Impotence Hub

Although it might seem to be a modern phenomenon, impotency – or erectile dysfunction as it is also known – is a problem which has blighted mankind for centuries.

During medieval times, a husband who was accused by his wife of impotence was forced to submit to the courts for inspection, and demonstrate publicly his ability to maintain an erection. This was particularly popular across Europe.

As late as the 17th century in France, impotence was still considered as a crime and certainly reasonable grounds for a divorce. The practice of forcing a man to exhibit his penis for all to see was eventually ruled to be obscene and unlawful in 1677.

Thankfully modern society deals with the subject of impotence is a far more sensitive way, but it’s still a subject which has the potential to cause great personal embarrassment, and can devastate relationships if not handled with care. What is impotence 

Impotence is the inability to develop and sustain an erection for long enough to be able to achieve sexual intercourse. It is distinct from other types of sexual problems such as premature ejaculation as the root causes of impotence can be very different, although there may be some overlap.

The causes of impotence can be either physical or psychological but both produce the same net effect.

An individual who is suffering from impotence may have a total inability to achieve an erection at all. This means they do not have erections during the night whilst asleep, and in the morning, they won’t have an erection either. Even with plenty of physical stimulation, it won’t be possible to develop an erection for masturbation.

In these types of cases, although there may also be a psychological component, the cause is likely to be physical and tests will need to be carried out by your doctor to establish the underlying reason.

If however you are able to develop and maintain an erection in circumstances other than sex, the cause is likely to be psychological.

Anxiety can play a big role in how the penis performs and it can sometimes be difficult to understand what the cause really is.

A good test for this is a variation of what is carried out in sleep laboratories by doctors, and can very easily be replicated at home.

You will need a strip of sticky paper which is easily torn and is also perforated. A strip of stamps is a good example and if you don’t mind the waste are perfect for the test. When you go to bed at night, stick a strip of stamps – or other perforated paper – around your penis, making sure the ends overlap. The ring should not be too tight, or too loose. You don’t want it to flap around but if it’s too tight it will tear off and rip too easily.

Once in place, replace your penis in your boxers or pyjama bottoms – it’s helpful to wear bedclothes over your penis for this test – and then go to sleep. In the morning, if the stamp ring has torn, you experienced erections during the night. If the ring is still intact, you are not experiencing erections during your sleep.

It is normal to have around 5-6 erections every night while you are asleep, regardless of what you are dreaming about. Therefore an absence of erections during sleeping hours would suggest the cause of your impotence is physical rather than primarily psychological.

How do I get an erection?

To really understand how impotence can be triggered by the various causes and how treatment can work, it’s necessary first of all to appreciate how many bodily systems are involved in getting an erection in the first place.

The whole process always starts with feelings of arousal; these may be spontaneous and caused by sights and thoughts, or they can be brought on by physical stimulation.

Once a man begins to feel aroused, the brain sends a message to the nerves in the penis which allows them to make room for the arteries to widen, thus resulting in a greater degree of blood flowing to the area.

As the blood flow increases, the penile tissues start to harden and expand, and in doing so the veins which would normally carry the blood back out become compressed. This helps to maintain the quality of the erection.

Therefore in order for an erection to occur, the man’s psychological state must be sufficiently receptive to enable the message to reach the brain. From there, the nervous system, hormones and circulatory system all work together to make sure the messages reach the right place and that the muscles, arteries and blood are all able to perform their role.

Failure in any one of these systems can result in the whole process faltering, with the end effect of impotency for the man.

What might cause impotency?

There is a myth that impotency is a condition only associated with older men. It’s certainly true that older men are more prone to suffering from impotency – around 70% of those aged over 70 will be impotent – it’s a condition which increasingly is affecting younger men too.

Over half of all men are thought to suffer with impotence at some point in their life, and one in five marriage breakups are estimated to be attributable at least in part to impotency. It really is an issue which is very widespread and doesn’t deserve the social stigma which many men feel.

There are a vast number of potential causes for impotency, both physical and psychological . In many cases it can be a combination of the two. Suffering from impotency can be such a devastating blow for men that it’s not uncommon to become anxious about performance in the future, or even depressed about the situation.

This is where it can become tricky. Around twice as many men who have impotence also suffer from depression, so it can be a case of trying to unravel what came first.

Anxiety, stress and depression are all common causes of impotency, but then the impact of suffering from erectile dysfunction can exacerbate the feelings even further.


Anxiety and tension can lead to headaches, stress and impotence

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There is a long list of possible physical causes too, but in a strange way, suffering from impotence can sometimes be a blessing. Undiagnosed cardiovascular disease is a major cause of impotence, with arteries hardening and narrowing and preventing sufficient amounts of blood from reaching the penis.

