Male Impotence

If failing to get an erection is an isolated, shortlived occurrence, then it’s nothing to worry about; this is quite normal and could be due to any number of things- too much to drink, strain and overwork, a temporary illness or worn’.

When impotence is a more long term problem than this, it usually develops after a period of normal sexual function, although there are a small number of men who, right from adolescence, have never managed to produce an erection that’s firm enough for intercourse.

Many women are fairly ignorant about male sexual problems; there’s a tendency to think satisfaction is ‘easy5 for men, and it can be quite a surprise for a woman to get involved in a relationship where the man has some sexual difficulty. When a man has a problem getting an erection, his partner’s attitude is crucial in trying to improve the situation. She can make things a lot worse by being demanding or derisory, while a sympathetic woman can contribute a great deal in helping a man to overcome his problem.

What is wrong if a man can’t get an erection?

Sometimes this is linked to an illness- about 10-15 per cent of impotent men have a physical basis for their sexual problem. If a man no longer awakes with an erection in the morning-as well as being impotent when he tries to make love- then it’s likely that there is a physical cause. On the other hand, if he consistently wakes up with a firm erection and can masturbate normally, then the reasons are much more likely to be psychological, such as depression.

If a man suspects his impotence is linked to an illness, or perhaps to some drug he is taking (those used to treat high blood pressure and some psychiatric problems have been known to affect sexual performance) then it’s really a question he has to discuss with his doctor.

Sometimes there is a psychological factor involved as well; for example, quite a few men become impotent after prostate operations – not because this need cause any ‘real’ physical difficulty, but because they are ignorant and afraid about the effect it’s going to have on their potency. Equally their wives may be unwilling to have sex after the operation, thinking that sex is now in some way forbidden. It seems that the men who are reassured about the operation and given all the facts are much less likely to develop problems after prostate surgery.

It’s more common for the cause of impotence to be entirely psychological, related to a strong source of anxiety about sex — ignorance about ‘what to do’, fear of failure, a sense of guilt, or of being discovered and punished. This in turn may be related to the attitudes to sex that were impressed on a man in childhood, if he had a very negative, restrictive upbringing or his parents had the attitude that sex was something dirty and forbidden. Occasionally it may be that the man suffered a traumatic childhood experience, such as being sexually assaulted by an adult, or perhaps his first attempts at intercourse were disastrous.

Any kind of hostility, anger or resentment towards the woman he is trying to make love to may mean a man cannot respond sexually sometimes this relates to a fear of making her pregnant or a fear of hurting her. It may be that she makes excessive demands on him; a man may feel so threatened if his sexual performance is criticized that the anxiety this sets up makes him impotent. Or it can reflect a general problem that affects the whole relationship – when sex has become a battleground for other conflicts.

Is it true that drinking a lot always makes a man impotent? Not necessarily. The effect of alcohol varies to some extent with the physical and psychological make-up of the man concerned, the amount consumed and how frequently he drinks. Alcohol is a general brain depressant which has the effect of releasing a person’s inhibitions to a greater or lesser extent, depending on how much of it has been consumed. The occasional evening of social drinking may reduce anxiety and tension in a usually inhibited man and cause a temporary increase in his sexual desire but, if a man gets really drunk, his sexual performance is usually affected and becomes inadequate.

Prolonged bouts of heavy drinking frequendy leads to a deterioration in a man’s sexual response as well as the kind of loud-mouthed, bullying behaviour that is liable to disrupt his marriage overall. It is estimated that about half of all male alcoholics suffer from some sort of sexual dis-turbance- around four in ten become impotent.

Can a man be impotent with one woman but sexually all right with another? Although it is possible for a man to develop impotence because he has become bored with his partner and no longer finds her attractive, this is not very common. On rare occasions, however, a man may be impotent with his wife but quite normal with his mistress. This may be because he ‘splits’ women into two categories — love objects and sex objects. He may fall in love with the pure, angelic, untouchable love object and find it impossible to have any kind of sexual relationship with this idealized woman. So he tends to confine his sexual activity to women for whom he has no respect or regard, embarking upon a sequence of meaningless, casual encounters.

Therapy with this kind of man involves exploring general sexual attitudes and relationships, trying to help him develop a more healthy approach to sex. Sex therapy could also be an essential part of his treatment, and ideally this should involve a woman for whom he feels positive affection.

How can a woman help her partner?

It rather depends on what kind of impotence the man is experiencing. Coping with a temporary problem within a basically good marriage is very different from taking on a relationship with a man who has always had a degree of sexual difficulty.

If some kind of short-term illness, worry or stress is at the root of the problem, then clearly it’s not going to help if the man feels extra tension or pressure about his sexual performance. If both partners can talk freely about it, they may find it quite acceptable just to ignore sex for a while, though still enjoying the warmth and affection of their usual close physical contact It’s a balance between the woman making it clear she still wants him – when he’s ready – but not making demands he cannot cope with for the moment.

For the majority of men, impotence is a short-lived state of affairs, brought on by factors including: • fatigue • certain prescribed drugs • too much alcohol • stress • acute illness

But for some, the problem is longer term and will need professional assistance. It may be there’s a physical cause that needs tackling (diabetes, emphysema or kidney failure have this effect), but more often there’s a psychological basis for the difficulty.

That ‘he doesn’t want me any more’, and try to reassure his partner that he still very much needs her affection and support. And if oral or manual stimulation can give some sexual satisfaction, there is no reason to stop this kind of love play. If the problem doesn’t resolve itself, then it’s certainly worth asking your doctor5 s advice. I f the problem is a more long term one, then it’s often essential for a wife to help by getting involved in whatever kind of counselling sessions or therapy are recommended by the specialist.

