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In 85% of cases affecting men aged 50 and older, organic factors such as vascular disease and atherosclerosis of the penile artery are the cause.
Physical factors include:- Systemic diseases (diabetes mellitus, syphilis, alcoholism - abstain for 30 days to see if there is improvement, drug dependency, hypopituitarism, and hypothyroidism, and adrenal insufficiency)
- Local disorders - prostate enlargement (BPH), congenital abnormalities and inflammatory diseases of the genitalia, prostatitis; vascular disturbances such as aortic aneurysm and atherosclerosis (for example Leriche's syndrome)
- Neurogenic disorders - multiple sclerosis, spinal cord lesions, pituitary microadenoma with hyperprolactinemia, and cardiovascular accident; drugs such as hypertensives, sedatives, Proscar (finasteride), tranquilizers, and amphetamines.
- Surgical procedures such as sympathectomy, prostatectomy and castration produce varying effects. Impotence is usually not induced by transurethral prostatectomy, whereas it almost always occurs after perineal prostatectomy.
- Impotence is not inevitable with aging, even into the 70s or 80s. While the amount and force of the ejaculate and thus sexual tension and the need to ejaculate are decreased, the capacity for erection often is retained.
- Contributing causes include a lack of exercise, smoking, excess alcohol consumption, obesity and increased total cholesterol or reduced HDL levels.
Psychological factors are strongly implicated if the patient has situational impotence, night or morning erections, or can achieve a firm erection by stimulation. First, correct any lifestyle problems: reduce alcohol consumption, get sufficient exercise, watch what you eat, stop smoking, optimize your health, and improve your circulation with ginkgo, if needed.
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