The most common of all these causes are THERAPEUTIC DRUGS and ALCOHOL EXCESS.

(Wyngaarden and Smith, Cecil Textbook of Medicine, W.B.Saunders Co., Phila. 1985, p.2030)

The aging process with its increase in ATHEROSCLEROSIS, eventually becomes a major cause; a quarter of all men over 70 have erection failure attributable to it alone. But DIABETES with its blood vessel and nerve damage remains the most common disease causing impotence. PSYCHOLOGICAL factors are always important, as they can be a cause of the impotence or a consequence of it. Patients who have a physical illness may develop psychogenic impotence, such as can happen after a stroke or heart attack. Up until the 1980’s it was thought that most cases of impotence had a psychological cause - now it is thought that physical sources are more prevalent. Long term HEAVY USE OF TOBACCO is also a relatively common cause.

The rest of the causes are comparatively uncommon. Most endocrine disorders that are severe enough to cause impotence are easily recognized. Usually the connection of impotence with  trauma, surgery, major neurological disorders and already diagnosed cancer is fairly evident. Sometimes however, a cancer (of prostate, say) has not been diagnosed and will be revealed in the work-up for impotence.

Peyronie’s Disease, which is a localized disorder of the connective tissue of the penis that leads to painful curvature, is rarely mistaken for anything else.

Therefore, in determining the cause of impotence, a man should think first of his intake of medications - particularly blood pressure drugs and psychoactive drugs like anti-depressants or tranquilizers. Next he should consider his alcohol and/or tobacco usage. The next step is a consultation with his physician about whether diabetes or hardening of the arteries could be the cause. Since impotence can be the first sign of these disorders, and since they can lead to coronary artery disease or stroke, it is quite important to check out these possibilities.