Male impotence is characterized by an inability to maintain an erection well enough to engage in sexual intercourse. It is also called erectile dysfunction. Impotence has many causes and is more common in older men. It is not, however, a natural or inevitable part of aging. Treatment depends on the cause of the impotence.
Physical Causes
Erectile dysfunction may start with the reproductive system or other parts of the body. The penis becomes erect when its arteries are engorged with blood. Therefore, a problem with the arteries can lead to impotence. This is often the case when a man has a narrowing of the arteries due to high blood cholesterol or atherosclerosis. A similar condition, called arteriosclerosis, occurs when the arteries are both narrowed and hardened. Arteriosclerosis is often the result of long-term hypertension (high blood pressure) or diabetes. Nerve damage in the penis can also cause impotence. Metabolic syndrome and Parkinson's disease are responsible for some cases. Peyronie's disease, most common in middle age, is characterized by scarring inside the penis, which can lead to erectile dysfunction. The National Kidney and Urologic Diseases Information Clearinghouse explains that multiple sclerosis, obesity, heart disease, low testosterone, kidney disease and lack of exercise are all possible causes of erectile dysfunction. Some men experience impotence after a surgical procedure in the area of the penis. Finally, injury to the spinal cord or area near the penis can cause this condition.
Drug- and Smoking-Related Causes
Many drugs, both illicit and prescribed, can cause male impotence. Drugs commonly considered when a reason for erectile dysfunction is sought include alcohol, pain medicines, diuretics, amphetamine appetite suppressants, cancer drugs, tranquilizers, blood pressure medications, hormones, cocaine and antidepressants. Merck Manual explains that cimetidine, a stomach drug, can also cause erectile dysfunction. Smoking tobacco is responsible for some cases of impotence, probably due to tobacco smoke's tendency to narrow the arteries.
Psychological Causes
When physical and drug-related causes are ruled out, psychological causes are often considered. Psychological causes may be due to conscious or unconscious motivations. Stress, excessive fatigue and performance anxiety may be at the root of impotence. Depression, poor self-esteem, body image issues and guilt must also be considered. A psychological cause may be as simple as poor communication or as complex as a sexual partner evoking unconscious memories of a bad prior sexual experience. Deep-seated emotions such as anger and fear are sometimes only discovered during therapy.
It is helpful to determine if impotence is situational. If it only relates to a certain partner, place or time, it is considered situational. Some men are able to sustain an erection while masturbating but not during intercourse. Therapy can also help determine the cause of the problem in these cases.
