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

The distress associated with impotence is only because of one simple reason. Somehow sexual functions of man have been linked with his, "manliness” which is not correct.

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 defined as failure to achieve erection or ejaculation or both. Loosely this term is used by patients and doctors alike for any form of sexual dysfunction. It can be loss of libido, failure to have an erection or ejaculation.

A decrease in desire or libido can be because of any   disease or substance causing   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, is some of them. A physician prescribing these medications should warn the patient before hand regarding impotence. This side-effect is reversible if the offending medicine is stopped.

Alcohol, tobacco, heroin, e.t.c. addicting substances cause impotence in young men.

Diabetic autonomic neuropathy is yet another cause of impotence in young men. Sometimes impotence may be the first clue leading to diagnosis of diabetes.  As the entire mechanism of erection and ejaculation is mediated predominantly by the nervous system any disease or tumour affecting the brain or spinal cord can cause impotence.

Atherosclerosis i.e., thickening of blood vessel walls because of advancing age, other   diseases, and 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 some of the common causes of impotence. Cheap pornographic videos and literature also are responsible for impotence in young adults. These depict stories of such "valour” and "bravery” on the bed that men assume that to be the standard of sexual behaviour.  There is no such "standard” of sexual behaviour.  Sex is a very personal need for a human being 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 once on the bed 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, loose interest in sex   by the right time i.e. when they get married.      

A careful history and clinical examination itself ascertains the cause of impotence in majority of cases thus saving the need for expensive tests like hormonal assays and scans. 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 all that is 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 non-qualified personnel 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 kept   away from   promiscuous sex.

Anybody complaining of impotence should be made to understand that impotence is not the end of the world.

E-mail-  rachna212002@yahoo.co.uk