Erections start in the mind. When sights, sounds, touches, or thoughts make a man sexually aroused, his brain tells the arteries in his penis to open the floodgates -- or, to paraphrase Captain Jean-Luc Picard, "Engorge!" The arteries become relaxed, the blood flow to his penis increases to seven times the normal volume, and an erection is born. Extra blood keeps rushing in as long as the man stays aroused or until he ejaculates. Of course, the whole process can break down. If the brain doesn't send the right signals, or if the arteries can't respond to them, a man will be unable to have an erection.
Many things can thwart an erection at one or more of the steps along the way. If you suffer from impotence, one of the following factors is probably to blame:
• Cardiovascular disease. High blood pressure, arteriosclerosis (hardening of the arteries), and other problems with the heart and blood vessels can cause impotence by hampering blood flow to the penis. The Massachusetts Male Aging study found that 15 percent of men with hypertension were completely impotent, compared with 9.6 percent of the entire study group. |
| •Medications. The National Institutes of Health reports that many common drugs can lead to impotence, including antihistamines, antidepressants, tranquilizers, appetite suppressants, the ulcer drug cimetidine, and blood pressure medications such as beta blockers and diuretics. (If you develop impotence while taking antidepressants or blood pressure medications, however, remember that the disease itself could also be to blame.) |
| •Diabetes. If it causes extensive damage to nerves and blood vessels, diabetes can block pleasurable sensations as well as blood flow. The NIH estimates that 35 to 50 percent of all men with diabetes suffer from impotence. |
| •Psychological factors. According to the NIH, psychological distress lies at the root of 10 to 20 percent of all cases of impotence. If you suffer from impotence but have erections in the morning or while you sleep, there's a good chance your problem is largely psychological. Factors that can lead to impotence include stress, fear, performance anxiety, guilt, depression, and low self-esteem. Feelings of resentment or hostility -- harbored by either the person experiencing impotence or his partner -- can also derail intimacy. |
| •Prostate surgery. Not long ago, many men had to sacrifice their sex lives after undergoing surgery for prostate cancer. Today, thanks to new surgical techniques that spare the nerves and vessels feeding the penis, impotence is far from inevitable. Surgeons at Washington University School of Medicine in St. Louis recently conducted a study of cancer patients who were able to achieve erections normally before surgery. Sixty-eight percent of the men studied were still able to have erections after the prostate gland was removed. However, only 48 percent of those 70 and older regained their potency. |
| •Smoking. Cigarettes can damage your arteries, with consequences that are enough to make even the Marlboro Man find a different habit. According to a recent report from the Centers for Disease Control, smokers between the ages of 31 and 49 are 80 percent more likely than nonsmokers of the same age to suffer from impotence. |
| •Bicycling. Although there is controversy on this subject, a few experts say regular cycling is a major cause of impotence. A recent Boston University survey looked at more than 1,000 male cycling and running club members, with an average age of 43, and found that 4 percent of cyclists had moderate to complete impotence, compared with 1 percent of runners. There's no doubt that pressing one's crotch into a hard bicycle seat puts tremendous pressure on the nerves and blood vessels that feed the penis. If you ride a bike, be sure to lean back regularly to shift your weight from the groin area to the buttocks. You should also consider investing in a seat that's specially designed to put less pressure on the groin. If you often feel numbness in your penis after bike riding, or if numbness is less frequent but lingers, schedule an appointment with your doctor or a urologist. |
•Other factors. Alcoholism, pelvic injuries, multiple sclerosis, and below-normal levels of testosterone are all capable of causing impotence.
