"Many men experience temporary impotence at some point in their lives, but chronic (recurring) impotence can lower a man's self-esteem and put a strain on his marriage or social relationships," according to the editors of Consumer Guide's Family Health & Medical Guide.

"If left untreated, persisting impotence can damage one's sexual life as well as the self image of one or both partners," added Dr. David E. Larson, editor-in-chief of the Mayo Clinic Family Health Book.

How common is impotence? In the United States, over 10 million people have this problem and many are suffering in silence. Although impotence is more likely to bother old men, it can affect anyone and is not necessarily an inevitable part of aging.

"It is alleged that 25 percent of men over 55 are impotent. In Australia, about 40,000 men are affected. But that doesn't mean that young men are spared. We have patients between 18 to 22 years old who are impotent. The average age, however, is 55," revealed Dr. Edward John Keogh, medical director of the Reproductive Medicine Research Institute at Queen Elizabeth II Medical Center in Nedlands, Western Australia.

What happens in impotence? To have and maintain an erection, three things are required. First, the man must be sufficiently aroused and have enough testosterone (the male hormone) to get things going.

"If the testes, which produce testosterone, have been surgically removed (as is often the case in prostate cancer), or are no longer working as well because of age, then even the most intense sexual provocation will do nothing more than leave you wondering what all the fuss is all about," explained Dr. Isadore Rosenfeld of the New York Hospital - Sloane-Kettering Cancer Center in The Best Treatment.

The second requirement is that the brain must be functioning well to communicate sexual excitation to the penis. The nervous pathways from the brain to the penis must be healthy enough to convey that message.

The third and last step is that blood must reach the penis to produce an erection. This is accomplished by means of two cylindrical sponge-like structures within the penis which fill with blood the moment the man is aroused to make intercourse possible.

"Nerve impulses cause the blood flow to the cylinders to increase to about seven times the normal amount. The sudden influx of blood expands the sponge-like structures and then straightens and stiffens the penis, producing an erection. Continued sexual arousal or excitation maintains the higher state of blood flow, keeping the erection. After ejaculation, or when sexual excitation passes, the excess blood drains out of the spongy tissue and the penis returns to its non erect size and shape," Larson said.

If any of the above are interrupted, impotence occurs. This may be caused either by psychological or physical factors. In the second part of this series we'll talk about these factors.

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