Without the warning of impotency, the cardiovascular disease could have continued to worsen unchecked, and could easily have led to a potentially fatal event such as a heart attack.

Diabetes is another disease, also linked to cardiovascular disease which can also lead to impotence, particularly if glucose levels aren’t being well controlled or monitored.

Elsewhere in the body, a stroke or neurological disease such as multiple sclerosis or Parkinson’s can also lead to impotence, with the nerve endings and peripheral nervous system unable to respond in the way it should.

Although many of the physical causes of impotence are due to problems elsewhere in the body, it may be that the cause is rooted in the penis itself. Infection or diseases such as Peyronie’s can cause significant problems, whilst a tight foreskin or a shortened frenulum can also have an impact on sexual performance.

For this reason, a doctor will always want to examine the penis first to see if there is any obvious structural abnormality which could prevent a full erection from forming.

Discussing impotence isn’t easy and you may not want to approach your doctor to discuss such an intimate subject. However, it’s really important that you rule out any underlying disease; don’t simply assume that being impotent is just because you are stressed.

You can ask for a male doctor if your usual doctor is a woman, or you can visit a GUM clinic if you prefer to discuss matters with a medical professional that you won’t have to see for other matters in the future. Whichever doctor you choose to go and see, they won’t be shocked by your symptoms as it’s something they will have seen many times before. You may feel like you are alone but impotence really is a widespread problem that affects men of all ages in every country around the world.

Treatment options
There are a number of different treatments which can be offered to individuals who are suffering from impotence, including medicinal, mechanical and surgical.

Viagra  is one of the most famous treatments for impotency , but the little blue pill as it is often described is far from the only medication which can be offered. Viagra belongs to a group of drugs known as PDE-5 inhibitors and they work by ensuring sufficient hormones are secreted in the penis to allow the arteries room to widen.

If you are suffering from impotence but want to enjoy sexual activity, Viagra and PDE-5 medications can make is possible, working for around two thirds of men who take the drug. Not everyone succeeds at first; doctors suggest trying the medication for at least eight times before deciding whether or not it works.

There are three main dosages available: 25mg, 50mg or 100mg; you take one tablet every 24 hours.

Don’t forget to pack Viagra travel pills in your travel case

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Your doctor might start you on a low dose in order to try and avoid any unwanted side effects, but if it’s not working the dosage can be increased to a level which is hopefully effective.

These medications don’t magically cause an erection; that could be a rather awkward state of affairs if you had no control over when it occurred and for how long! However, they allow the right conditions in the penis for an erection to occur, providing there is sufficient stimulation for the man to become suitably aroused. This may require physical stimulation rather than just erotic thoughts or sights.

Once the man is aroused, the chain of biochemical events is triggered; the medication helps to ensure that blood flow is maximised and that each step of the process falls into place. In many men this means they are able to develop and maintain an erection, even if they have not been able to do so for some time.

PDE-5 inhibitors are contraindicated in some people, although these are not hard and fast rules, simply guidelines about which groups may not be given a prescription.

Individuals who have had a recent stroke, a heart attack, have been advised to refrain from sexual activity, are more inclined to develop priapism (a painful condition where the erection lasts for hours), suffer from low blood pressure or are taking certain medications such as nitrates or alpha-blockers.

There are some other conditions or criteria which may mean it’s not safe for you to take PDE-5 inhibitors. Your doctor will help to reach that decision with you.

It is possible to get PDE-5 inhibitors prescribed for free on the NHS (subject to the normal prescription charge) but only if you have one of the conditions explicitly named. The following diseases and conditions may mean that you quality to receive Viagra on the NHS:

removal of the prostate gland, often done in order to treat prostate cancer

surgery on the pelvis – may have been carried out in order to treat incontinence, remove growths or repair injuries sustained in an accident

kidney dialysis – as a result of kidney failure

kidney transplant

Huntington’s disease and other genetic conditions

prostate cancer even without removal of the prostate gland

spina bifida


multiple sclerosis

Parkinson’s disease


In addition, if you are receiving help from a specialist centre you may be able to receive NHS prescriptions for PDE-5 inhibitor medication, such as Viagra, if you can demonstrate that impotence is causing you significant distress. This would include disruptions to your relationships and daily life as well as having an impact on your mood and behaviour.

Local areas of the body impacting male impotence

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Getting prescribed medication can be a huge relief for some men who have been struggling with impotency but it’s worth emphasising that the treatments can also have some unpleasant side effects. Not everyone who takes PDE-5 inhibitor medication will definitely suffer the side effects, but the risks increase the higher the dose is.

Some of the effects you may experience include:


muscular pains

visual disturbances

nasal problems – either a blocked or a runny nose

migraines and headaches

nausea (feeling like you want to be sick)

vomiting (actually being sick)


back pain

The severity of the side effects will determine whether they are significant enough to deter you from taking the medication. Many men take PDE-5 inhibitor medication without suffering severe side effects.

