For centuries, male impotence has been popularly dismissed as an inevitable phase in the aging process -- like menopause for women. Most impotent men fall between the ages of 40 and 69, but the condition can also afflict the very young and the very old.
Only in the past 20 years have scientists begun attributing impotence to anything other than psychological instability.
Today, physical disorders are blamed for most cases of impotence. Diabetes, cardiovascular ailments, prostate surgery, brain and spinal cord injuries, penile injuries, prescription drugs, drug and alcohol abuse, and smoking are considered the leading causes because each in some way restricts blood flow to the penis or damages nerve tissue. Some men do not discover they suffer from a serious illness until after they consult a doctor about their impotence.
Performance anxiety -- fear of failure -- is what researchers consider the primary cause of psychologically induced impotence. Other psychological factors are premature ejaculation, emotional distress, depression, diminished sexual desire, post-vasectomy trauma, marital strife, midlife crisis, and guilt or anxiety about such issues as homosexuality or religious orthodoxy.
Men whose impotence is traced to psychological problems can be treated through counseling and sex therapy. But it often takes more drastic treatment -- injections of muscle relaxants into the penis or surgical implants -- to treat impotence caused by physical ailments.
Injected testosterone supplements that increase vitality and sexual desire in men with hormonal imbalances cost $10 to $40 depending on the dosage; their effects last up to three weeks. Vacuum constriction devices, which draw sufficient blood into the penis to cause an erection and then prevent leakage with rubber bands, vary in cost from $250 to $500.
Self-injected doses of muscle relaxants into the penis -- the most frequently used treatment method -- cost from $15 to $20 for the near-immediate capacity to have sex for up to three hours. Doctors advise limiting sex facilitated by penile injections to three times a week.
Psychological counseling costs $100 per hourlong session on average. And penile implant surgery -- the most radical form of treatment -- costs $10,000 to $15,000.
In most cases, medical insurance pays for all varieties of impotence treatment except for penile injections.
Consulting the family doctor, or a urologist who specializes in such disorders, is the only way a man can be sure if a dysfunctional occurrence indicates impotence.