Impotence literally means an inability to have intercourse. In practice people use the word for an erection problem: not getting an erection, or not holding it long enough. It is an old-fashioned term, and doctors now say erectile dysfunction.
It is more common than most men think. In the Massachusetts Male Aging Study, 52 percent of men between 40 and 70 had it to some degree (Feldman, 1994).
What bothers me about the word: it lumps four very different problems together. That helps nobody searching for what is going on with him.
What does impotence mean exactly?
Impotence is an umbrella term for being unable to have intercourse. Usually the erection problem is meant. But historically more falls under it, and those meanings still live on in how people use the word.
That is exactly where the confusion starts. Two men both say "I am impotent" and mean something totally different.
| What you experience | Medical term | What goes wrong |
|---|---|---|
| No erection or too soft | Erectile dysfunction | Blood supply to the erectile tissue |
| Climaxing far too fast | Premature ejaculation | Timing of the ejaculation |
| Arousal but no ejaculation | Anejaculation | The ejaculation reflex itself |
| Sex but no pregnancy | Reduced fertility | Sperm quality or count |
Search for "impotence" while you mean climaxing too fast? Then you read for half an hour about blood vessels. They have nothing to do with your situation.
So I would work out which of the four it is first. That saves you a lot of wrong advice.
What is the most common cause?
For the erection problem the core is almost always blood supply. An erection happens because blood flows into the erectile tissue of your penis and stays trapped there temporarily. If that system does not work well, it does not get stiff enough.
That makes an erection a kind of daily stress test of your blood vessels.
The vessels in the penis are thin, roughly 1 to 2 millimetres. The coronary arteries around your heart are three to four times as thick. When vascular damage sets in, you notice it in the thin vessels before the thick ones.
That is precisely what makes erection problems medically interesting. They sometimes run years ahead of heart complaints.
Is impotence a sign of something else?
It can be. Research followed over 9,000 men. Those with erection problems later developed cardiovascular disease more often than those without (Thompson, 2005). It is a signal, not a diagnosis.
I find that the strongest argument for taking it to your GP. Not the sex, but what sits underneath.
Conditions that often play along are diabetes, high blood pressure, an unfavourable cholesterol and excess weight. Medication counts too, especially some blood pressure drugs and antidepressants.
The link with blood sugar is one of the strongest. We work that out in diabetes and erection problems.
Smoking belongs on this list. It damages exactly the vessel wall you need.
Does testosterone play a role in impotence?
Sometimes, but less than the advertising suggests. A low testosterone goes together with less drive more often than with a poor erection. Many men with erection problems have a completely normal testosterone.
The EMAS study among over 3,000 men found that sexual complaints only clearly related to testosterone below roughly 11 nmol/l (Wu, 2010). Above that line the association weakened quickly.
Take two men of 52 with exactly the same testosterone, 13 nmol/l. One has erection problems and has smoked for twenty years, the other does not. The number is identical, the cause sits elsewhere. That is why a single testosterone number so often leads to a dead end.
If you want to know which values appear on a hormone test, we listed the male sex hormones.
Is it physical or is it in your head?
Usually both, in varying proportion. The classic rule of thumb: if your morning erection disappears too, that points more towards the body. If you do get a good erection in the morning or during masturbation, context plays a bigger role.
Performance anxiety is the nastiest part. One time it goes wrong, and the tension of the next time makes it more likely to go wrong again.
If your morning erections are gone, we cover that separately. If you are under 40, the causes often sit elsewhere: see erection problems at a young age.
Chronic stress presses on both sides at once. How that hits your hormones is in cortisol and testosterone.
What can you have measured?
No blood test proves impotence. Some values do map the known risk factors. Your GP then often looks at your fasting glucose, your cholesterol and your testosterone. Sometimes prolactin joins in.
The NHG guideline on erectile dysfunction describes which physical factors play into this. What you need, your GP decides together with you.
My advice stays simple. Do not go chasing a number yourself, take the context with you.
The Men's Hormones panel maps your hormonal values. For a broader view including blood sugar and cholesterol, the Complete Men's Health Panel looks at more values at once.
If you recognise yourself in this piece, book a double appointment with your GP. Then you do not have to say it in the last two minutes.
References
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. PMID: 8254833.
- Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. PMID: 16414947.
- Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-135. PMID: 20554979.
- NHG guideline on erectile dysfunction (biology and risk factors). Dutch College of General Practitioners.
Disclaimer
Caliberhealth works with BIG-registered doctors who assess your blood results. This article gives general information and does not replace medical advice from your GP or specialist. A blood test is a tool, not a diagnosis on its own. With serious complaints, contact your GP, or call 112 in an emergency.
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