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(im`pətəns), inhibited sexual excitement in a man during sexual activity that, despite an unaffected desire for sex, results in inability to attain or maintain a penile erection. Known medically as male erectile dysfunction, it affects younger and older men alike. Impotence can result from psychological factors (performance anxiety or fear of abandonment or unwanted pregnancy), sociocultural factors (negative sexual attitudes or religious beliefs), or physical causes. Impotence is distinguished from sterility (inability to produce sperm adequate for reproduction; see infertilityinfertility,
inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has had intercourse regularly for one year without using birth control.
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Physical causes include low testosteronetestosterone
, principal androgen, or male sex hormone. One of the group of compounds known as anabolic steroids, testosterone is secreted by the testes (see testis) but is also synthesized in small quantities in the ovaries, cortices of the adrenal glands, and placenta, usually
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 levels, diabetesdiabetes
or diabetes mellitus
, chronic disorder of glucose (sugar) metabolism caused by inadequate production or use of insulin, a hormone produced in specialized cells (beta cells in the islets of Langerhans) in the pancreas that allows the body to use and store
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, arteriosclerosisarteriosclerosis
, general term for a condition characterized by thickening, hardening, and loss of elasticity of the walls of the blood vessels. These changes are frequently accompanied by accumulations inside the vessel walls of lipids, e.g.
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, prostate cancer surgery, and neurological diseases such as multiple sclerosismultiple sclerosis
(MS), chronic, slowly progressive autoimmune disease in which the body's immune system attacks the protective myelin sheaths that surround the nerve cells of the brain and spinal cord (a process called demyelination), resulting in damaged areas that are unable
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 and Parkinson's disease. Many drugs, illicit (e.g., marijuanamarijuana
or marihuana,
drug obtained from the flowering tops, stems, and leaves of the hemp plant, Cannabis sativa (see hemp) or C. indica; the latter species can withstand colder climates.
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, heroinheroin
, opiate drug synthesized from morphine (see narcotic). Originally produced in 1874, it was thought to be not only nonaddictive but useful as a cure for respiratory illness and morphine addiction, and capable of relieving morphine withdrawal symptoms.
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, and cocainecocaine
, alkaloid drug derived from the leaves of the coca shrub. A commonly abused illegal drug, cocaine has limited medical uses, most often in surgical applications that take advantage of the fact that, in addition to its anesthetic effect, it constricts small arteries,
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) and prescription (e.g., ulcerulcer,
open sore or circumscribed erosion, usually slow to heal, on the skin or mucous membranes. It may develop as a result of injury; because of a circulatory disturbance, e.g.
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 medicines such as cimetidine (Tagamet) and hypertensionhypertension
or high blood pressure,
elevated blood pressure resulting from an increase in the amount of blood pumped by the heart or from increased resistance to the flow of blood through the small arterial blood vessels (arterioles).
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 medicines such as beta-blockersbeta-blocker
or beta-adrenergic blocking agent
, drug that reduces the symptoms connected with hypertension, cardiac arrhythmias, angina pectoris, migraine headaches, and other disorders related to the sympathetic nervous system.
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 and diureticsdiuretic
, drug used to increase urine formation and output. Diuretics are prescribed for the treatment of edema (the accumulation of excess fluids in the tissues of the body), which is often the result of underlying disease of the kidneys, liver, lungs, or heart (e.g.
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), have been associated with impotence in some men. Smokingsmoking,
inhalation and exhalation of the fumes of burning tobacco in cigars and cigarettes and pipes. Some persons draw the smoke into their lungs; others do not. Smoking was probably first practiced by the indigenous peoples of the Western Hemisphere.
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 and alcoholismalcoholism,
disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is the most
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 also can inhibit sexual excitement. Often, more than one factor is involved. In general, anything that can affect the flow of blood to the penis can cause impotence.

Treatment depends on the underlying cause, and may involve education and counseling of the man and his partner. Treatments include self-injection of a vasodilating drug before intercourse, and implantation of rod-shaped devices into the penis that are inflated via an attached fluid reservoir. In 1998 the first prescription medication for the treatment of impotence, sildenafil (Viagra), was approved for sale in the United States. It acts by blocking an enzyme called phosphodiesterase 5 (PDE5), which can end an erection prematurely; vardenafil (Levitra) and tadalafil (Cialis) work similarly.

See also sex therapysex therapy,
treatment of sexual disorders and dysfunction, including impotence, orgasmic dysfunction, vaginismus (spasm of the muscles of the vagina), premature ejaculation, and lack of sexual responsiveness, not caused by a physical problem.
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a symptom of various pathological conditions manifested by a weak erection, which interferes with the normal course of the sex act. Impotence may accompany organic and functional disorders of the nervous system. It may also be a symptom of a urological disease.

Many male sexual deviations are associated with impotence. These deviations range from infertility to various forms of sexual incompatibility between partners. There is a tendency in modern sexology to be more exact in defining concrete sexual disorders, especially in cases of sexual incompatibility. Soviet sex pathologists have shown that many who seek the help of a sexologist are suffering from imaginary deviations. The male may be making excessive demands upon himself. He may also be imagining nonexistent sexual defects or overreacting to changes in his sex drive. Failure to observe the elementary requirements of sexual psychohygiene and improper behavior on the woman’s part can also lead to male sexual deviations. Sexual neuroses may result if psychosomatic deviations are not treated promptly. The counseling of a sexologist is usually effective.


Iakobzon, L. Ia. Polovoe bessilie, 2nd ed. Petrograd, 1918.
Aktual’nye voprosy seksopatologii. Managing editor, D. D. Fedotov. Moscow, 1967. Pages 183, 270.
Vasil’chenko, G. S. O nekotorykh sistemnykh nevrozakh i ikh patogeneticheskom lechenii Moscow, 1969.
Problemy sovremennoi seksopatologii (collection of works). Moscow, 1972.
Masters, W. H., and V. E. Johnson. Human Sexual Inadequacy. London, 1970.



Inability in the male to perform the sexual act.
Lack of sexual vigor.


Chatterly, Sir Clifford
paraplegic from the war, unable to satisfy his wife sexually. [Br. Lit.: D. H. Lawrence Lady Chatterly’s Lover in Benét, 559]