Impotence, potency disorder

Overview

Potency disorder (impotence, erectile dysfunction) is the inability to develop or maintain an erection firm enough for satisfactory intercourse. The causes can be psychological (stress, self-doubt, etc.) or physical (hormone deficiency/age, vascular disease, diabetes, etc.). To improve erectile function, it's important to avoid stress and pressure during intercourse.

Symptoms

• Inability to develop or maintain an erection (stiff penis) which is firm enough for sexual intercourse

Causes and treatment

Causes

Psychological causes and risk factors

Sudden or occasional failure to get or keep an erection or a temporary loss of libido point to a psychological cause:

• Performance pressure, stress and fatigue
• Too much alcohol
• Physical surroundings, lack of time, distraction
• Partnership problems
• Burnout, depression, self-doubt

Organic causes and risk factors

If the erection gradually grows weaker or failure to get an erection happens more often, an organic cause is likely

• Reduced production of male sex hormones in the testicles
  o E.g. age-related, male menopause
• Overactive or underactive thyroid
• Adrenal disease (Cushing’s syndrome)
• Arteriosclerosis, high blood pressure and other cardiovascular diseases
• Impairment or failure of the nerve impulses that lead to an erection
  o Pelvic surgery (prostate, rectum, bladder)
  o Diseases or injuries of the intervertebral discs and spinal cord
  o Multiple sclerosis
• Diabetes
• Liver or kidney diseases
• Medication: tranquillisers and medication to lower blood pressure, antidepressants, appetite suppressants, etc.
• Abuse of nicotine, drugs and alcohol, chronic poisoning
• Malformation of the penis
• Impaired blood flow in the veins of the erectile tissue

Further treatment by your doctor / in hospital

Possible tests

• Physical examination (search for an underlying disease)
• Blood test (focus falls on hormones, search for an underlying disease)
• Discussion (search for possible causes)
• Ultrasound (e.g. testicular volume)

Possible therapies

• Treatment of an underlying disease
• Use of stimulant medication (tablets, sometimes injections), if necessary
• Sexual health, psychological/sexological or psychiatric counselling
• Surgical methods: only as a last resort (risk of complications)

What can I do myself?

• Avoid alcohol, nicotine and a lack of sleep
• Discuss the problem with your partner or friends
• Avoid stress, performance pressure and fear of failure
  • It’s normal for intercourse to sometimes “not work” or be unsatisfactory (regardless of age) for both genders
• Use mechanical aids (e.g. penis ring and pump), if necessary
• Go for psychological counselling
• Reduce masturbation, if applicable
  • Mechanical stimulation during normal intercourse can be experienced as insufficient by men who engage frequently and heavily in masturbation

When to see a doctor?

• Treatment of organic underlying diseases
• Wish to discuss the problem
• Severe psychological strain
• Hoping for a child
• Own strategies don't bring improvement
• Discussion of stimulant medication or other measures as an option

Synonyms

impotence, potency disorder, disorder of potency, erectile dysfunction, ED, impotentia coeundi, erectile disorder