the vacuum pump works, your doctor may suggest surgery. With surgery, the doctor can place a device in your penis that will cause enough hardness for intercourse. In a few cases, infections may develop after the operation, and the doctor may have to remove the device. Another operation that may help you is rebuilding the blood vessels in the penis to increase blood flow into the penis or decrease blood flow out of the penis. These procedures can help you to get and maintain an erection.

However, these operations aren't right for all patients. Speak to your doctor about whether this type of surgery could help you.

What is the role of sex therapy?

With sex therapy, your counselor looks at the sexual problems you and your partner are having. Sex therapy works with problems such as performance anxiety, which means that you worry so much about whether you will be able to have sex that you are not able to. It also helps when you have erection problems that are not due to physical or drug problems, or premature ejaculation (you come too quickly). It may help you to reach orgasm or to learn to relax enough to avoid pain during sex. Counseling can help you to adjust to the treatment you and your doctor choose.

How do I know what treatment is right?

You should talk to your doctor about possible treatments. You may want to talk to other patients who have had the treatment planned for you. You also may want to seek a second doctor's opinion about surgery before making your decision. You may find it difficult to talk to your doctor about impotence. You will want to find a doctor who treats this condition and will help you feel comfortable talking about the problem and choosing the best treatment. You can also get more information by contacting your local National Kidney Foundation affiliate.

Do insurance plans cover the cost of treatment?

Most insurance plans will pay most of the cost of diagnosis and treatment. You should talk with your doctor about the cost. Then check with your insurance agent to see what will be covered by your insurance plan.

If you would like more information, please contact us.

© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.