Impotence is a description of a range of symptoms that interfere with male sexual intercourse and reproduction. This begins with those who have low levels of libido, which may have psychological or physiological causes, and moves on to those who experience problems with ejaculating or achieving an orgasm. It also includes the more specific condition of erectile dysfunction (ED) which is the repeated experience of failing to get or to maintain an erection hard and long enough for sexual intercourse to be completed. The use of the term ED excludes the other problems with sexual activity and reproduction.
The fact that "impotence" includes such a wide spectrum of conditions makes it quite difficult to estimate how common it is. In the USA, for example, the numbers start at fifteen million and rise to thirty million, depending how narrow or wide the definition used. In the National Health and Social Life Survey in men aged 18-59, the following reports of sexual dysfunction were made by respondents:
- premature ejaculation 28.5%;
- lack of, or low levels of, sexual desire 15.8%;
- anxiety about the ability to perform sexual 17%; and
- finding no pleasure in sex 8.1%.
Among the most common causes specific to ED are Diabetes, high cholesterol levels, hypertension and heart disease. It is also clearly linked to men who have had radiation therapy or surgery for prostate cancer. Generally, anything that injures the nerves or impairs blood flow in the penis may cause ED. In older men, ED usually has a physical cause arising from disease, injury or the side-effects of medications. It is a fact that the reports of impotence increase with age, but it is not a necessary part of the ageing process. The psychological conditions most likely to result in ED include depression and anger. But there is increasing acceptance among researchers that ED is most likely caused by mixed physical and psychological factors.
In the National Ambulatory Medical Care Survey (NAMCS) for 1985, only 0.75% of visits to a doctor were to seek treatment for ED. In 1999, the percentage had increased to 2.25%. There are a number of explanations for this increase, the most important being a change of male culture. It became more acceptable to admit sexual dysfunction as treatments became more widely known and discussed. The trend began with the introduction of vacuum devices and a number of injectable drugs were approved for clinical use. But the major change was the launch of Viagra in 1998. NAMCS reports an estimated 2.6m inquiries about Viagra in visits to a doctor in 1999 regardless of the declared purpose of the consultation.
Today, ED is regarded as treatable at any age and, as this has become better known, more men have had treatment and returned to normal sexual activity.
What are the causes of ED? |
