ED Basics

Everything You Need to Know About Impotence

March 25, 2022

Impotence is another term for erectile dysfunction and refers to the inability to achieve or maintain an erection that's firm enough for sexual activity. 

While troubles with an erection from time to time aren't immediately a cause for concern, frequent and ongoing issues "getting it up" may contribute to stress, self-confidence issues, and relationship problems.

Having trouble getting or keeping an erection can also be a sign of an underlying medical condition that could require specific treatment. 

If you're concerned about having erectile dysfunction, it’s a good idea to talk with a doctor. Frequently, treating an underlying medical condition like diabetes or severe obesity is enough to reverse erectile dysfunction. In other cases, you may need prescription erectile dysfunction medications or other treatments to combat ED.

What is Impotence?

Erectile dysfunction is the inability to get or keep an erection that's firm enough for sexual intercourse.

It’s also referred to as impotence, although this term is used less and less often these days.

Occasional erectile dysfunction is not uncommon, as many men experience ED during times of stress, after drinking too much, or simply when tired. Frequent erectile dysfunction, however, can be an indicator of health problems that require medical treatment. It may also be a sign of emotional or relationship difficulties that may need to be addressed by a professional. 

There are several symptoms of erectile dysfunction. If you routinely experience one of more of these issues, you may want to speak with a doctor:

  • Anorgasmia, the inability to achieve orgasm even after ample stimulation
  • Delayed ejaculation
  • Difficulty maintaining an erection when engaged in sexual activities
  • Premature ejaculation
  • Reduced interest in sex
  • Trouble getting an erection 

How Are Erections Caused? 

An erection is the result of increased blood flow into the penis. Blood flow is typically stimulated by either sexual thoughts or physical contact with the penis or other parts of the body. 

Any problems at any stage of the erection process can cause erectile dysfunction. This is why medical conditions that affect blood flow or the cardiovascular system can result in ED.

When a man becomes sexually aroused, the muscles and tissues in the penis relax. This allows for an increase in blood flow through the penile arteries, filling two chambers located inside the penis. As these chambers are filled with blood, the penis grows more rigid. An erection ends when blood flow slows and the muscles contract, then the accumulated blood can  flow out through the penile veins and back into circulation.

During an erection, the penis can hold as much as seven times its usual amount of blood.

What Causes Impotence? 

There are quite a few possible causes of erectile dysfunction, including both emotional and physical conditions. Some of the most common causes of ED include:

  • Age
  • Anxiety
  • Cardiovascular disease
  • Consuming too much alcohol
  • Damage to the pelvis are through injury or surgery
  • Diabetes
  • Depression
  • Drug use
  • Health conditions, such as Parkinson’s disease or multiple sclerosis
  • High blood pressure, or hypertension
  • High cholesterol levels
  • Hormonal imbalances or low testosterone levels
  • Kidney disease
  • Obesity
  • Peyronie’s disease, which can cause scar tissue development in the penis
  • Prescriptions medications, such as those treating depression or high blood pressure
  • Relationship issues
  • Sleep disorders
  • Spinal cord damage
  • Stress
  • Using tobacco products

It’s possible for erectile dysfunction to be caused by one of these factors or by several of them at once. This is why it can be so important to work with a doctor to rule out or treat any underlying medical conditions. 

What Are the Treatments For Impotence? 

The best treatment for erectile dysfunction will vary significantly depending on underlying root cause. It may require a combination of several treatments, including medication, counseling, and even lifestyle changes. 


One of the most common treatments for erectile dysfunction is prescription medication. These medications are effective for the majority of men who try them, and most of them have been around for twenty years and used by millions of men safely.

Most oral medications are PDE5 inhibitors. These help to treat erectile dysfunction by relaxing the muscles located in the penis, which results in better blood flow into the penis. 

The most popular available prescription medications include:

  • Sildenafil (Viagra®)
  • Tadalafil (Cialis®)
  • Avanafil (Stendra®)
  • Vardenafil (Levitra®, Staxyn®)

Another medication that's sometimes used to treat erectile dysfunction is alprostadil (Caverject, Edex, MUSE). This can be administered in two ways: as a penile suppository or as a self-injection either at the base of the penis or the side of the penis.

Testosterone therapy may also be recommended by your doctor if you currently have low levels of testosterone. 


