Impotence is a term that has mostly fallen out of use, in favor of the more descriptive and clinical term erectile dysfunction, although it is still used at times in both in popular culture and by some physicians when talking about sexual dysfunction in males (for example, there is still a medical journal called The International Journal of Impotence Research).

What Is Impotence?

The way it's used today, impotence refers in general to a man's inability to perform sexually, and specifically to his inability to get an erection. Of course, impotence has many other meanings, including powerless, helplessness, weakness, etc... The inaccurate idea that if a man can't get an erection, he has no sexual power, is what makes impotence such a dangerous but also popular term. It's a word that strikes fear in the hearts of those who are worried it might happen to them, and causes pain when it's directed at someone as an insult.

Impotence isn't an accurate term because the truth is that men have sex all the time with and without erections, and a man's sexuality or power isn't related to just one part of his body. When we confuse ability to get erections with ability to give and receive sexual pleasure, we make worse a complicated and common sexual complaint -- an inability to get an erection that is satisfactory for sexual pleasure.

In order to understand why erections don't work, you need to understand the basics of how erections work. Getting an erection involves multiple parts of your body, including your brain, nerves, hormones, muscles, and heart. Anything that interrupts this any of these systems may result in what gets called impotence.

Causes of Impotence

Because erections involve multiple systems, there are often multiple causes of impotence, even for one man. Causes of impotence are often broken down into different categories. These include:

Physical Causes:

  • Diabetes
  • High blood pressure
  • Multiple sclerosis
  • Parkinson's disease
  • Heart disease
  • Conditions that affect thyroid function and/or interrupt hormones in the body
  • Spinal cord injuries
  • Injuries to the groin (recent research also points to consistent but mild trauma related to cycling)
  • Colon surgery
  • Hemodialysis
  • Prostatectomy
  • Other treatments for prostate, penile, and rectal cancers, including some chemotherapy and hormone treatments
  • Medications for high blood pressure, heart disease, and some antidepressants
  • Alcohol
  • Marijuana
  • Cocaine
  • Tobacco

Psychological Causes:

  • Depression
  • Stress
  • Sexual performance anxiety
  • Relationship problems (which may or may not be related to sex)

Treatments for Impotence

Once you've determined the cause or causes, there are various treatment options, including:

What Should I Do If I Think I'm Impotent?

If you are experiencing difficulty with erections, the first step should be to speak with a doctor. Erectile difficulties may be an early warning sign of other potentially serious health problems -- your body's way of telling you that something else is going on. It's important to understand what might be causing the changes in your erections.

In addition to seeing a physician, you may want to consider speaking with a therapist or counselor, and perhaps a sex therapist. Sex therapists specialize in the diagnosis and treatment of sexual dysfunctions. If you see a sex therapist, you'll also need to get a medical exam, but a therapist will likely have more information than your regular doctor about the details of sexual dysfunction.

One of the most difficult aspects of erectile difficulties is the way that our thoughts and feelings can perpetuate our difficulties. We all have the right to use language we want to describe ourselves. But you may want to consider how describing this problem as impotence, or calling yourself impotent, is actually working against your goal of feeling positive about yourself and your ability to both give and receive sexual pleasure.

What Should We Call Impotence?

The term impotence is already in the process of disappearing from medical literature (although it's a slow process). Impotence is a problem in part because of the way it makes men feel, and also the message it explicitly sends about sexual power being only about erections. Impotence is also a problem because it isn't precise. This might be fine for literature, but if you're trying to isolate and solve a health problem, the more precise you can be, the better. So impotence should be called whatever it actually is. If it's erectile dysfunction, call it that. If it's premature ejaculation, call it that. If it's a bad relationship, or a bad year, call it that.


Sex and Aging for Men: Main Changes

Primarily due to a drop in testosterone, men will experience changes in their sexual function as they age. These changes include (see sex tips for the older man for tips on dealing with these changes):
  • Fewer sperm are produced
  • Erections take longer to occur
  • Erections may not be as hard
  • The ‘recovery time’ (time between erections) increases to 12 to 24 hours
  • The force of ejaculation decreases
  • Sexual desire decreases are due to emotional reasons or health problems

Decreased Testosterone

As a man ages, his testosterone levels decrease. Typically this decrease in testosterone stabilizes around age 60. Testosterone decrease is the primary reason for many of the conditions listed above. Testosterone replacement therapy is becoming popular for addressing concerns of aging men. This type of hormone treatment is controversial and should be approached with caution. Increasing muscle mass through exercise and proper nutrition can help maintain a healthy testosterone level.

Cardiovascular Disease, High Blood Pressure and Male Sexual Health

These health conditions alter how the blood flows in the body. When the arteries become narrower and harder, blood does not flow as freely. This can be troublesome for men trying to achieve an erection, as erections depend on the ability of blood to fill the penis. Controlling high blood pressure and other cardiovascular diseases through lifestyle change and medication can improve sexual performance.

Diabetes and Male Sexual Health

Many men with diabetes have normal sexual lives. However, diabetes can cause impotence, the inability to have sex. Men with diabetes are approximately three times more likely to experience erectile dysfunction than men without diabetes. They also experience this condition approximately 15 years earlier than men without diabetes. If you have diabetes and are having trouble maintaining an erection, talk to your doctor. Many medications can help.

Pain and Male Sexual Health

Many health conditions such as arthritis, back pain and shingles can interfere with sex by causing pain that may make sex uncomfortable. These conditions also can alter your mood, sleep habits and attitudes. Experimenting with different sexual positions and techniques can help. You can also talk with your doctor about managing pain.

Incontinence and Male Sexual Health

Incontinence is the loss of bladder control which can cause urine leakage. This condition becomes more common as people age. Often leakage occurs during exercise, laughing or coughing. During sex, extra pressure is placed on your bladder. Men with an incontinence condition may be afraid to have sex. By controlling incontinence through medical or behavioral approaches, the chance of leakage during sex can be greatly reduced.

Medications and Male Sexual Health

Some of the medications prescribed to treat common age-related health conditions can interfere with sex. Some blood pressure medicines, antidepressants and diabetes drugs can make it more difficult for men to maintain an erection. These medications can also reduce sexual desire. You may be able to use alternative medications if you experience these side effects. Talk to your doctor.

Prostatectomy: Prostate Surgery

A prostatectomy is a surgical procedure that removes some or all of a man’s prostate. This is often done to treat prostate cancer or an enlarged prostate. A consequence of this surgery can be incontinence or impotence. Before undergoing a prostatectomy, be sure to talk to your doctor about any concerns you have about your sex life.

The Bottom Line

If you are not satisfied with your sexual ability, talk to doctor. Changes in your medication, managing your health conditions and treatment of sexual problems may help.


National Institute on Aging. Bound For Your Good Health: Sexuality in Later Life. NIH Publication Number 05-7185.