Unfortunately, only 10 percent of the 30 million American men affected seek help. What's more, even men who do seek treatment typically wait an average of six to nine months. That's unfortunate because the sooner the problem is diagnosed and treated, the more likely it is that treatment will be successful.
And doctors have found that sexually active men who suddenly have trouble sustaining an erection need to be examined immediately, because the condition may signal that a heart attack or stroke is imminent.
One reason for the reluctance to come forward is embarrassment. Many men are afraid that erectile difficulties are due to psychological problems. In about 80 percent of cases, the causes are mainly in the body, not the mind.
The most common physical cause is damage to blood vessels which impairs blood flow to the penis (usually related to hardening of the arteries, high blood pressure, or diabetes). A reaction to some prescription medications can also cause erectile problems.
Other risk factors include smoking; excessive alcohol or cocaine use; a nerve or hormonal disorder; and nerve damage due to prostate, bladder or colon surgery. Emotional factors such as stress or guilt sometimes come into play, but usually in younger men.
The following treatments for impotence are currently available:
- Caverject. Injected into the penis shortly before intercourse, this produces an erection within 5 to 20 minutes without interfering with sensation or ejaculation. The active ingredient is alprostadil, a synthetic hormone that works by relaxing smooth muscle tissue in the penis to improve blood flow.
- MUSE (Medicated Urethral System for Erection). This also uses alprostadil. Instead of an injection, the drug is administered with a tiny plunger that drops a pellet of medication into the opening at the tip of the penis. Caution: Alprostadil should not be used by men who have sickle cell anemia; who have had bone marrow tumors, leukemia, prostate or breast cancer; or who have an abnormally formed penis or penile implants. Caverject is not recommended for use more than three times a week; do not use MUSE more than twice in 24 hours. MUSE should not be used with a partner who is pregnant except with a condom.
- Testosterone replacement therapy. This is used to treat impotence problems related to a deficiency of the male hormone testosterone and is given by intramuscular injection or via adhesive patches that deliver the drug through the skin. The Androderm Testosterone Transdermal System, previously available in a 2.5 mg formulation, is now also available in a 5 mg. version, allowing users to apply a patch only once a day instead of twice.
- For some men whose impotence stems from impaired circulation, pelvic-muscle exercises called Kegels can help.
- The Rejoyn support sleeve, sold over-the-counter in pharmacies, fits over the penis and allows men who don't have natural erections to have intercourse.
- Hand-powered pumps, like the ErecAid system, form a vacuum around the penis. As air is sucked from the tube, blood flows into the penis, creating an erection.
- Inflatable or noninflatable penile implants.
- Vascular surgery, to boost the blood supply to the penis, is usually effective only in younger men who can obtain an erection but not sustain one.
- Reconstructive surgery may be used in the case of Peyronie's disease, where scar tissue forms on the penis. This causes pain and erectile difficulties and bends the penis to one side.
Impotence & Aging
About one in three men over 60 has erectile difficulties due to health problems that are more common among older men. If you're in this group, here's some helpful information from the National Institute on Aging:
Regular sexual activity helps maintain sexual ability, by bringing oxygen-rich blood to the penis. This keeps penile blood vessels and nerves healthy.
Over time, most men (and women) notice a slowing of sexual response. Men may find it takes longer to get an erection, that the erection may not be as firm or as large as in earlier years, or that ejaculation may occur more quickly. Some may find they need more manual stimulation. Using different positions, new techniques, or medical devices can help.
Most men can start having sex again 12 to 16 weeks after a heart attack. But many men lose potency because they fear that sex will cause another attack. The risk of this happening is very low. Follow a doctor's advice.