Impotence can be one of the most difficult things to talk about, but letting a member of your healthcare team know there may be a problem is the first step in finding a solution. Urology specialist nurse Sarah Henderson, from St George’s Hospital, London, explains what can be done to help.

When it happens to you, it can feel like you are the only man to have been hit by impotence – the inability to achieve and maintain an erection. But impotence (technically called male erectile dysfunction) is not uncommon. At least one in every ten men in the UK are affected at some time in their lives. There are many causes of impotence, including ageing, high blood pressure and smoking, in addition to illnesses such as cancer.

Having cancer and being treated for cancer can cause impotence in several ways. The stress, anxiety and loss of confidence that can affect many people with cancer can result in being unable to achieve or maintain an erection. Drugs, such as Zoladex and Prostap, used in the treatment of prostate cancer usually cause problems with erections. While people are receiving chemotherapy or feeling unwell for any reason, they may have a temporary loss of sex drive (libido). Surgery for cancer – such as radical prostatectomy, cystectomy and bowel surgery – and radiotherapy to the pelvic area may also cause impotence.
Talking about impotence

One of the biggest hurdles in dealing with impotence is actually telling someone that you have a problem. But if you want to continue having a sexual relationship then there may well be something that can be done to help.

Once you have decided that you would like to deal with the issue – and perhaps discussed it with your partner – then you should try to talk to your GP or hospital consultant. They may be able to help directly, or will refer you to a specialist clinic, probably based at the hospital. The doctors and nurses at these clinics are used to discussing impotence, and will do their best to put you at ease.

Initially, the extent of the problem will be assessed – probably with a questionnaire asking about your erections, drugs you take and your medical history. The nurse or doctor will then discuss treatment options with you, and together you can decide what may be best. They may ask for some blood tests and carry out a physical examination.

There is a wide range of treatments for impotence, including devices to help achieve an erection, tablets and counselling to help with the psychological side of things.

* Vacuum devices: These are rigid tubes that are placed over the penis and activated by a pump. The pumping action draws blood into the penis and makes it erect. The erection is maintained by using a tight rubber band at the base of the penis. The vacuum can then be released and the cylinder removed.
* MUSE (intraurethral alprostadil): A small waxy pellet of the drug alprostadil is inserted into the penis with a narrow applicator. The penis should then be massaged gently to allow the pellet to dissolve. This causes an erection in about 10 minutes.
* Injections (intracavernosal alprostadil): This involves injecting a small quantity of the drug alprostadil into the shaft of the penis when you want an erection. An erection will develop in about 15 minutes. Although injecting your penis sounds painful, many men do get used to it.
* Viagra: This drug is not yet widely available but can be prescribed to men with certain conditions. The tablet should be swallowed an hour before intercourse and produces an erection if you are sexually aroused.
* Sexual counselling: As psychological difficulties are often associated with impotence, your doctor may suggest that you attend counselling. Many people find this helpful.

Impotence: some ways to help yourself

* Talk to your partner – discussing the problem can reduce tension.
* Ask your doctor for help.

Further information

The following organisations can give more information and help:

* The Impotence Association
PO Box 10296, London SW17 9WH
Tel: 0181 767 7791
* Relate
Tel: 01788 573241
* British Association for Sexual and Marital Therapy
PO Box 13686, London SW20 9ZH.