What is it?

Impotence means the inability to achieve erection of the penis. It can occur as an isolated problem in any relationship or it may be a symptom of an unhappy relationship. It could occur all the time (total or primary) or under certain situations only (selective or secondary).

Most cases of impotence (9 out of 10) are of the secondary type.

Secondary impotence tends to occur in a specific situation during sex with a particular partner. The man may be able to achieve erection in other situations including during sleep, on waking up, sexual fantasising, during masturbation, or with different sexual partners.

What causes it?

Primary impotence may be due to a lack of male hormones in the blood (hypogonadism) or may be caused by underlying diseases that cause nerve damage (such as diabetes) or reduced blood flow to the penis. Anaemia, tuberculosis and cancer may also cause primary impotence.

Secondary impotence is largely due to psychological factors. Other factors that can contribute include tiredness, alcohol and/or drug abuse, and the use of certain medicines (such as some high blood pressure and anti-psychotic medicines).

“Ageing does not cause impotence in men”[/box>

What problems can it cause?

Problems that arise from impotence include sexual frustration, relationship difficulties and infertility. It can contribute to a feeling of low self-esteem and inadequacy in the male partner.

What treatment is available?

The treatment of impotence is best carried out in a clinic with appropriate specialists who have experience of these matters. Primary impotence will usually respond following treatment of the underlying disease. Psychotherapy and counselling can help secondary impotence by helping the individual get to the psychological reasons behind the impotence. Impotence that occurs in an otherwise good relationship will need examination and can be helped by some modification of the couple’s sexual techniques.

The steps of a typical programme of modification involve:

  • Encouraging the couple to practise foreplay and non-penetrative sexual arousal.
  • Allowing vaginal penetration (but not thrusting) only when the male partner’s confidence is restored that he can produce and maintain an erection.
  • Allowing gentle controlled thrusting interrupted by periods of rest only when the penis can be maintained in the vagina for a few minutes without losing its firmness.


The treatment of male impotence has been revolutionised in recent times by the use of medicines such as Viagra. Viagra works by improving the blood flow pattern of the penis such that it does not only improve the flow but also helps retain the blood in the penis (a necessity for adequate erection). It has been shown to be successful for both primary and secondary impotence, with more than 3 out of 4 men treated achieving erection successfully. It is recommended that a doctor be consulted before commencing the use of such medicines as they can cause side effects and may not be suitable for people with certain diseases (especially of the heart and lungs).