Before we say anything else, we need to warn folks that impotence can be a symptom of several serious and life threatening conditions including diabetes, heart trouble, high blood pressure and hemochromatosis. It can also be a sign of depression. ANY MAN WHO HAS BECOME IMPOTENT NEEDS TO PUT ASIDE HIS EMBARRASSMENT AND GET A PHYSICAL!!! Let the doctor know about the impotence at the outset so he will know to check/test for certain things. This is more than just your sex life at stake, it could be the only warning you will get of something that could kill you.

First it would be nice define impotence; but that's not as easy as it seems. To simply say it's the inability to get an erection misses how complex the process of erection is. An erection is not an "all or nothing" deal where either you have one or you don't; the penis can be completely unerect, fully erect, or anywhere in between. A man might seem erect, but not be firm enough for penetration, or he might be firm enough for intercourse in some positions, but not in others. In addition, it's normal for the firmness of the penis to wax and wane while it's erect; even during intercourse. Normally this isn't an issue, but if the erection is less than fully firm to start with, even a slight loss might be enough to cause the penis to fall out, and the man may not be able to continue.

It's also possible that a man is only impotent in certain situations. This usually indicates that the problem is in the mind. In years gone by, it was said that most impotence was caused by mental factors, but now it's known that a number of physical problems can cause it too. It's also possible that both mental and physical causes combine to leave a man unable, and once it happens a few times, his fear of it may be enough to make it happen again.

The typical test for eliminating mental or emotional factors is to check for erections at night. From before birth until very very old age, men have erections whenever they're dreaming. (Women also show signs of arousal, increased vaginal blood flow and lubricating, during dreams.) If a man has nocturnal erections, it proves that his impotence is not physical; if he doesn't have them, it shows that there is physical problem. This testing can be done at a sleep lab, but the simple at home method is "the stamp test". At bedtime the man wraps some stamps from a roll of 1¢ stamps around the base of his penis, wetting the last stamp to seal it together. He wears close fitting underwear to avoid tearing the stamps in his sleep. If he gets an erection during the night the stamps will tear, if he doesn't, they won't.

Some men get no erection, some men don't get enough, and some can't keep an erection.

Even with physical causes there are different types of impotence. Some men get no erection, some men don't get enough to do much with it, some get an erection just fine, but can't keep it. Here we need some biology.

The penis is made up of three tube shaped chambers of "spongy" tissue; two tubes on top (the corpora cavernosa) which extend well into the body to anchor the penis, and one underneath (the corpus spongiousm) which becomes the glans or head of the penis. The three tubes are surrounded by a sheath of skin which is stretchable, to a limit. The arteries which feed blood to the spongy tubes are surrounded by smooth muscles fibers which are normally contracted, limiting the amount of blood entering the penis. When a sight, touch, or thought cause sexual stimulation, the brain signals the muscles to relax, greatly increasing the blood flow. The spongy bodies fill up, making the penis enlarge. Because the veins which drain the spongy bodies pass between the bodies and the sheath of skin, erection causes the vessels to be compressed, reducing the amount of blood that can leave the penis. When the growth of the penis reaches the limit of the stretchable sheath of skin, the penis becomes very firm. Erection continues until the muscles in the arteries cut back the blood flow. Erection is lost in two "stages": the initial loss is sudden, but leaves the penis erect enough to continue intercourse; the second stage loss happens more slowly. Younger men typically lose their erections more slowly, and prolonged arousal or penile stimulation prior to ejaculation can greatly slow the second stage loss. Now, going back to the men who get but can't keep an erection, this is "leaky vein impotence" and it's caused by the veins leaking blood during erection. There's actually a bypass operation for this condition.

Should I take testosterone is a common question asked by men with impotence, but will more of it solve the problem? Testosterone is not needed for erection, as proven by the erections of young boys and men who have been castrated, so low levels don't cause impotence. However, there may be a second hand effect; low testosterone kills libido, and a man who has no desire for sex has little use, or desire, for an erection. In this situation a man's wife should be able to bring him to erection, showing that the man has a libido problem, not an impotency problem.

Viagra does not actually cause an erection ...

