Most men will experience impotence — failure to achieve or maintain an erection — at some time in their lives. This is usually a temporary experience, often due to anxiety or too much alcohol.

For many men impotence, also called erectile dysfunction (ED), is a persistent, chronic problem causing much anxiety, stress and unhappiness for them and their partners.

Erections are due to increased amounts of blood flowing into the penis and remaining ‘trapped' there. Many factors combine to make this happen.

It used to be thought that impotence was mainly a psychological (mental) problem, related to stress, fear of failure and relationship problems. However, modern medicine has shown that about half of these problems are due to physical causes. Many of these causes can be treated and are reversible.

What causes impotence?
Among the medical conditions causing impotence are:

Some of the medications that may cause impotence are sedatives, tranquillisers, blood pressure medications and diuretics. The problem can also occur following surgery to the bladder, prostate gland, lower bowel and spine.

Psychological causes could be feeling stress over a recent life event or a change in lifestyle. Psychological causes account for about 15 per cent of impotence cases, but there is often a psychological contribution to impotence that has a physical cause. Whatever the cause, though, most men with impotence can be helped. Counselling can assist those with psychological causes. Medical treatment, surgical treatment or erectile aids may help many others.

Your doctor is the best person to evaluate the cause of your impotence and recommend suitable treatment.

The discovery of medications like sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) have made a remarkable difference to the lives of many couples. These medications work by improving the circulation and retention of blood in the penis. They are effective but must be used with caution by those with certain medical conditions. Men taking drugs known as nitrates, for heart problems, must not use Viagra, Cialis or Levitra.

Injection of a hormone directly into the side of the penis is also effective and men can be taught to do this themselves. Special vacuum devices can help and, for irreversible cases, special pump-like devices can be surgically inserted into the penis, allowing its owner to literally turn an erection on and off as he wishes.

Many men are embarrassed about discussing impotence with their doctor. If they pluck up the courage to talk about it there is a good chance they and their partners will lead a much happier life.