Physical causes include low testosterone levels, diabetes, arteriosclerosis, prostate cancer surgery, and neurological diseases such as multiple sclerosis and Parkinson's disease. Many drugs, illicit (e.g., marijuana, heroin, and cocaine) and prescription (e.g., ulcer medicines such as cimetidine (Tagamet) and hypertension medicines such as beta-blockers and diuretics), have been associated with impotence in some men. Smoking and alcoholism also can inhibit sexual excitement. Often, more than one factor is involved. In general, anything that can affect the flow of blood to the penis can cause impotence.
Treatment depends on the underlying cause, and may involve education and counseling of the man and his partner. Treatments include self-injection of a vasodilating drug before intercourse, and implantation of rod-shaped devices into the penis that are inflated via an attached fluid reservoir. In 1998 the first pill for the treatment of impotence, a prescription drug called Viagra (sildenafil citrate), was approved for sale in the United States. It acts by blocking an enzyme called phosphodiesterase 5 (PDE5), which can end an erection prematurely.
See also sex therapy.
Inability to achieve or maintain erection of the penis; hence, inability to participate fully in sexual intercourse. Erectile impotence (failure to achieve erection) may have either physical causes (e.g., alcoholism, endocrine disease) or psychological ones (e.g., anxiety, hostility toward the partner). Ejaculatory impotence (inability to reach orgasm, sometimes with an erection maintained for a long time) nearly always has an emotional cause. Seealso Viagra.
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