So, how can a couple deal with impotence? There are a variety of medical treatments, which we will just barely touch on. Viagra does not actually cause an erection; rather it blocks a chemical in the body that breaks down a second chemical that's required for erection. Viagra makes it possible for many men to have normal erections, but stimulation is still needed to actually become erect. For many this is an improvement over the injectable drugs used; injections actually cause an erection, but the duration of the erection is based on the drug, and erection is lost at a set time - which can be before or well after sex is over. There are men who don't respond to Viagra who can be helped with injectable drugs, and several new delivery systems now, or soon, on the market have ended the need of putting a needle in the penis. There are also implants which can give any man an erection regardless of the cause of his impotency, but these are expensive, require surgery, and are not always as functional as the recipient expects. With the increase in drug options, implants are likely to become obsolete.
There are now several impotency aids available without a prescription. A company called Rejoyn makes a full compliment of these items which are available in drug stores. Other manufactures are making similar items. You can find Rejoyn on the web at http://www.rejoyn.com/Rejoyn.html. They have information, pictures of the products, a locator service for finding the products near you, and on-line ordering. We will give a bit of a generic explanation for each item currently available. All of these methods have one possible problem, in that they only cause the part of the penis outside the body to become stiff. Without the internal part of the penis being erect the penis is "floppy"; it's like a tent pole which is just barely pushed into the ground. Because of this, the couple should avoid positions where the man is not in control of movement; if the woman moves or thrusts too much she could cause a painful bending of the penis. {Note: we would greatly appreciate hearing from anyone who has used or tries any of these products; the more we know the better able we are to help others. If you would like to do this anonymously, you may use this form.}

Support rings: These are stretchy rings that go around the base of the penis after an erection or partial erection is obtained. The ring helps keep blood in the penis, and may improve the firmness of a partial erection. This is perfect for "leaky erections". All rings are designed to be safe and easy to remove (please don't improvise) and most are designed to allow for normal ejaculation.

Support sleeves: These are more or less shoe horns worn between the penis and a condom. There are different versions, but basically a plastic support runs across the top and over the front of the penis, making it possible to penetrate with or without an erection. The only thing on the sensitive underside of the penis is the condom, so the man is able to reach orgasm. This method is good for men who's erections tend to come and go, as it allows him to continue intercourse even if his erection softens.

Vacuum Pump: Not to be confused with the pumps sold claiming to give a man a bigger penis. The pump fits over the penis and creates a partial (controlled) vacuum. This causes blood to enter the penis and make it erect. A ring such as the support rings described above is then used to keep the blood in the penis. This works regardless of the cause of impotency, and should allow any man to have intercourse. Some couples are very happy with this method, but some men complain it creates a "cold" erection, and some say it numbs feelings some. When vacuums were prescription items costing $350+ it was an expensive option to try out; now that a pump can be had without a prescription for about $100 it's a more tempting option.

There are also some things couples can do without any devices.

Missionary requires less of an erection than most positions.

For men who get a partial erection, certain positions require less of an erection than others. Missionary requires less of an erection than most positions, and experimenting with the woman's leg position may help too; try pulling the legs up towards the body to "open" the vagina. Female on top positions are a poor choice because she can accidentally bend the penis. Rear entry may be difficult because it makes the vagina tighter, but he may be able to make this work by holding the base of the penis as he moves. Pulling the skin of the penis back tight (grasp mid shaft and pull towards the base) can help stiffen the penis; he can do this during rear entry, or she can do it during missionary.

Another possibility is what Lori and I call pseudocourse. Pseudocourse can be done with or without an erection, and it's the closest thing to intercourse possible without penetration. The man lies on his back, legs together. The woman is above as if they were going to have intercourse with her on top. His penis is laid against his body pointing towards his chin, so that the underside is facing up. The woman lowers herself so that his penis comes into contact with her vulva, between her outer lips. She then either pushes against him (as if thrusting), or she can slide up and down (parallel to the bed) the length of his penis. (Greater movement is possible with some erection, but even without she can slide some.) Since this is basically her clitoris rubbing against the most sensitive part of his penis, it's very possible for both of them to reach climax this way. Changing the point of contact and the amount of movement will change the intensity of the stimulation for both of them, making it possible to find a method which brings them to orgasm at about the same time. If he climaxes before her, she should start farther down the shaft; if she climaxes first, she needs to be more on the glans. Pseudocourse is more than just physically enjoyable, it has most of the emotional contact which many find missing in manual or oral sex.

And of course oral and manual sex are both possible without an erection; stimulation of the glans and frenum will be most effective. Sucking on the glans will also feel good, and it might coax a bit of an erection. During manual sex, a lubricant will prevent soreness, and actually intensify the stimulation. Most water based lubricants made for intercourse dry out pretty fast, but Vaseline (which should never be introduced into the vagina) will work well, as do silicone based lubricants. Finally, an easy way to bring a man without an erection to climax is to apply a vibrator to the glans.

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