Herbs and Supplements 

Certain herbs and supplements have been shown to help with erectile dysfunction in some men. They have varying degrees of success, and they may have no effect depending on the reason for your erectile dysfunction, but some of the more popular herbs for ED include:

  • Asparagus racemosus
  • Dehydroepiandrosterone (DHEA)
  • Ginseng, namely Korean red ginseng
  • Horny goat weed
  • L-arginine
  • L-carnitine
  • Yohimbe
  • Zinc

It’s important to speak with your doctor before rushing out to try any of these supplements. None are regulated like prescription medications are, which means they might contain additional ingredients not listed that could be dangerous. For example, the FDA regularly warns consumers about tainted "male performance enhancers" laced with illegal sildenafil and imported from overseas.

These can interact negatively with other medications too, cause an allergic reaction, or contain unsafe amounts or sources of PDE5 inhibitors.

That's why at Rex MD we recommend sticking with real prescription medications.

Vacuum Pumps 

This type of treatment uses the a vacuum in a cylinder to create an erection. Blood is drawn into the penis using this cylindrical device, essentially forcing the formation of an erection. A vacuum pump device is made up of three components:

  • A plastic tube, which is where the penis is inserted
  • A pump, manual or electric, which works to create a vacuum in the cylinder by drawing air out
  • An elastic ring, which remains at the base of the penis when the plastic cylinder is removed to help maintain the erection

The elastic ring plays a pivotal role of maintaining the erection by holding the blood in the penis and preventing it from returning to circulation. It can only be left in place for 30 minutes though. Any longer and you can risk possible damages.


Kegel exercises are simple movements that can strengthen your pelvic floor muscles. Strengthening these muscles can help combat erectile dysfunction. These exercises look something like this:

1. Identify your pelvic floor muscles by trying to stop urination midstream. That feeling, and the muscles that you're using, are pelvic floor muscles.

2. Once you've identified where these muscles are, contract and hold them for three seconds and release.

3. Repeat this exercise 10 to 20 times in a row for three times every day.

A study in 2005 compared two groups of men with erectile dysfunction. The first group performed regular pelvic floor muscle exercises with a physiotherapist and was equipped with biofeedback, sensors attached to their body to measure key functions. The second group was a control group and had neither of these factors. 

The men in the first group saw their penile function improve significantly after three months of regular pelvic floor exercises, while men in the second group saw little improvement. Over the course of the following three months, all the participants were given at-home exercises to perform. 

After six months, 40% of all participants (including some men from the second group) had regained normal erectile function.

In addition to Kegel exercises, aerobic exercise can also be beneficial to treating erectile dysfunction. Moderate to vigorous exercise is not only good for your overall health, but it can help to increase blood flow broadly, which can help with the symptoms of erectile dysfunction. 

A review of ten studies examined the effect of aerobic exercise on erectile dysfunction. The investigators concluded that 160 minutes of weekly exercise for six months could lead to a decrease in erectile problems.


A number of psychological factors have been known to cause erectile function. Some of these issues can include:

  • Stress
  • Anxiety
  • Post-traumatic stress disorder
  • Depression

If you're experiencing any of these issues and are having erectile dysfunction as a result, it may be beneficial to undergo counseling or "talk therapy." 

Over the course of several sessions, you and your therapist might discuss:

  • Your major stress or anxiety factors
  • Your thoughts and feelings involving sex
  • Subconscious conflicts that might be affecting or influencing your sexual well being

In the event that erectile dysfunction is affecting your relationship, talking with a relationship counselor may benefit your relationship substantially. This type of couples counseling can help you and your partner to reconnect emotionally, which can also help to relieve erectile dysfunction. 

The Takeaway

Impotence is now a rarely used term to describe erectile dysfunction, which is the inability to achieve or maintain an erection. There are lots of reasons why someone may be experiencing this issue, and as a result, there are a variety of treatment approaches. Oral medications like Viagra work well for most men, but lifestyle changes, identifying and treating underlying medical conditions, and even counseling can all help too.

An estimated 30 million American men experience erectile dysfunction. 

The most effective immediate treatment is with the use of prescription ED medications. It’s important to talk with a doctor about why erectile dysfunction is happening and consider the best ways to resolve the issue.

With Rex MD, you can do it all online. We prescribe generic ED meds online, with the help of a licensed clinician, and deliver them to your door, if approved. Click here to get started.