IMPOTENCE

IN MY PRACTICE, over the years I’ve noticed that men complain of two distinct sexual problems: lack of desire and impotence. Patients often confuse the two problems and describe both as “impotence,” but they’re distinctly different.

Many men, and the numbers seem to be increasing over the years suffer from what can be termed lack of desire. They no longer seem to have much interest in sex. They’d really rather watch TV or go to the gym, and they begin to wonder if what they’re experiencing is an early sign of impotence. While lack of desire may precede impotence, it’s not the same thing. Lack of desire usually stems from stress, fatigue, and/or depression.

Sam, a youthful fifty-year-old patient, was seriously worried about his sex life. He was convinced that he was becoming impotent because he hadn’t had relations with his wife of twenty-five years in nearly six months. He still loved her and was happy in his marriage, but he no longer felt the drive to have sex. Sam said he had two children in college and he felt enormous financial pressure, he was working harder than ever, but despite his excellent job performance, a younger man in his office was assuming more and more responsibility and seemed to be breathing down his neck.

Sam’s story is typical of what many of my male patient’s experience. At a point in their lives when they might begin to notice a decreased ability to develop and maintain an erection, they are also feeling enormous pressures in other areas of their lives. They begin to think that sex is something that they no longer do very well, so why do it at all? With more and more time lapsing between sexual experiences, anxiety and avoidance build.

What Sam was experiencing was lack of desire. While his erection was probably slightly slower to build and less engorged than his erection of twenty years ago, he was not impotent. He was able to achieve intercourse but was avoiding it or ignoring it. He simply needed to get his sex life jump-started. By thinking about sex in a positive way, making stress-free time for sex, and, in Sam’s case, avoiding too much alcohol before sex, he found he was able to enjoy a satisfying sex life again.

But there are other psychological problems that can trigger impotence. One is the notion that sex is an athletic event. Obviously most men can’t compete at sixty the way they could at twenty. And so they begin to lose confidence in their ability to perform. Their anxiety sets off a self-perpetuating problem: They’re afraid to engage in sex and so they don’t, until they finally try, and, paralyzed by anxiety, they can’t. Counseling and reassurance can reverse the problem.

Impotence, while it sometimes mimics Sam’s problem, is more complicated than lack of desire and, in fact, more easily defined. Impotence is simply a permanent or temporary inability to have or maintain a sufficiently rigid erection to achieve intercourse.

Many men are confused by changes in their sexuality as they age and ascribe their problem to impotence. Here are some changes that most men can expect as they grow older:

• By age sixty, many men notice that it takes longer to reach an erection.
• As they age, many men notice that their lubrication prior to ejaculation lessens or even disappears.
• Older men produce a smaller amount of semen and thus feel less of a desire to ejaculate.
• Most older men notice that it takes them longer to achieve an erection after ejaculating:

All of these changes are normal and do not indicate impotence.

If you do suffer from actual impotence, there may be a variety of contributing factors. A number of natural remedies have proven helpful, and there are other remedies a physician may prescribe that may be the answer if you have a problem that won’t respond to the natural solutions.

Alcohol is implicated in numerous impotence problems. The solution is obvious- If you drink too much, you are probably going to have trouble achieving and maintaining an erection. Contrary to what you might think, those three or four or five drinks that “get you in the mood” sabotage your performance.

Many men believe that reduced male hormones cause their impotence. While it is true that adequate testosterone is essential to achieving an erection, it’s not common for a man to be deficient unless he has had prostate surgery for cancer and his testes have been removed. Your doctor can check your hormone level to reassure you: You may be one of the few who does need hormonal injections to restore potency.

One possible cause of diminished hormones is heavy smoking which leads to large amounts of carbon dioxide in the blood, reducing the hormonal levels and contributing to impotence. Not only does smoking affect hormonal levels, it also can contribute to the clogging of penile arteries, which can cause impotence even in younger men. One study found that men as young as thirty-five suffered impotence connected with smoking. Men who smoked a pack a day for twenty years were four times more likely than nonsmokers to become impotent as a result of clogged arteries.

Vascular problems can cause impotence. When the flow of blood is impaired, you may not get sufficient blood into the penis to engorge it sufficiently. High blood pressure and high cholesterol are problems that can cause some level of impotence. If you have and of these problems, please read the sections on them in this book: It’s quite possible that by remedying these problems you can eliminate impotence.

Some men develop adult-onset diSamtes as they age, without knowing it. If this happens, in addition to impairing the blood flow to the penis, it can wreak havoc with blood-sugar levels; this, too, can contribute to impotence (see DiSamtes).

A major cause of impotence is illness. Sometimes the illness itself causes the problem, but more often the illness creates fear concerning intercourse. Many men who’ve suffered a heart attack worry about sex and its effect on their heart. In fact, regular sexual activity can reduce the risk of another heart attack. Countless studies have shown that sexual intercourse causes stress comparable to climbing several flights of stairs or other normal activities. For most people, by the time they are released from the hospital, they are able to resume normal activities including a normal sex life. The publicized cases of men dying of heart attacks while having intercourse often involve men who are having extramarital affairs (a cause of considerable stress) and who are also suffering from the effects of alcohol, overeating, and/or drugs.

