Impotence can be simply understood as the inadequate erection of penis for the purpose of sexual intercourse. Though a rarity to talk about it’s rather a very important topic lying beneath the carpet due to the hesitancy to discuss anything in relevance to our sexual lives.

Sexual intercourse and erection are much more than a mere physical happening where the process requires a delicate interplay of our emotional cognitive physical and situational factors. Therefore, quite unfortunately for both man and woman, there is a multitude of determinants for one may get an erection or not within the intimacy of his partner,” says Dr Ferdinan Perera, Acting Consultant Psychiatrist MBBS MD, shedding light on Sexual Impotence for Health Capsule.

 The simplified mechanism of erection is blood vessels of penis get dilated with the release of a chemical called Nitric oxide. The trigger for the release of chemical may come from your brain over a sexually stimulating thought or an interaction. Nerve impulses from brain to penis run with this message of hype where Testosterone, the male hormone, primes the ground for this drama to take place. Therefore any mishap of brain- mind, nerves, blood vessels, hormones and your partner may obliterate the delicate process.

Causes for sexual impotence vary
 Ageing is regarded as a main cause for impotence as 50% of men between 40-70 years have the complaint. This can be understood by the fact that ageing leads to higher rates of diabetes, hypertension, hypercholesterolemia, heart disease etc.

 Diabetes and high cholesterol are two nasty conditions as diabetes reduces neuronal- vascular responsiveness of the penis while cholesterol deposits obstructs the penile blood supply which means no erection as it’s simply the engorgement of blood in penis equals erection. 

 Smoking, which further accentuates the blood vessel obliteration from cholesterol plaques also plays a role.

Dealing with the problem 
 “Generally, men experience something called morning erection, natural mostly non-triggered, erected penis in mornings. Clinicians are used to assume the absence of morning erection may signal the presence of a medical cause for impotence rather than a psychological cause” explains Dr Perera.

 Also, for the ease of making a working diagnosis for the cause of impotence one may use the age as a guide. In fact, a man of 20-40 years presenting with impotence with no history of diabetes, cholesterol or high blood pressure may signal the presence of a psychological cause for the impotence. 

 Late onset impotence after the age 35-40 years may be coming from diabetes or high cholesterol,  which may be undiagnosed. 

 Certain medications can cause erectile dysfunction so it is always better to encourage people to be more open on their needs and sexual symptoms with their doctor.
 Spinal cord injury and hormonal changes are rarer causes of impotence.

Psychological issues are not uncommon
 Depression and anxiety are the usual psychological causes for impotence.

 According to the doctor, a sizeable number of couples may experience performance anxiety, in which the male partner gets anxiety anticipating he might not perform well on the bed.
In fact performance anxiety is an erection killer. This may further worsen the anxiety on future performance. 

 Alcohol intoxication is also another killer of erection, both short term and long term.

 Furthermore, turbulences in couple relationships like conflicts, disputes and gaps of communication can play a significant role.

The impact of Digital-era on impotence
 “One cannot emphasise less about the important psycho-social developments in our modern day digital living. Digital sources offer ample of avenues of instant sexual gratification for men of all ages” Dr Perera emphasises.

 “Downside of this overflow is significantly harmful for the natural sexual response.

Because, with time, the brain adapts in a way of only responding to the sexually implicit videos or images of the virtual world but not for the physical man-woman interaction. This condition is observed more and more now in all over the world, especially affecting younger men who access the digital world more”

A green light on therapy
 “Luckily, treatment options offer more optimism for the treatment in erectile dysfunction now than it was twenty years ago.

 Following an assessment to look for the possible causes and contributors, the intervention can range from pharmacological to psychological (in fact, rarely psychological).
With the discovery of new medications, given the indication tallies: there are good medications at the hands of clinicians currently.  Nonetheless, psychological interventions are highly recommended for almost every case given it is available, even in the form of simplest psycho-education. 

 Performance anxiety can be addressed with a unique delivery of gradual exposure therapy and improvement in couple relationship aspects, communication, mutual understanding are never to be missed” concludes Dr Perera.