Impotence – Causes & Treatments

Impotence may have a physical, lifestyle, or psychological cause. An underlying medical condition is the most common cause of impotence. Such conditions may interfere with the blood supply to the penis, the generation of nerve impulses involved in getting and maintaining an erection.

Some medical conditions that commonly cause impotence include diabetes, cardiovascular disease, atherosclerosis, or the hardening of the arteries, kidney disease, and diseases affecting the nervous system. Diabetes causes damage to both blood vessels and nerves. Cardiovascular and other vascular diseases reduce the flow of blood to the penis, and the veins that remove blood from the engorged penis may be leaky. Kidney disease may cause impotence through chemical changes that affect circulating hormones, blood supply, nerves and overall energy. Conditions that affect the brain or nerves, such as stroke, Alzheimer’s disease, or multiple sclerosis may all interfere with the flow of nerve impulses that are needed for an erection.

Besides medical conditions, surgery that involves the bladder or prostate and pelvic and spinal cord injuries may affect nerves supplying the penis or involved in maintaining an erection. Certain hormonal imbalances such as low testosterone levels can also cause impotence and several types of prescription drugs can cause impotence as a side effect.

Lifestyle factors implicated in impotence are lack of physical exercise, being overweight, and the use of alcohol, smoking and illegal drugs. Alcohol and tobacco cause damage to blood vessels and nerves. Lifestyle factors may exist alone or be accompanied by psychological factors such as depression.

Psychological causes of impotence include stress, anxiety, depression, or guilt. Sometimes, people who have been physically or sexually abused may suffer from psychological impotence. Another cause of psychological impotence is confusion about one’s sexual identity. Often, someone with an underlying physical condition may also be depressed or anxious, adding to the combination of factors causing impotence.

Mental stimulation plays a major role in sex, both in its overall enjoyment and in mediating the physiological pathways of arousal. There are a number of reasons for psychological impotence. Often, stress or exhaustion may be possible explanations for impotence. Anxiety, depression, or post-traumatic stress disorder also may result in impotence, as can a history of sexual or physical abuse. Guilt associated with a sexual relationship or encounter or problems in a relationship may also contribute. One often-overlooked reason for psychological impotence is confusion over one’s sexual identity.

Unfortunately, most people are unaware that the vast majority of impotence cases are the result of an underlying physical disorder. If someone is unaware of this disorder, anxiety and stress may build up over a period of time to worsen impotence and in turn cause more stress. It is therefore always a good idea to rule out a physical explanation for impotence before evaluating psychological reasons. For many people, psychological impotence may be situational or only with a certain sex partner. It is important to differentiate between situational and ongoing psychological impotence, as the approaches taken in treating these may be very different.

A person suffering from true psychological impotence may benefit greatly from counseling. This may help identify if the underlying reason can be removed or its effect reduced through appropriate treatment. For example, people suffering from depression or anxiety may need treatment to improve their condition. People who have suffered from post-traumatic stress disorder or abuse may need counseling on coping skills and may also be depressed. For those whose impotence is worsened because they don’t understand the physical condition that’s causing it, a simple explanation of the underlying condition and reassurance that impotence is treatable may suffice. An evaluation of psychological impotence should assess the person’s sexual identity, as confusion in this area may be the cause.

Female impotence, or female sexual dysfunction, is a catchall term used to describe difficulties in having sexual desire, enjoying sex, being adequately aroused or having an orgasm. A woman may experience decreased sexual desire for a number of reasons including stress and exhaustion. She may be unable to enjoy sex because she has one of several sex pain disorders, which in turn may be caused by an underlying condition. Women with breast cancer or gynecologic disorders may experience sexual dysfunction.

One type of female impotence is analogous to male impotence and may be caused by decreased blood flow to the clitoris during sexual intercourse. Psychosocial factors such as previous or ongoing sexual or physical abuse or an unresolved conflict over sexual identity may also play a role in female sexual dysfunction.

To provide appropriate treatment to a woman suffering from sexual dysfunction, her physician first has to overcome the challenge of separating intrinsic from extrinsic reasons for such dysfunction. Besides pain during sex or the presence of a clear underlying disorder, it may be difficult to distinguish between a woman’s inability to become aroused and have an orgasm from the technique used by her partner to stimulate her. Many women may only be able to have an orgasm through clitoral stimulation but gender roles and other barriers may get in the way of a woman expressing her needs to her sex partner. Mental stimulation plays a major part, if a woman is dissatisfied with her sex partner for other reasons, this may translate into decreased libido with that partner. This is called situational sexual dysfunction and the woman may experience no problems with a partner she considers more appealing.

Where an underlying reason can be identified, female sexual dysfunction is treatable. In many cases, a doctor may recommend counseling for a woman and possibly her partner.