Impotence is one of the most common problems faced by men globally. It causes enough distress mentally. Very few men will want to discuss this problem with anyone. The distress associated with impotence is simply because sexual functions of a 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 of something erotic due to the influence of hormones. Erection and ejaculation follow it. Technically, impotence is defined as failure to achieve erection or ejaculation. Loosely, this term is used to refer to any form of sexual dysfunction. It can be loss of libido, failure to have an erection or ejaculation. A decrease in libido can be because disease or a substance, causing deficiency of androgens. Hypogonadism or testicular atrophy because of congenital chromosomal disorders may cause impotence. Childhood viral infections, causing inflammation of testes such as 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 and antidepressants are some of them. Alcohol, tobacco or heroin are addicting substances and 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 are psychic in origin. Excess work, tension at the work place and anxiety because of some problem lead to failure of arousal in men. Dislike for a partner, marital discord, suspecting a wife or girl friend having an affair or guilt regarding one’s own deviant sexual relations are some other causes of impotence. Pornographic videos and literature are also responsible for impotence in young adults. These depict stories of such “valour” on the bed that men assume that to be the standard sexual behaviour. There is no such “standard”. Sex is a very personal need like food and it varies from person to person. The number of times one may have sex or the desire cannot be compared with another person’s. Another cause of impotence is promiscuous sexual behaviour. Those youngsters who start indulging in sex from puberty normally lose interest in sex as adults. A careful history and clinical examination itself ascertains the cause of impotence in majority of cases. If a physical cause for impotence is suspected, such as 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 a problem like any other the body can face 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. For instance, a drug claimed to cure impotence was very popular about a decade or more. But later on there were many reported cases of sudden fall in blood pressure, sudden cardiac arrest and death following its use. Dr Rachna Pande, specialist – internal medicine.
