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Impotence / Erection Problems

Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting or maintaining an erection. In many cases, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man's self esteem and harm his relationship with his partner, and thus requires treatment.
If you have difficulty having or keeping an erection more than 25% of the time, it is considered a problem.

In the past, erection problems were thought to be "all in the man's mind." Men often were given unhelpful advice such as "don't worry" or "just relax and it will take care of itself." Today, doctors believe that when the problem is not temporary or does not go away on its own, physical factors are usually the cause.

One way to know if the cause is physical or psychologic is to determine if you are having nighttime erections. Normally, men have 3 to 5 erections per night, each lasting up to 30 minutes. Your doctor can explain a test to find out if you are having the normal number of nighttime erections.

In most men, erection difficulties do not affect their sex drive.

Premature ejaculation (when orgasm comes on too quickly) is not the same as impotence. Together with your partner, you should seek counseling for this problem, which is usually due to psychological factors.

Male infertility is also quite different from impotence. A man who is unable to maintain an erection may be very capable of producing sperm that could fertilize an egg. An infertile man is usually able to maintain an erection, but he may be unable to father a child due to problems with sperm count or other factors.

Erection Problems: Common Causes
An erection requires the interaction of your brain, nerves, hormones, and blood vessels. Anything that interferes with the normal process can be a problem. Common causes include:

  • Diseases and conditions -- such as diabetes, high blood pressure, heart or thyroid conditions, poor circulation, low testosterone, depression, spinal cord injury, nerve damage (for example, from prostate surgery), or neurologic disorders (like multiple sclerosis or Parkinson's disease)
  • Certain medications -- such as blood pressure medication (especially beta-blockers), heart medication (such as digoxin), some peptic ulcer medications, sleeping pills, and antidepressants 
  • Nicotine, alcohol, or cocaine use 
  • Stress, fear, anxiety, or anger
  • Unrealistic sexual expectations, which make sex a task rather than a pleasure. 
  • Poor communication with your partner 
  • A "vicious circle" of doubt, failure, or negative communication that reinforces the erection problems 
  • Erection problems tend to become more common as you age, but it can affect men at any age and at any time in their lives. Physical causes are more common in older men, while psychological causes are more common in younger men.

Erection Problems: Home Care & Treatment

For many men, lifestyle changes can help, and even solve, erection difficulties:

  • Cut down on smoking, alcohol, and illegal drugs.
  • Get plenty of rest, take time to relax, and address excessive stress in your life. 
  • Exercise and eat a healthy diet to maintain good circulation. 
  • Use safe sex practices if the problem is caused by fear of contracting a sexually transmitted disease. 
  • Talk openly to your partner about sex and your relationship. If you are unable to do this, counselling should be sought.

Couples who cannot talk to each other are not likely to be able to make love to each other. Men who have trouble communicating their feelings may find it difficult to share with their partner any anxieties about their sexual performance. If you keep worries to yourself, you are more likely to lose erections. Men who cannot express and resolve feelings of anger or frustration towards their partner may hold back their erection as a weapon in the conflict. In these circumstances, counseling can be very helpful for both you and your partner.

If erection problems seem to be caused by a medication you are taking for an unrelated condition, consult your doctor. You may benefit from reducing the dose of the drug or changing to another drug that has the same result but not the same side effects. DO NOT adjust or discontinue medications without consulting your doctor first.

Talk to your health care provider if your erection problems are related to fear of recurring heart problems -- sexual intercourse is usually safe in these circumstances.

Call your doctor if:

  • Self-care measures do not resolve the problem and you continue having difficulty with erections.
  • You suspect that a medication is causing the problem. 
  • The problems begin after an injury or prostate or related surgery. 
  • You have other symptoms like low back pain, abdominal pain, or change in urination. 
  • Call your doctor immediately, or go to the nearest emergency room, if you are taking medication for erection problems, and you have an unwanted or painful erection that lasts more than an hour. If you do not, permanent impotence or other lasting damage to your penis may result.