Q&A: Impotence

What is Impotence?

Impotence literally means inability, specifically the inability of the man to get an erect penis. Nowadays, erectile dysfunction is more commonly spoken of than impotence. The disorder can vary in severity. A man can sometimes not get a boner or never. The erection can also become less hard or the ejaculation less powerful or intense.

How does an erection come about?

An erection is created by a cooperation between mind and body. During sexual stimuli, the brain sends signals to the penis. There blood vessels in cavernous bodies dilate and fill with blood. The result is an erection.

What are causes of erectile dysfunction?

This can be psychological, for example when a relationship is no longer good or when someone is under great stress.
Physical causes occur, for example vascular disease, diabetes, depression and side effects of medicines. And normal physical changes with aging play a part. For example, the testosterone level may drop, or the blood vessels may constrict. A 2000 NIPO study found that the risk of erectile dysfunction increases with age. A quarter of 50 to 64-year-olds had erectile dysfunction, and 45 percent of those over 65.

What can you do about it?

In the case of psychological causes, treatment will often consist of therapy with a psychologist, together with the partner. The treatment varies with physical therapy. An erection pill can help with both psychological and physical causes.

How do these pills work?

The erection pills work by relaxing the smooth muscles around the penile arteries. As a result, those blood vessels dilate and enough blood enters the erectile tissues of the penis. Since 1998 Viagra (sildenafil) on the market. In 2003 followed Cialis (tadalafil) and Levitra (vardenafil). All three make the erection more powerful and keep it longer, but the man no longer feels like having sex because of these pills.

How do they work?

All three are quickly absorbed into the blood. In men who are sensitive to the substances, the desired effect of sexual arousal is sometimes achieved within 15 minutes. But other men don’t feel any effect until after ten hours.
Viagra and Levitra work only four to five hours, Cialis up to 36 hours. It seems as if the body has to get used to the pills. It is only after four attempts to properly assess whether the drug is effective. One in five men turns out to be insensitive to Viagra and Levitra. Cialis can work for them, but one in five men is insensitive to that too. The insensitivity does not have to do with vessels that are difficult to dilate. It may also be due to psychological factors.

Do they have side effects?

Four to ten percent of men suffer from headaches (all three), flushing (Viagra and Levitra) or upset stomach (Viagra). One to four percent suffer from a stuffy nose (all three), dizziness or a blue haze (Viagra), stomach upset or nausea (Levitra), muscle pain or back pain (Cialis).

How do you get the pills?

They are only available by prescription. The doctor assesses whether an erection pill is a safe and suitable treatment. Among other things, they should not be used by men who use nitrates, such as the heart pill under the tongue. The pills are not reimbursed in the basic package. The cost for one pill is €6 to €9.

Are there other resources?

Yes, there are also means that are injected into the penis, and mechanical means, such as a pressure ring, vacuum pump prosthesis and artificial penis. Exercising the pelvic floor muscles may help.