Of all the problems faced by men world over, impotence is one of the most common, non-fatal but incapacitating. It causes so much distress mentally. A man does not want to discuss this problem with anyone.

A variety of neurological, psychic and vascular factors interplay in the sexual function of a man. The desire to have sex arises when one sees or thinks something erotic, due to the influence of hormones. Erection and ejaculation follow it.

Technically, impotence is failure to achieve erection or ejaculation or both. Loosely, this term is used by patients and doctors alike for any form of sexual dysfunction, whether  loss of libido, failure to have an erection or ejaculation.

A decrease in desire or libido can be because of any cause of deficiency of androgens. Hypogonadism or testicular atrophy because of congenital chromosomal disorders may cause impotence. Childhood viral infections, causing inflammation of testes, like mumps can lead to impotence. Pituitary and thyroid diseases result in sexual impotence. 

Many drugs produce impotence as a side-effect. Cimetidine used for gastritis, antihypertensive drugs like propranolol, antidepressants, are  some of them. This effect is reversible if the offending medicine is stopped. 

Alcohol, tobacco, heroin, among other addictive substances, cause impotence in young men. 

Diabetic autonomic neuropathy is yet another cause of impotence in young men. Any disease or tumour affecting the brain or spinal cord can cause impotence.

Atherosclerosis, that is to say, thickening of blood vessel walls because of advancing age, trauma to the brain, spinal cord, penis or testicles can also produce impotence.

Majority of the cases of impotence especially in a young man are psychic in origin. Excess work, tensions in work place, anxiety because of some problem lead to failure of arousal in men. Dislike for a partner, marital discord, suspicion of a wife or girl friend having some other relation or guilt regarding one’s own deviant sexual relations are responsible. Impotence in young adults also occurs due to pornography. Stories of such "valour” on the bed are depicted, that men assume that to be the standard of sexual behaviour.  There is no such "standard”. Sex is a very personal need like food and it varies from person to person. Number of times one may like sex or how long one would like to have sex, is one’s own need and is not to be discussed or compared with any other person. 

 Another cause of impotence in men is promiscuous sexual behaviour. Those youngsters who start indulging in sex from puberty, lose interest in sex by the right time, that is, when they get married.       

If a physical cause for impotence is suspected like hormonal disorder or neurological problem it should be investigated and treated.

Good counselling, motivation and encouragement are needed for treating impotence. The affected person should be told that it is like a problem like any other problem of the body and there is no need to be ashamed about it. Because of the fear, shame and apprehension regarding impotence many young men visit traditional healers  and resort to magic cures to gain potency. A drug claiming to cure impotence surely, sold faster than hot cakes all over the world in the last decade. Later on, there were many reported cases of sudden fall in blood pressure and even sudden cardiac arrest and death following its use.

Adolescents and teenagers need to be counselled about promiscuous sex.

Others need counselling, avoidance of addicting substances and treatment if a treatable cause exists.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital