What is impotence?

Impotence is a repeated problem with getting or keeping an erection of the penis. Impotence is also called erectile dysfunction, or ED. An erection is when the penis gets hard, stiff, and raised so that sexual intercourse (sex) is possible. Impotence may or may not affect a man's ability to have an orgasm (sexual climax) and release semen. Semen is the thick white fluid that comes out of the penis during ejaculation. Impotence is a very common problem. It may be a long-term condition, or it may only occur once in a while. Impotence can often be helped with treatment.

What are the physical causes of impotence?

More than one thing may cause impotence. Impotence is most often caused by a physical (body) problem. Physical problems that may cause impotence include:

  • Health conditions. A common cause of impotence is problems with the blood vessels of the penis. Certain conditions, such as hardening of the arteries (atherosclerosis), can reduce blood flow to the penis. Other diseases that may cause blood flow problems include high blood pressure and obesity. Some diseases cause nerve problems as well, which may also lead to impotence. Diabetes, alcoholism (abusing alcoholic drinks), and multiple sclerosis (MS) are examples. Some cancer treatments, such as surgery or radiation therapy, can lead to impotence. Deformities (growth problems) of the penis caused by disease or that are present at birth may also result in sexual problems.

  • Medicines. Some medicines used to treat other illnesses may decrease your desire for sex, or make it difficult to have an erection. Medicines used to treat depression, blood pressure problems, and mental problems are just a few examples. If you think that your medicines are causing impotence, talk to your caregiver. Do not stop taking your medicine without your caregiver's OK.

  • Injury or surgical nerve damage. A brain injury, such as a stroke or a head injury, can affect normal sexual function. An injury to your back or groin area may damage the nerves that help cause an erection. Surgery of the prostate, bladder, or groin may also cause nerve damage. The prostate is a male gland that lies just below the bladder. The groin is the area where your leg and abdomen meet.

  • Hormone problems. Hormones are special chemicals that your body makes. Hormones act as messengers to help control how your body works. Impotence may happen if you have too much or not enough of certain hormones in your body. For example, a lack of the male hormone testosterone may cause problems with getting and keeping an erection. Having too much of the hormone prolactin may also cause impotence problems. Diseases (such as thyroid disease) or certain injuries can cause hormone imbalances.

  • Aging. Impotence is more likely to happen as a man ages.

  • Lifestyle. Smoking, drinking alcohol, or using street drugs can cause or worsen erection problems. Lack of exercise may increase your chances of having impotence. Not getting enough rest may also cause sexual problems.

Can thoughts or emotions cause impotence?

Emotional problems are problems with your mood or state of mind. These problems can cause impotence or make it worse, even if the original cause was physical. Sometimes impotence can lead to an emotional problem. For example, anxiety or depression may be caused or worsened by problems with your sex life. Emotional problems that may cause impotence or make it worse include:

  • Anger. You may be angry or upset with your sex partner. These emotions may prevent you from having an erection.

  • Anxiety. Fear or anxiety may keep you from having a normal response to sex. You may be nervous about pleasing your partner, or be afraid of causing pregnancy. Fear of not being able to have or maintain an erection may actually cause those problems.

  • Stress. Being under stress can prevent you from focusing your mind on having sex. For example, worry over money problems or losing a job may cause sexual problems. Guilt about having sex, or low self-esteem may also cause impotence problems.

  • Depression or other problems. You may feel depressed (very sad) during certain times in your life. During these sad times you may not have your usual desire to have sex. Some mental illnesses (and the medicines used to treat them) may also cause impotence.

How is impotence diagnosed?

Your caregiver will try to find out if your impotence has a physical cause. This can help your caregiver find the right treatment for you. Your caregiver will give you a physical exam to check for prostate or medical problems. Your caregiver may ask you many questions about your recent problems with sex. Blood tests may help your caregiver find or rule out certain problems that may be causing your impotence. You may need other tests if an injury or disease may be causing your impotence. You may need to see a special doctor called a urologist who specializes in impotence. Ask your caregiver for more information about any tests you may need.

How is impotence treated?

It is often helpful to ask your sexual partner to learn about impotence and its treatment options with you. Treatment may depend on your age, your general health, your lifestyle, and what is causing your impotence. Ask your caregiver about the most up-to-date treatments that may be right for you. Some common treatments include:

  • Control of other health problems. Medicines taken for other illnesses may cause or worsen sexual problems. Your caregiver may decrease or change some of your medicines if they are known to cause sexual side effects. Some medicines, such as testosterone, may be given to help correct a physical cause of impotence. Work with your caregiver to keep other health problems, such as kidney disease or diabetes, under control.