It is important to check with your doctor whether there are any interactions with other medications you may be taking; this includes complementary medicine. Some complementary or alternative medications can either block or heighten the effects of prescribed drugs so it’s essential that your doctor knows exactly what you will be taking.

There are other approaches you can take as well as trying PDE-5 inhibitors. Although they are successful for many men, they don’t work for everyone. In addition, some men may not be able to take them because of their risk factors.

If this is the case there is another medication which can be prescribed; this is taken in a different way, either injected into the penis or inserted into the urethra.

If you want to avoid drugs completely, a vacuum pump can create an erection in around 90% of men which lasts for around half an hour.

Surgery is rarely suggested and is very much a last resort. Not available on the NHS, it’s expensive and typically only an option for those cases where anatomical abnormalities are the cause of the impotence. Semi-rigid rods or inflatable implants can be used, although the latter offer the most natural looking and effective results. The former are typically only suggested for use in older men who don’t plan on having regular sex.

Maintaining relationships

The practicalities of when to get treatment and what the cause might be are important to consider but some of the biggest problems can arise in trying to maintain relationships <How to manage impotence and relationships> when the impotency is ongoing.

For a man who is in a relationship, there can be the temptation to withdraw and hide away without discussing the matter with their partner. All attempts at communication may be blocked off or even met with aggression and blame. This can make it really hard to tackle the issue as a couple and work out a plan.

It’s important to resolve impotence issues to maintain a healthy sexual relationship

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Unfortunately, it is a common reaction. The impact of suffering from impotency both for the individual and for the partner should never be underestimated. Both parties can feel unattractive, unloved and rejected and may fear the other person will leave them for someone else.

The partner may be worried that the man no longer finds them attractive, and needs reassurance that this is not the case. This is the real meaning of impotence <What is the Meaning of Impotence> and how it affects individuals.

But if the man is not ready to discuss the issue, these reassurances may not be forthcoming and the situation can spiral downwards very quickly.

Impotency is a common theme in marital breakdowns so the importance of working through the problem together cannot be overstated if you want to preserve your relationship. No blame should be attributed and you can follow a number of techniques which sometimes can be sufficient to resolve the impotence without any further ado.

Impotence is often cited as a cause of divorce and marital breakdowns

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These techniques involve making a number of lifestyle changes such as stopping smoking, cutting back on alcohol, learning to relax, getting enough sleep and taking regular exercise. Even if you aren’t overweight, if you have an unhealthy lifestyle it can lead to impotence, even if you are well in other ways, and simply making a few changes can bring about a miraculous cure.

It may also be worth considering counselling too. Going as a couple allows you to address any issues which may be contributing to the situation as well as helping to work through any frustrations you may be feeling.

It’s important not to diminish those feelings: when it first occurs impotence can be incredibly frustrating for both parties in the relationship but there are steps you can take which can help.

Sexual fulfilment doesn’t always have to be about penetrative sexual intercourse and learning to spend time exploring each other’s bodies intimately without the pressure of sex, can be quite an enlightening experience. It’s not something you may have chosen to do if you weren’t put in the position but it could bring you closer as a couple, and allow you to become more physically intimate in different ways.

Mutual masturbation can be a very effective technique which allows both parties to feel sexually fulfilled whilst sharing an erotic experience. Sex toys can also be used on both the man and the woman, not just for penetration, and the stimulation can produce quite exhilarating sensations.

A sex therapist can help couples to find different and new ways to be intimate together if penetration is temporarily not an option.

The jury is out on whether sexual positions make a real difference; opinion is divided amongst experts. However some suggest that the man lying on his back with his partner on top may increase the chance of penetration being possible, if you want to attempt full sex again. This is because not having to move any large muscle groups is thought to concentrate the blood into the penis. This is an experimental view and may not work for everyone.

Don’t be paralysed by the stigma

There’s no denying that impotence can be frustrating and lead to a downturn in mood for both parties. However, a large part of the problems can be caused by feelings of shame, guilt and embarrassment.

Impotence has a lot of jibes – e.g. “no hard feelings”

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Impotence is a huge subject with lots to think about so an A-Z of what to remember could help you focus on the main points.

Impotence is such a common problem, there’s really no need to feel stigmatised by being a sufferer, and the route to overcoming the disorder is open and honest communication and a stress-free approach. Piling the pressure on yourself to perform no matter what won’t help, so giving yourself the permission to take time to recover is the first step to regain sexual satisfaction.

Image Credits: Carbon NYC, See-Ming Lee, Enoch Choi, Jon Rawlinson, Monochrome and Lulu Hoeller