Impotence is the inability to maintain or obtain an erection of sufficient firmness to permit the initiation or completion of intercourse. Impotence comes in two forms, primary and secondary. Primary impotence is defined by never being able to have intercourse, whereas secondary Impotence is experiencing erectile dysfunction after a previous period of normal functioning.
Transient occurrences of Impotence, either losing an erection during intimacy, or not obtaining an erection, can be caused by a variety of factors such as fatigue, alcohol intake, distraction or anxiety. Approximately 12% of men are affected by impotence. It appears there also can be an organic basis for this sexual dysfunction.
Common causes include the use of some anti hypertensive medications, beta blockers such as marijuana usage, endocrine disorders, anemia, diabetes, cerebral palsy, and a variety of other illness and issues can cause Impotence.
Approximately 85% of Impotence is due to a psychogenic cause, as opposed to a metabolic factor or physiological problem.
There are many causes of psychogenic Impotence. It’s mentioned briefly below;
Some developmental factors are maternal or paternal dominance, parent/child conflicts, a traumatic childhood sexual experience, gender identity issues, traumatic first intercourse experience, anxiety, depression, poor self esteem, fear of pregnancy, fear of sexually transmitted diseases, communication issues, hostility or anger towards the partner, lack of attraction, and performance demands. It is not uncommon when a child is growing up to have very rigid, negative attitudes towards sex impressed upon the child. This can definitely lead to sexual impotence or erectile dysfunction in adulthood, especially when it included punishment with masturbation.
Men whose impotence due to a physical cause often find they gradually lose the ability to have an erection, and it tends to happen with all sexual activities.
These physical causes may include;
Diabetes
Multiple sclerosis
Parkinson’s disease
If you have had surgery in your pelvic area
Hormone imbalances
Lifestyle
If you drink too much alcohol, this can after your ability to get and keep an erection. In the longer term, it interferes with the production of the male hormone testosterone. This can reduce your sexual drive and desire.
Smoking damages your blood vessels and so increases your risk of erection problems. Similarly, being physically inactive, this contributes to poor cardiovascular fitness, may raise the chances of you having impotence. Impotence may be an early warning sign that you are at risk of coronary heart disease.
Many men need greater tactile stimulation as they get older. You may want to consider a change in sexual foreplay and technique to ensure a sustained erection.
Most men will experience an occasional failure to get an erection. This can usually be put down to stress, tiredness, anxiety or too much alcohol.
In the past it was thought that more frequent impotence was caused by almost entirely psychological factors, but we now know that physical conditions are present in about 70 percent cases. However, the majority of men with erectile dysfunction experience a combination of psychological and physical causes.
Psychological
Psychological problems can influence your ability to get and keep erections. These include:
Feeling anxious, guilty or depressed
Stress at work
Conflicts with your partner
Unresolved issues about your sexual orientation
Men find they are unable to achieve an erection at all, or to sustain one that is hard enough for sexual intercourse. Men with ED may feel angry or guilty, and become depressed. Many lose interest in sex and relationships often suffer. It’s thought that 70% of cases have physical causes and 30% psychological cause. Most men experience occasional erectile failure at some time in their lives as result of fatigue, stress or excessive alcohol consumption.
Widower’s syndrome:
This is fairly common disorder, usually occurring after the 5th – 6th decades of life, after a husband loses his spouse. There will be a normal grieving period. During that time, sexual interest will decrease. Also it is fairly typical that if and when the husband is involved in his first relationship after the death of his spouse, he may experience impotence secondary to a variety of issues. It is important to note that this is similar to panic attacks in that it does cycle back and forth, where the frequency of impotence increases anxiety and depression, which then increases the likelihood of impotence at the next sexual encounter. A very common question to ask when taking a history is, “Do you notice an erection upon awakening?” This is a normal physiological response. If there is not an erection in the morning, other physiological factors have to be ruled out inclusive of depression.
Treatment of psychogenic impotence:
It is not useful to blame one’s partner or oneself for the occurrence of sexual problems.
There is no such thing as an uninvolved partner when sexual difficulties do exist.
Sexual dysfunctions are common problems, and do usually indicate psychopathology
It is not always possible to be certain of the sexual dysfunction.
In general, cultural stereotypes about how men and women should behave or function sexually are grossly misleading and counterproductive.
Sex is not something a man does to or for a woman. It is something a man and woman do together.
Sex does not only mean intercourse. The developing of awareness one’s feelings and the ability to communicate feelings and needs to one’s partner sets the stage for effective sexual interaction.
Treatment approaches
We need to reduce any type of performance anxiety, and the beginning we need to prohibit any type of sexual activity for the couple. This is usually results in a calming effect, and there is immediately decrease the anxiety.
We need to bring the individual’s anxieties into the open, and at the same time communicate to his wife what these are so she is not in the dark, and he is able to communicate directly around his concerns.
Lastly, sensate focus is very effective. Sensate focus has been around for quite awhile and is very beneficial. It begins with, basic interactions such as talking. Communicating, sharing with each other concerns, anxieties and fears. It will occur in bedroom. It can occur in other places. It is amazing what kind of stimulation can occur in the outdoors. This process should occur over the course of a week or two. There can be touching, backrubs, shoulder rubs, leg rubs, with clothes on.
This slowly accelerates into shoulder rubs, leg rubs, with shorts on, no shirt, which then slowly progresses the following week to both individuals being nude, still no touching genitalia, no touching of breasts, rubbing fronts and backs. This does increase arousal states, but individuals have to be instructed to be much disciplined and not to have intimacy even if the individuals have an erection. This then slowly progresses to the next week where they can touch genitalia, and over a period of time touch breasts, but they are still not allowed to intercourse. The final week, they can utilize the same technique of touching a lot of rubbing and caressing, but now then can move to intercourse.
Viagra treatment is very effective. It is common that the first or second time Viagra it is used; there is not much of response. However after that, there has been enormous success with this medication, with minimal to no side-effects. It should be noted that Viagra should be used cautiously in individuals with a history of cardiovascular disease, arrhythmias, myocardial infractions, strokes, individuals over the age of 65, or those with renal or hepatic impairment. It should not be taken with nitrates in any form which can result in serious and potentially fatal hypotension. Other than those side- effects and concerns it is very safe in the correct population.
It is also important to understand when treating impotence with sex therapy that the fears may come back. There can be some recurrence. They will never be 100% resolved. It is important to set the stage for that so people do not get frustrated if the impotence does recur.
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