  • Medication. Some medicines may help improve your ability to get and keep an erection. These medicines come in many different forms. Some are taken in pill form, or are put on the skin of the penis. Other medicines are given through a needle put into the side of the penis. Some may be given by placing a small medicine pellet into the urethra The urethra is the tube through which urine and semen pass when leaving the penis.

  • Counseling. Counseling (talk therapy) may be needed to help with possible emotional causes of impotence. Counseling can also help with problems that impotence may cause with your relationships or emotional well-being.

  • Vacuum devices. You and your partner can learn how to use a special vacuum pump that may help you have an erection. Most vacuum devices use a plastic tube that is placed over the penis. A gentle vacuum is made inside of the tube by using an attached hand pump. This vacuum helps to increase blood flow to the penis, which causes an erection. A special band is then put around the base of the penis to help you keep the erection.

  • Surgery and other treatments. Surgery to correct an injury or blood vessel problem may be needed if other impotence treatments have failed.

  • Penile implants.

    • Penile implants, also called penile prostheses, are devices that are placed inside of the penis during surgery. These devices allow the penis to become erect and make sexual intercourse possible. Penile implants do not interfere with penile sensation (feeling), orgasm, or ejaculation.

    • One kind of implant uses a pair of bendable rods that are permanently placed inside the penis. You bend the rods to an upright position before having intercourse. Another kind of implant uses chambers (like balloons) in the shaft (long part) of the penis. These balloons can be filled with liquid to cause an erection whenever you want one. A permanently implanted pump allows you to control how much liquid goes into the balloons. This lets you control the size and firmness of the erection. The pump is usually placed in the scrotum, which is the sac that contains the testicles.

How can I decrease my chances of having impotence problems?

  • Avoid alcohol. Do not drink alcohol. Alcohol can damage your brain, heart, and liver. Almost every part of your body can be harmed by alcohol. Drinking alcohol can also make your sexual problems worse.

  • Quit smoking. It is never too late to quit smoking. Smoking harms the heart, lungs, and blood vessels. Blood vessel damage may lead to impotence and other health problems. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.

  • Control risk factors. High blood pressure, high blood cholesterol, diabetes, or being overweight can increase your risk of hardening of the arteries. Ask caregivers for help controlling these conditions. You may be told to eat foods that are low in fat or cholesterol. Special cookbooks can make it easier to plan low fat and low cholesterol meals.

  • Reduce stress. Since it is hard to avoid stress, learn to control it. Learn new ways to relax, such as deep breathing, meditation, relaxing muscles, music, or biofeedback. Talk to someone about things that upset you.


  • Impotence may be an early sign of illness or disease, such as diabetes or heart disease (atherosclerosis). Some diseases that cause impotence may be serious, even life-threatening. It is important to let your caregiver know about any new problems with your ability to have sex.

  • Some drugs and nutritional supplements used to treat impotence may be dangerous when used with nitrate-containing medicines. Medicines that may have nitrate include certain heart medicines (such as nitroglycerin, or "nitro") and blood pressure medicines. Even some street drugs may contain nitrate. Before taking impotence medicines, ask your caregiver if any of your other medicines contain nitrate. Always tell caregivers if you take medicine for impotence. Never allow anyone else to take your medications.

Coping with impotence:

Accepting that you have a sexual problem can be upsetting. You and your partner may feel sad, confused, or anxious because of your impotence. These feelings are normal. Talk about them with your caregiver or with someone close to you. You may want to call or write the following organizations for more information.

  • American Urological Association
    1000 Corporate Boulevard
    Linthicum , MD 21090
    Phone: 1- 410 - 689-3700
    Phone: 1- 866 - 746-4282
    Web Address:

When should I call my caregiver?

Call your caregiver if:

  • You have questions or concerns about impotence or your medicine and treatments.

  • You cannot see or hear as well, or at all, after using medicine to treat ED. You may also have ringing in your ears or dizziness.

When should I seek immediate care?

Seek immediate help or call 911 if:

  • You have chest pain at any time, especially after taking a medicine to treat ED, or during or after having sex.

  • You have chest pain, dizziness, or nausea during sex.

  • You have a painful erection.

  • After using medicine to treat ED, your erection does not go away after four hours.

  • You pass urine that is a pink or red color.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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