What is impotence?
The origin of the word impotence – from a historical viewpoint, the word impotence is derived from the Latin word ‘impotencia’, which literally means “lack of power” (including lack of sexual power). In the course of history, impotence has been associated with mental illnesses, anxiety, demons or witches. During the Greek times, treatments for impotence included a wide range of herbal based medicines which were applied topically to enhance the patient’s sexual strength. 1
The modern dictionary definition – according to Mariam Webster dictionary, the term impotence is broad and includes the following two interpretations (the first is a general one and the second relates to a medical problem):
1) “not potent: lacking in power, strength, or vigor: weakness”
2) “an abnormal physical or psychological state of a male characterized by inability to engage in sexual intercourse because of failure to have or maintain an erection : erectile dysfunction”
Synonyms – the word impotence has a wide range of synonyms, both in medical and popular jargons, such as:
1) medical jargon – erectile dysfunction, sexual dysfunction
2) popular jargon – inability, incapability, incapacity, incompetence, ineptitude, insufficiency, inefficacy, powerlessness, helplessness, weakness
The difference between Erectile dysfunction (ED) and impotence – in the past, it was customary to use interchangeably the terms ‘impotence’ and ‘sexual dysfunction’ to describe the various problems related to each of the four phases of the male sexual activity (1. sexual desire/libido, 2. sexual arousal/erection, 3. orgasm, 4. sperm ejaculation. However, nowadays, the term impotence is hardly used in medical terminology due to its negative connotations. The medical term ‘Erectile Dysfunction’ on the other hand, is related to a problem in one of the four phases of the male sexual activity. Its medical definition is: “the continuous (chronic) inability to attain and maintain an erection sufficient for satisfactory sexual intercourse.”
The difference between impotence and sterility/infertility – impotence and sterility are two problems that can affect male sexual health and the ability of men to have children, however they do so in different ways. Impotence refers to the inability to get or maintain an erection sufficient for penetration, thus it makes it impossible to have full sexual intercourse. Sterility/infertility, on the other hand, refers to an inability to produce or release sperm.
What are the Causes of Impotence?
The causes of impotence include physical or psychological/emotional (psychogenic) factors or the combination of both. 2 It is important to medically diagnose the causes of impotence in order to get the most effective treatment.
Physical causes of impotence:
- Vascular problems – i) a reduction in blood supply to the penis, as the arteries which supply it with blood become narrowed3, or ii) a problem in the venous system, causing the blood to drain too fast from the penis during erection.
- Problems in the central or peripheral nervous system – diseases such as Multiple Sclerosis, Parkinson or stroke as well as prolapsed disc or spinal cord damage which compromise the brain’s ability to conduct sexual arousal signals to the reproduction system.
- Benign prostate enlargement
- Hormonal causes – such as decrease in testosterone production (the male sex hormone)
- Anatomical changes – caused, for example, by trauma or Peyronie’s disease
- Taking medication – such as antihypertensives, diuretics, anti-depressants, and more
- Alcohol and drugs abuse
- Long distance bike riding – where pressure on the nerves leading to the penis affect neural function.
Psychological causes of impotence:
- Performance anxiety – when a random episode of impotence causes repeated anxiety over the possibility of subsequent ED reoccurrence.
- Different psychological states – including stress, anxiety, relationships or intimacy problems, depression, and more.
What are the Treatment Options for Impotence?
There are 3 lines of treatment for impotence:
First-line therapy for impotence – oral medications
In Israel there are 3 different prescription medications for treating ED, all belonging to the same class of drugs called ‘PDE5 inhibitors’. They are taken 1-2 hours prior to sexual intercourse (depending on the specific medication), and they increase blood flow to the penis, thereby causing an erection.
Second-line therapy for impotence – vacuum devices and penile injections
- vacuum devices – the use of a device into which the penis is inserted, which creates a vacuum that causes blood to be drawn into the penis. An elastic band is then placed at the base of the penis to maintain the erection.
- Penile injections – which cause vascular dilation and a relaxation of smooth muscle in the erectile tissues, resulting in an increased blood flow into the penis.
Third-line therapy for impotence – surgery
- Penile Implant – which is inserted into the penis through an incision made in the scrotum. There are semi-rigid implants that provide permanent rigidity, and inflatable implants that enable the penis to remains flaccid throughout the day.
- Penile revascularization surgery – when impotence is caused by a blocked artery in the penis
Treating psychogenic causes of impotence
When impotence is triggered by fear, stress, anxiety, low mood or relationship problems, it may be best treated by psychotherapy or sex therapy.
Novel Treatment Options for Impotence
- Low-intensity shockwave therapy – the use of low-intensity shockwaves (sound waves) to encourage the regeneration of new blood vessels and consequently an increase in penile blood flow.
- Vertica® Radio Frequency (RF) technology – the use of RF (thermal energy) to improve and enhance the natural erection mechanism. The Vertica® device stimulates collagen synthesis in the erectile tissues and the regeneration of new blood vessels. The treatment increases penile blood flow and promotes normal spontaneous erections.
The Symptoms of Impotence
The symptoms of impotence include a continuous inability to obtain an erection hard enough for penetration during intercourse, or if an erection has been obtained, the recurrent inability to maintain it. The psychological symptoms of impotence include anxiety, stress, feeling insecure, low self-esteem and even shame. Impotence can cause problems achieving a pregnancy due to lack of penetrative sex.
Impotence – Medical Diagnosis and Professional Consultation
The diagnosis of impotence usually starts with a family physician. It involves taking the patient’s personal medical history and an inquiry into his mental state. When it comes to physical causes of impotence, a family physician may order various lab tests (such as blood, urine and testosterone tests as well tests to detect any underlying problems such as diabetes or heart disease), and possibly offer first line therapy consisting of a class of drugs called ‘PDE5 inhibitors’. If the blood tests show low testosterone levels, a family physician may refer the patient to an endocrinologist specializing in treating hormonal problems.
Patients who did not respond well enough to drug therapy or those who cannot initiate drug therapy due to medical reasons, may consult urologists specializing in erectile dysfunction, who could offer second line therapy. In circumstances in which third line therapy may be required, the surgical procedure will be performed by a surgeon specialized urologist. If impotence occurs due to psychological causes, the patient may be referred to psychotherapy or professional sex therapy. If necessary, anti-depressants or anti-anxiety medications may be prescribed by a family physician or a psychiatrist.
↩Santoro D, Savica V, Satta E, Scaffidi M, Mallamace A, Li Vecchi M, Bellinghieri G. Impotence in the 18th and 19th century: concepts of etiology and approaches to therapy. J Nephrol. 2009 Nov-Dec;22 Suppl 14:67-70. PMID: 20013735.
↩ Gandaglia G, Briganti A, Jackson G et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014 (65):968-978.