By Dr. Loretta Lanphier, ND, CN, HHP, CH

What is Impotence?

Impotence, also known as Erectile Dysfunction (ED), is the inability of a man to experience or maintain an erection long enough to have satisfactory sexual relations. The condition of impotence can be the result of physical problems, psychological issues, or a combination of both.

It is normal for every man to have difficulty getting an erection occasionally, but consistent or repeated incidents may indicate a problem that needs intervention. Impotence is a very common occurrence in the United States. Estimates place the number of men who struggle with impotence at about 30 million, but this number may be significantly low because of the vast numbers of men who never admit they have a problem and seek help. Some researchers estimate that only 10% of men with impotence ever seek medical attention for it. Erectile dysfunction is thought to affect about half of all men between the ages of 40-70, to one degree or another.

Erectile dysfunction can range in intensity from regular episodes of inability to obtain a complete erection, to difficulties maintaining an erection long enough to have intercourse, and all the way up to complete inability to ever experience an erection.

What Causes Impotence?

To better answer this question, it might help if we first have a quick overview of the mechanics of male sexual performance. The penis is designed with two “cylinders” of spongy tissue that run the length of the shaft, parallel to the urethra (the structure that carries both urine and semen). Upon sexual arousal, the nerves are stimulated to send more blood to the area, and the cylinders are engorged with blood to a volume that is about seven times that of a flaccid penis. This produces an erection by enlarging, straightening, and stiffening the organ. After an orgasm, or after the arousal has subsided, the blood drains back out of the cylinders, and the penis returns to normal. These steps, involving arousal, neurological response, and blood vessel response, must all take place in order to achieve a successful erection. If any part of the process breaks down, erectile dysfunction can result.

For many years, most medical people believed that the vast majority of impotence cases were the result of psychological problems. It is now known that while nonphysical issues definitely play a role in impotence, many cases (some say up to 60% of cases, especially in older men) can also be traced to physical causes as well. The truth of the matter is that both factors usually play a role, because even if the problem is purely physical, it begins to wear psychologically on its victims, which can further exacerbate the problem.

Nonphysical Causes:


  • Psychological issues: These types of problems are responsible for the majority of nonphysical caused related to impotence. The most common ones are:

ü       Fatigue:  Many men are so mentally and physically beat from long hours at their vocation and insufficient sleep, that it may be difficult to have the emotional stamina or physical energy to have relations. Fatigue can also cause a failed erection when intercourse is attempted.

ü       Stress and anxiety:  The pressures of modern life (family, finances, jobs, etc.) can take their toll on a healthy sex life. If a man does have an occasional bout with impotence, the anxiety created by that and the fear of it happening again can be one of the greatest stressors. Depression can also be a factor in impotence.

  • Relational issues: An argument with your spouse or negative feelings going either way between you and your partner can make it difficult to perform sexually. Any hostility or resentment can translate into erectile dysfunction for some men.

Physical causes:


  • There are many potential physical conditions that can trigger erectile dysfunction. Some of the more common ones include:

ü       Various diseases:  The list is long regarding diseases that can affect male sexual performance.


Ø       Atherosclerosis:  “Hardening of the Arteries” can cause narrowing of the blood vessels to the penis and prevent adequate blood supply for an erection.


Ø       Diabetes



Ø       Chronic diseases:  Just about any part of the body can be the culprit: Conditions of the lungs, heart, liver, kidneys, nerves, and circulatory                 system, to name a few.


Ø       Male hypogonadism:  This occurs when the hormone testosterone is found at unusually low levels in a man’s body. Actually, this is quite rare. Most men who are tested measure in at levels within the normal range.


ü       Trauma:  Any form of major trauma, whether it be surgery or an accident, can result in physical causes of impotence. Examples include spinal chord or back injuries that may cause neurological damage to the pelvic area. Surgery for prostate cancer is a possibility as well. Even extensive bicycle riding can pose a physical threat that can cause erectile dysfunction.

