About impotence
Impotence occurs when a man has difficulty with either getting an erection or keeping one for long enough to allow penetrative sex.
It's one of the most common segxwal problems and affects around 2.3 million men in the UK. Half of all men over 40 will experience it at some point in their lives. It becomes more common and severe as men get older. However, only about one man in 10 seeks help. If you have problems getting or maintaining an erection over several weeks, ask your GP for advice.
Causes of impotence
Physical health
A number of conditions may cause impotence, including:
high blood pressure
high cholesterol
diabetes
obesity
multiple sclerosis
Parkinson's disease
stroke
surgery (such as an operation to remove your prostate gland) or radiation in your pelvic area
hormone imbalances such as hypogonadism which causes low levels of testosterone
Peyronie's disease - a condition affecting the sheath that surrounds the erectile tissue of the penis
hypospadias - a condition causing the urethra and penis to develop abnormally
Psychological
Psychological problems can influence your ability to get and keep erections. These include:
feeling anxious, guilty or depressed
stress at work
partner conflicts
unresolved issues about segxwal orientation
segxwal boredom
Lifestyle
Drinking too much alcohol can affect your ability to get and maintain an erection (often called 'brewer's droop'). In the longer term, it interferes with the production of testosterone, which can reduce your libido.
Smoking damages your blood vessels, so if you smoke this will increase the risk of erection problems. Chewing tobacco such as gutka may increase the risk of impotence. There is also anecdotal evidence suggesting that regular cannabis use can cause impotence.
Being physically inactive contributes to poor cardiovascular fitness, and may increase your risk of impotence. Impotence may be an early warning sign that you're at risk of coronary heart disease (when the arteries that go to your heart are narrowed).
Many men need greater tactile stimulation as they get older. You may want to consider a change in segxwal foreplay and technique to ensure a sustained erection.
Medicines
If your GP thinks prescription medicines are causing or contributing to impotence, it may be possible for you to switch to an alternative.
A trial with a medicine that will help you obtain and keep an erection is probably the next step. However, you will only be able to receive these medicines on the NHS if you have a specific medical condition, such as diabetes, multiple sclerosis or Parkinson's disease. You may also be eligible for them if you have had major pelvic surgery, spinal injury or kidney failure.
There are three different types of medicine known as phosphodiesterase type-5 (PDE5) inhibitors. The three most commonly used are sildenafil, tadalafil and vardenafil. They work in the same way to relax the blood vessels in your penis so more blood can flow into it, leading to an erection. They don't increase your libido so you will still need segxwal stimulation. The medicines will enable you to have erections for several hours.
There are other medicines available and your GP will be able to advise which is most suitable for you.
These medicines may cause side-effects, including headaches, feeling sick, indigestion and flushing. There have been rare cases of more serious complications including heart problems. All of these medicines are only legally approved for use in men and haven't been shown in clinical trials to be safe for women.
It's now possible for you to buy some of these medicines over the counter in pharmacies, following a consultation with a pharmacist. Be careful if you're considering buying medicines on the internet, particularly prescription medicines. If you buy medicines over the internet, there is a risk that they are from unregulated and illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness of the medicines provided. It's illegal to sell medicines on the internet in the UK. To protect patient safety, the law is that they must be prescribed by a doctor, and dispensed by a pharmacist. If you do wish to purchase medicines online, speak to your GP about the provider first.
If your impotence is being caused by a hormonal imbalance, your GP may refer you for hormone replacement therapy.
Alternative treatments
An external vacuum pump device pumps out the air from the penis and so sucks blood into it. You can use these with a constriction band to trap blood inside the penis.
You may be able to have surgery to increase the blood supply to the penis, although this is very rarely done, or have a penile implant inserted. Ask your GP for more information.
Complementary therapies
You may see herbal remedies advertised that claim to cure impotence without any scientific evidence to prove this. Many contain ingredients that can affect other medicines and cause side-effects, so always speak to your GP before trying any herbal remedies.
However, there have been studies showing that yohimbine, a chemical found in the bark of an African tree, can improve erections.
A small trial showed that Korean red ginseng increased segxwal desire and successful erections and intercourse compared with a placebo (dummy treatme
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