Impotence is the medical term for an inability to raise or sustain an erection. It can be divided into physical and psychological causes. To understand the mechanism of this, it is necessary to illustrate how an erection works.

Under the stimulant of arousal, either physical touch or psychological eroticism, the nerves of the penis cause the arteries to expand and the veins to constrict. This allows more blood to fill the corpus cavernosa, which, like a fluid-filled tyre, will harden and erect the penis. Any interference with these mechanisms will lead to impotence. This reaction is caused by the autonomic (uncontrolled) nervous system.

Physical causes

Trauma to the corpus cavernosa, arteries or nerves.

Atheroma clogging the arteries.

Disease (or trauma) of the central nervous system.

Toxic effects.

Certain drugs including alcohol, amphetamines and cocaine are a common cause of temporary impotence.

Several orthodox drugs, including those used for cardiac and blood pressure problems, can cause temporary impotence.

Postoperative trauma following prostate or bladder surgery can damage the nerves controlling erection.

Psychological causes

Over 90 per cent of erection failure that present to a holistic counsellor or GP are caused by psychological matters.

Evolution has made it very clear that the chemicals and hormones of stress must outweigh the effects of sex hormones. If we were busily procreating when a sabre-toothed tiger came into view then we would need to be more fearful than excited otherwise we would not, by preference, run away. Those of our prehistoric ancestors whose testosterone levels outweighed their adrenaline flow would stay to finish the job and were, presumably, killed. Nowadays we are rarely confronted by wild animals but the fear chemicals induced by bank managers, employment situations and domestic difficulties are just the same and override the hormones and neurological impulses involved with intercourse.

One most frequent cause is fatigue. Chemicals produced in response to tiredness inhibit erections. Anxiety, stress and phobias all produce large amounts of catecholamines, which directly affect the nervous system and specifically cause dilation in the penile veins, thereby preventing erections. The causes may be superficial, such as anxiety about performance, or they may be more deeply buried. Either way, a counselling session will help to illustrate the need of psychotherapeutic work.

Tiredness, stress and anxiety, fear and guilt are all, therefore, responsible for erection failure.


Establish or rule out any physical cause by having a full examination from a GP or specialist if in doubt.

Assess and remove bad habits and stress-creating situations wherever possible.

Employ meditation and relaxation techniques through the practice of yoga, Qi Gong and meditation.

Exercise. This reduces the amount of adrenaline in the system and enhances endorphins and encephalins, which are sexual stimulants and, paradoxically, stop the tiredness associated with stress.

If the above measures are not easy to comply with, then techniques of counselling such as neurolinguistic programming are most often beneficial.

Consider the use of homeopathic remedies: Lycopodium if anticipating problems, Conium maculatum if erection occurs but does not last and Agnus castus if the erection is not firm enough. These remedies should be taken at potency 30 every night for two weeks. Further consultation with a homeopathic prescriber is well recommended as there are many remedies that are documented as being useful with erection problems.

Vitamins E and K, the botanical medicines Gingko biloba and Ginseng and a variety of Chinese, Tibetan and Ayurvedic herbs can be considered as adjuncts to the necessary treatment to deal with the underlying cause, but they should be prescribed by a complementary medical practitioner if taken above the doses recommended on the packaging that are necessary to elicit a response.

Testosterone may be recommended by specialists if testosterone levels are found to be low. There are many side effects associated with this drug and I would recommend a visit to an Ayurvedic, Chinese or Tibetan physician who will prescribe herbal medicines appropriate to the case. Use testosterone as a last resort.

A new drug, Viagra, is available and has proven through initial studies to enhance erection. Like all new drugs I recommend waiting for at least two years of its being available on the market since studies are often flawed and problems only arise after any drug has been used for some time.

Orthodox specialists can teach an individual to inject a drug known as prostaglandin El into the base of the penis. This is only used in cases where other treatments have failed since penile pain and prolonged erection are just a couple of the more common side effects.