ü       Substance abuse:  Excessive use of alcohol, cocaine, marijuana, and other street drugs can cause difficulty achieving an erection, as well as lower sexual drive and desire. Heavy tobacco use can also create physical problems by affecting blood vessels in the penis.

ü       Certain medications:  There are a multitude of drugs that can include erectile dysfunction on their list of possible side effects. Among the most common are: tranquilizers, some antidepressants, medications for high blood pressure, sleeping aids, antihistamines, and some pain medications. If you see your health care provider for impotence, one of the first questions you will probably hear is “What medications are you on?”


How is Impotence Diagnosed?

Diagnosing erectile dysfunction is not hard. In fact, you don’t need medical help to know you can’t get or maintain an erection. The difficult, but very important part, is determining what is the cause or causes behind the problem. A thorough exam and interview with your provider is the place to begin. He will probably ask you about medications, as well as about the circumstances behind the impotence—when did it start, what are the patterns, any recent changes physically, emotionally, or relationship wise—things like that. He may also do a physical exam of your genital area to look for any physical signs that could indicate a problem.

There is a common sense test that can be done to collect “clues at the scene of the crime.” If you are successfully having erections while sleeping, this probably indicates that the problem is more psychological than physical. It is very common and completely normal for men to have multiple erections while asleep. Sometimes they will wake up with an erection. There is a special perforated tape that can be wrapped around the penis before bed. If you have had an erection  at any time during the night, the tape will be broken and you can rule out a primary physical cause for your impotence.

If there is no apparent physical cause, more questions might shed some light on patterns that could indicate a nonphysical cause. It is critically important to determine the correct cause for erectile dysfunction, because the decision of how to treat it will be based on the suspected causes for it.

What Treatments Are Available for Erectile Dysfunction?

If your impotence is traced to a nonphysical cause, then dealing with the triggers that are causing the problem is critical. If it is fatigue, try bringing more balance into your life by working less and sleeping more. If you are depressed or anxious and fearful, take a step back and give some long hard thought as to how you can reduce the stress and anxiety in your life. Sometimes one of the best things you can do is start to talk about your impotence and these other issues with someone such as a counselor or a friend or even your spouse. Many couples find that impotence is much easier to overcome when they work on it together. After all, it truly is a family problem that affects you both.

If you determine that you have a physical cause for your impotence, you are at the mercy of the medical establishment that would love to lavish all kinds of drugs and procedures on you, to no surprise. Let me make a few comments in that regard. Be very careful of the viagra’s and other medications that are on the market to treat impotence. Despite what the FDA says, there is considerable evidence that they can be very dangerous for some men to take. Over 130 men have died while taking Viagra, and the reasoning that the sexual activity killed them and not the medication is pretzel logic as far as I am concerned.

There are also some pretty wacky therapies available as well. One is called needle-injection therapy, and it involves self-administering injections of chemicals from a tiny needle into your penis. How safe is that? No one knows for sure, because there simply isn’t enough data yet. Another is called self-administered intraurethral therapy.  This little gem involves placing a tiny suppository into the tip of the penis just before sexual relations. Many men have found it to be a painful experience, and the admitted side effects include bleeding in the urethra, dizziness, and the formation of scar-like tissue in the area.

There are also a slew of vacuum pumps, implants, and other devices available to help provide on-demand erections. The best thing to do, if you have a physical problem that you think might be helped by any of these contraptions, is to thoroughly research the effectiveness and safety of any option you are considering.

Are There Any Natural Therapies to Treat or Prevent Impotence?

The only herbal treatment that has a proven track record is called yohimbe, and it is derived from a tree by the same name that is found in West Africa. It is quite effective for many men who suffer from erectile dysfunction, and the FDA even approved it for over-the-counter supplements and as a prescription drug. It works by increasing blood flow to the penis.

The best natural approach is to develop a lifestyle that focuses on staying healthy to avoid all kinds of illnesses, including impotence. Plenty of exercise will keep the circulatory system strong and ample blood flow will be available for a great sex life too. Eating right and exercise will keep your mind and emotions strong and balanced as well, and will also help to eliminate any nonphysical problems that can contribute to erectile dysfunction.

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