If the impotence is a symptom of a general personality problem or neurotic illness, then individual psychotherapy may be the appropriate treatment. Anxiety-recfucing drugs may also be used, and hormone preparations are sometimes helpful in the rare instances when hormone imbalance is causing the impotence. Sometimes, when the sexual problem comes second to some other source of tension in a relationship, then marriage counselling is the most useful first step.

The success of this treatment depends on both halves of the couple taking joint responsibility for their problem — and this is something the counsellor will help them to work towards. He will also encourage them to discuss with each other their sexual attitudes and fears, for recognizing them is the first step to overcoming them. The counsellor’s suggestions and interpretations will help resolve any conflict.

One particular therapy technique, known as is commonly used to help overcome impotence. The counsellor will suggest a series of exercises for the couple to follow at home. These teach them to explore each other’s bodies; to start with, touching the sexual organs and intercourse itself is banned. This removes any fear of failure or pressure to ‘perform’ from the man. So sexual stimulation is non-demanding and free from anxiety – the emphasis is on experiencing sensation, not achieving an orgasm.

Gradually, in this more relaxed atmosphere, the man will usually get spontaneous erections. The couple can then begin to stimulate each other’s genital area. The man gains confidence as his erections come and go. The next stage is for the woman to lie on top of the man and to insert his penis into her vagina; she should thrust a few times but stop before the man becomes anxious and loses his erection. The man can reach an orgasm by manual stimulation, either from himself or his partner. Only once the man has sufficient confidence should the couple continue making love; and eventually they will progress to the man taking the so called ‘dominant’ position above the woman.

During the last 10 to 15 years, a number of devices have been developed that can be implan-ted surgically in an impotent man to help him have intercourse. This treatment would usually only be used when his impotence was due to some irreversible physical cause, such as the effects of bowel or bladder surgery or a disease of the nerves that supply the sexual organs.

Either a fixed plastic rod or an inflatable device can be fitted. The disadvantage of the plastic rod is that it produces a permanent state of semierection, which maybe embarrassing for the man. Infection is also a risk. The inflatable penile implant produces an erection only when the man wants it, and the penis looks entirely normal; both the patient and his partner seem to find this more acceptable.

Can a single man have therapy to treat impotence? Many men without partners seek help for their sexual problems. Some have become so distressed and humiliated by their problem that they deliberately avoid socializing with women. Others become reluctant to start a relationship, knowing that before long their problems will be revealed and they will be subjected to further embarrassment These men pose a problem for therapists working in sex clinics, since sexual therapy nearly always involves treating the couple, im-proving their communications and encouraging them to collaborate in the kind of exercises described above. Some single women with sexual problems, such as those who have never experienced orgasm, can be helped with mastur-batory exercises, but with men there are fewer treatment options.

Some clinics run special therapy sessions for males without partners. The group provides a setting where the men can discuss and share similar problems and experiences. Educational and erotic films are occasionally used, and the primary emphasis is on restoring the men’s confidence. Some men can be helped by discussing the possible sources of their problem, by explaining the principles of sex therapy, and by reassuring them about the outcome should they find a suitable partner in the future.

When a single male with a sexual problem does meet a partner, he has to grapple with a number of problems. Should he disclose his problem anct risk the consequences, or’wait and see’ hoping all will be well on the night? The second alternative is rarely successful and itfs usually much better for him to discuss his difficulties before trying to have intercourse. If the relationship is reasonably stable and the woman is willing to attend a therapy clinic, there’s every chance of a successful outcome. Your own doctor will be able to refer you to a suitable therapy clinic

What should you do if your husband denies he has a problem? This can create a considerable dilemma for a woman. If she believes that their relationship is being damaged by her partner’s sexual problem she should try to discuss it with him; if he continues to deny that the problem exists then she becomes the person with the problem who has to decide on a policy of action. This really depends upon the degree of her commitment to the relationship, and in practice her options are limited.

If she wants the relationship to continue then she should seek advice from her doctor or a marriage guidance counsellor, who may be able to devise a method of getting the man to acknowledge his problem. One useful way is to adopt the ‘what if approach. This does not challenge a man who rigidly denies the problem, but merely asks him to consider the issue from a different viewpoint For example, the man could be asked: ‘What if your best friend developed a sexual problem and was unable to tell his wife about it?’ ‘What would you advise him and his wife to do?’ ‘If this were someone’s problem, what do you think he should do?’

Of course, some women may choose to leave the man and seek sexual satisfaction elsewhere, but this decision obviously depends how committed she is to the relationship. If s worth emphasizing that once the man has been en-couraged to seek treatment, the outlook for their sexual relationship is optimistic

Should a man expect to become impotent when he’s older? Males reach the peak of their sexual drive and potency at 17 or 18; at this age erections may occur instantaneously. With increasing age a man requires more time and stimulation to achieve an erection. After the age of 50, orgasm gradually assumes less importance within the sexual experience and there is usually less of a physical need to ejaculate. It’s quite usual for some men over 50 to be unable to have an erection for 12-24 hours after they have ejaculated, and a man over 60 will certainly have a slightly less firm erection as compared to someone younger.

For many men over this age, sexual activity can be satisfying without ejaculating at each attempt at intercourse, and there is no reason why tne older man who has a happy relationship with his wife cannot enjoy satisfying love-play and intercourse well into old age.