Chapter 6

### Erectile dysfunction (impotence)

##### What is erectile dysfunction?

Erectile dysfunction refers to the persistent inability of a man to get or maintain an erection of the penis sufficiently to have sexual intercourse. Most adult men have probably experienced a short period of temporary impotence at some time. This is usually due to a psychological rather than a physical problem and is not a cause for concern.

##### How common is the problem?

It is common and affects at least 3 in 10 males at 45 years and 2 in 3 males at 70 years.

##### What are the causes?

Most cases of erectile dysfunction (up to 75%) have a physical (organic) cause while the rest have a psychological (functional) cause.

Physical causes

• Ageing

• Alcohol excess

• Chronic illness

• Diabetes

• Nervous system disorders (e.g. stroke)

• Decreased circulation to penis

• Drug reactions, for example:

• marijuana, cocaine, narcotics

• heavy smoking (4 times the risk by age 50)

• sedatives, tranquillisers, antidepressants

• blood pressure drugs

• Hormone irregularities

• Surgery (e.g. prostate surgery)

Psychological causes

• Stress and fatigue

• Anxiety or depression

• Marital disharmony

• Guilt feelings

• Situational stresses, such as the presence of other people in the home (e.g. in-laws)

Sometimes we simply do not know what causes impotence. You can get an idea of whether you are functional by being aware of erections during sleep or morning erections or erections through masturbation.

Although the risk of impotence increases with age, it is not inevitable. Most men keep the ability to get an erection, although more stimulation is usually required.

##### What tests need to be performed?

Tests will include blood tests and possibly special investigations for the function of your penis. Special sleep studies on erections during sleep can be performed.

##### How can it be prevented?

• Careful treatment of any medical problem such as diabetes is important.

• Avoid drugs of addiction, including common ‘social’ drugs.

• Discuss the effects of any medicines with your doctor.

• Do not have more than two standard alcoholic drinks a day.

• Cut down smoking.

• Promote sexual feelings:

• have good communication with your partner

• talk over any concerns

• choose a good atmosphere for lovemaking.

##### What is the treatment?
Lifestyle

Reduce any high alcohol consumption and refrain from smoking (cigarette, cigar and pipe). Significant stress and overwork should be attended to.

Counselling for psychological causes

This will involve brief sexual counselling, for which you may be referred to a specialist clinic. It is important to attend with your partner.

New anti-impotence ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.