The term 'male impotence' is used in the English language to denote the inability of the male to achieve or maintain an erection sufficient to complete successful coitus. Disturbances affecting libido and ejaculation are viewed as separate symptoms. In German, however, the term 'male impotence' denotes a syndrome consisting of malfunctions in erection, libido, and ejaculation. The main symptom - disturbances in erection - will be empha-zised.
In the diagnostic process, it is just as important to identify etiological factors as to describe the symptoms and the progression of the disease. In a case of male impotence, organic as well as psychological factors must be taken into account.
The psychological factors may be subdivided on the basis of symptoms, which are prompted by a specific situation, by the partner, by the patient's personality and by subconscious problems. A detailed description of psychological factors affecting male impotence and their therapy is not the subject of this article. However, the special problems connected with the fear of failure are mentioned here, since fear of failure is diagnosed in nearly all longer lasting cases of male impotence: this fear is greatly responsible for the perpetuation of a 'vicious' circle which is furthered by inhibitions resulting from the patient's self-consciousness and from his partner's demands or withdrawals. Treatment by psychotherapy and/or pharmacological means tries to break that circle.
Male impotence becomes more frequent with old age. However, pathological changes must be separated from the physiological changes of aging: Sexual interest normally wanes with age and coitus becomes less frequent, although in certain older males an increase of sexual interest has been reported. Frequency of ejaculation also diminishes and often an orgasm is achieved without ejaculation. The latency period of ejaculation increases, as does control of ejaculation.
Results of research concerning the frequency of various etiological factors in patients with sexual impotence are not available. It is assumed that psychological factors outnumber the organic. Although this hypothesis has not been documented, the physician must be aware of the fact that for certain organically based illnesses treatments exist which attack the roots of the illness. Therefore, it is vital that each patient is thoroughly examined for all possible organic factors involved. There are certain syndromes, especially in internal medicine and neurology, in which sexual impotence is merely one of the accompanying symptoms. In such cases, sexual impotence will be interpreted as having organic roots. Included are particular metabolic diseases (e.g. diabetes mellitus), disturbances of the endocrine system (e.g. hypogonadism), neuroendocrinological disorders (e.g. tumor of the pituitary), vascular diseases (e.g. arteriosclerosis), and diseases affecting the central nervous system (e.g. syphilis, multiple sclerosis, degenerative illnesses). Organic sexual impotence is also suspected after external injuries to the genitals as well as following dermatological illnesses affecting male organs (e.g. phimosis, prostatitis). The importance of psychotropic drugs as possible causes leading to sexual impotence will be discussed later.