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Impotence means that a man is unable to sustain or maintain an erection .

At times it is a term used, incorrectly, to cover a variety of sexual dysfunction’s, as different as premature ejaculation and sterility. Usually the premature ejaculator loses the erection soon after ejaculating ... and if this happens before entry it can seem like impotence, but premature or rapid ejaculation is not the same as impotence, the causes are different and the treatment of coming too quickly is simpler.

There are, we now know, a large variety of causes for the condition of impotence; where it used to be common to talk about primary and secondary impotence we now prefer to consider the underlying problems so talk about organic or psychogenic impotence.

Psychological factors used to be considered the commonest causes of impotence but the particular factors underlying an individual problem need to be explored and the cause discovered before treatment is possible.

With more impotence now being related to physical causes, the scope for successful treatment is greater.

Sex is a so called “paradoxical behaviour”, because whenever we put pressure on ourselves may cause the erection to be lost, or rapid or premature ejaculation to occur, and sometimes it is difficult to get a “hard on”. Such performance anxiety may be related to fear of failure, lack of self confidence, feelings of inadequacy, life stresses, (related to job, the family situation, even to guilt as a result of religious or societal taboos). Fatigue is another common cause for a failure to “get it up”.

A counsellor will need to look at the state of the relationship, the quality of communications, the expectations of both partners, and often the myths that were learnt during childhood or adolescence. Even today a good sexual education is rarely offered to children. Work done at Monash University suggests that less than 10% of Australian children are given a good working knowledge of sex relationships. If we start without an adequate awareness of how our bodies work it is hardly surprising that to find the remedy for our problems means we may have to turn to others for help and assistance.

In the past - say 30 to 40 years ago - it was believed that most erectile problems arose in the mind, but there has been an increasing awareness since 1978 that medical causes play an important role. In men of under 35 it is believed more than 25% of those who have had difficulty in getting an erection will have medical problems, whilst at 65 the figure rises much closer to 50%.

If one thinks about the male anatomy it is realised that a man has three collections of spongy tissue in the shaft of his penis, and when he gets an erection these are pumped full of blood; in principle this is a simple hydraulic process.

The two sponges in the upper part of the shaft make up the so called corpora cavernosa; the other collection of spongy tissue surrounds the urethra (the tube through which we pass our urine), and expands out to form the head or glands of the penis.

Obstruction of blockage of the blood vessels supplying any of this spongy tissue can result in an inability to achieve a rigid penis. The obstruction may be related to smoking, high levels of cholesterol, blood pressure, a family history of vascular disease - heart attack or stroke .... or vascular problems elsewhere in the body.

Sometimes the arteries supplying the penis can be damaged by trauma, such as a crush injury to the pelvis, for instance.

Blockages can also be related to complications of other diseases such as Diabetes, especially in insulin dependent young diabetics, where, after someone has suffered from the disease for 15, 20 or more years, occlusion or blockage of the vessels is quite common.

Drugs can affect a man’s capacity to achieve erections, and there is known to be a close connection between drugs used, both medically and for recreation, and his ability to get an erection.

- Ageing - AIDS
- Anorgasmia - Barrier Methods of Contraception
- Frigidity - Genital Herpes
- Impotence - Loss of Libido
- Masturbation - Miscarriage
- Post Natal Depression - Pregnancy
- Premature Ejaculation - Retarded Ejaculation
- Sex and Disability - Sexual Activity during and after Pregnancy
- Smoking and Pregnancy - Stretch Marks in Pregnancy
- Syphilis and Gonorrhoea - Termination (Abortion)
- The I.U.D. (or Intra Uterine Device) - The Pill (Oral Contraceptive Pill or OCP)
- The Rhythm Method of Birth Control
or Natural Family Planning
- Tubal Ligation
- Vasectomy - What is Normal??

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