by J. Douglas Trapp, M.D.

Impotence, or erectile failure, is a condition in which a man either cannot get an adequate sexual erection or cannot maintain that erection long enough for vaginal penetration and successful sexual intercourse. This condition is surprisingly common in our population. An estimated 25-30 million men in the United States alone are affected by impotence. In fact, about 15 percent of the male population in any country in the world is impotent. So, if you are experiencing erectile problems, you are definitely not alone.
The good news, however, is that successful treatment is available for over 90 percent of all impotent men. Despite what you might have heard, most erectile failure can be treated in nonsurgical and relatively simple, inexpensive ways. These treatments may include:

1. Sexual counseling
2. Change of medications or lifestyle habits
3. Oral drugs
4. External vacuum therapy
5. Penile self-injection
6. Penile prostheses

The success of some of these treatments may depend upon the type of impotence. At the World Meeting on Impotence in San Francisco on November 4, 1996, a panel of medical experts with the American Urological Association (AUA) recommended three medically proven treatments: vacuum therapy, injection therapy, and penile prostheses. The panel's findings regarding the treatments are summarized as follows:
Vacuum therapy is reliable and safe when the products are prescription devices and used properly. Vacuum therapy has a lifetime-cost advantage over injections and prostheses. Patients can easily discontinue vacuum therapy and try other treatment options if desired. The most common patient complaints concerned an interruption of lovemaking, numbness or coolness of the penis, or discomfort ejaculating, but the panel found no serious side effects from vacuum therapy.
Injection therapy is easy and usually painless, although some men report mild discomfort following the injection. The injected drug produces an erection within 5 to 15 minutes. The most serious possible complications are prolonged erections or the formation of scar tissue within the penis.
The surgically implanted penile prostheses are available in several designs and do not affect a man's other normal bodily functions. The panel points out, however, that like all mechanical devices, prostheses can fail and a small percent do. The implantation and removal of a prosthesis may also prevent a man's ability to try other treatments.
The guidelines discounted other treatments as either investigational or ineffective. For example, success from vascular surgery was deemed unpredictable and therefore not recommended, and the natural plant substance yohimbine was stated to produce only modest results.
What should you do if you are impotent? Talk with your physician about what you are experiencing. Impotence may be a sign of a serious medical condition like diabetes or heart disease, which should be treated. Your physician may refer you to a specialist or specialty clinic where a few simple tests can determine the type and cause of your impotence.
Some physicians may test you themselves. After testing, your doctor can offer you appropriate treatment options for the problem. In some instances, implant surgery or vascular surgery may be added to the options listed above.