What to do if Viagra won't do

Erectile dysfunction (ED) — impotence — is an extremely common problem that affects up to 22% of American men, mostly in the older age groups. Once considered primarily a psychological disorder, it is now clear that most cases of impotence have a physical basis. The leading causes are the chronic diseases that damage blood vessels and nerves vital for normal erectile function; diabetes, atherosclerosis, and hypertension head the list. The medications used to treat these problems and other ailments can also contribute to impotence. Hormonal abnormalities are less common, but they are particularly important to detect since they can be corrected. That's also true of the psychological problems that cause up to 15% of impotence; table 1 below summarizes some of the differences between psychological and physical impotence.

For many men, the hardest thing is to admit the problem. Every man experiences erectile dysfunction from time to time, but doctors define impotence as the inability to get and keep an erection satisfactorily for penetration on at least 25% of attempts. It's a good definition, but it should not be used to exclude men with less severe difficulties from getting treatment. A simple questionnaire can help you determine if you are having erectile dysfunction (see below). If so, talk to a primary care doctor, urologist, or endocrinologist.

Table 1: Erectile dysfunction: Mental or physical?

Psychological impotence

Organic impotence

Onset

Usually abrupt

Usually gradual

Nighttime erections

Preserved

Absent

Partners

May occur with one partner only

Occurs with all partners

Erections triggered by erotic stimuli other than intercourse

May be preserved

Absent

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