If you have had a heart attack, it’s possible that your partner also is nervous about sexual activity. I strongly suggest that you discuss this with your doctor. Cardiologists are used to dealing with this problem about the best advice concerning your particular case. Medications are thought to be responsible for about one quarter of all cases impotence. Some prescription drugs can interfere with the autonomic nervous system as well as with the production and action of sex hormones. Bill came to see me because of high blood pressure. He had been on medication for his condition for nearly three years, and while his blood pressure was under control, he was looking for a way to reduce his medication. On his second visit, he rather sheepishly mentioned that he had been having some sexual problems. His blood pressure prescription was causing impotence, but he had never made the connection. Too embarrassed to mention it to anyone before, he spent three years agonizing over this-a simple change of medication restored his ability to enjoy sex. The natural treatment for reducing blood pressure can also, in many cases, reduce the need for medications.

Surgery can cause impotence. Prostate surgery (prostate problems are quite common ill men over fifty) can impair the ability to achieve erection. Major abdominal surgery can also cause impotence. Both types of surgery can compromise the nerves and/or the blood supply serving the penis. If surgery has caused your impotence, only your doctor can tell if it is possible to repair the damage and restore your ability to achieve erection.

If you can think of no explanation for your impotence-if you can eliminate medications, illness, surgery, hormonal levels, DiSamtes, high blood pressure, elevated cholesterol, and psychological problems as the source of your problem-there are natural remedies that you should try.

Zinc is a mineral that is crucial to the production of testosterone, the male sex hormone. We now know that if you are even marginally deficient in zinc, your potency can be affected. Zinc supplementation has been helpful for many men. Incidentally, patients on kidney dialysis -70 percent of whom have some degree of impotence-are helped enormously by zinc supplements. I suggest that patients take 50 mg. of zinc daily.

There are two natural substances that offer great promise for impotent men. The first is the herb Ginkgo biloba, which can be helpful for men whose problem stems from diminished blood flow to the penis. You should hope to see some improvement in about two months; some patients regain full potency within six months. You can get ginkgo at health food stores. There are no known harmful side effects.

Another natural remedy for impotence is yohimbine, a substance that is derived from the bark of the yohimbe tree in Africa. Yohimbine (available by prescription) is known to dilate surface blood vessels and stimulate the release of norepinephrine. The usual dose is three 5.4-rog. tablets a day; you should see some results in two to three weeks. By the way, yohimbine can increase your heart rate and make you feel slightly nervous as well as raise your blood pressure, so if you experience any of these reactions, you should lower the dosage and gradually increase it to the prescribed amount.

Finally, there is a mechanical device that’s useful for men who have found no other solution. It’s known as a vacuum constrictor device (VCD), available by prescription. The device consists of a tube into which the penis is inserted. A vacuum is then created by means of a small pump, which encourages blood flow into the penis and thus an erection. A flexible ring is then slipped onto the base of the penis to maintain the erection. The device is safe and effective for most men, and if nothing else has been helpful you might want to ask your urologist about it. One of my patients has a ninety-two-year-old father who has fulfilled a happy sex life by means of the pump.

NATURAL PRESCRIPTION FOR IMPOTENCE

Stop smoking.

If you suffer from high blood pressure or elevated cholesterol, you should try to remedy these problems, as they can affect potency.

• If you suffer from arteriosclerosis, DiSamtes, or high blood pressure (see Arteriosclerosis, DiSamtes, Hypertension), your impotence could be connected to these problems.
• Make sure that you are following appropriate measures to keep them under control.
• Check any medications you take to see if they affect potency. Ask your doctor to check the Physicians’ Desk Reference, a listing of all prescription drugs (also in the library), to learn about side effects of your medications.
• If you have had a heart attack or other major illness, you should discuss with your doctor its effects on your sex life. Usually fear about sex following a heart attack or health problem is unfounded.
• If you’ve had surgery-prostate or abdominal-it’s possible that you’ve had nerve or vascular damage that can be reversed. Check with your doctor.
• If you sense that your impotence has a psychological basis, make an effort to get counseling.

IN ADDITION TO YOUR DAILY SUPPLEMENTS, TAKE:

• Zinc: 50 mg. daily.
• Ginkgo biloba: one 40-mg. capsule or tablet daily for up to six months. If you’ve seen no results by then, discontinue.

IN ADDITION: Try yohimbine-a natural extract available only by prescription. Take three 5.4-mg. Tablets daily of the generic form (it’s cheaper than the brand names) daily for about two months. If no results, discontinue.

If other efforts have failed, ask your doctor about a vacuum constrictor device or VCD than can be of help and/or penile injections