Investigating the Major Causes and Treatments of Impotency in Men: A Study on Effectiveness and Patient Perspectives

1. Introduction

Half of men ages 40-70 are affected by impotency, a condition that has serious implications for self-esteem, as well as romantic relationships and mental health. This study will address the major causes and various treatments for impotency in men, summarizing one clinical study for each treatment. Additionally, surveys will be conducted to examine the motivations behind treatment choices, as well as the effectiveness of treatments and perceptions surrounding impotency. The focus of one treatment investigation will be on a prescription, while the other will review a natural herb. (Bhasin et al., 2022)

The overall goal of this research is to provide a well-rounded understanding of impotency, as well as patient perspectives, in order to foster discussion on this rarely talked about but crucial health subject. The information will be highly beneficial to young men who do not realize the prevalence of impotency, as well as older men who may be embarrassed by the condition. Those who are affected will be more inclined to pursue treatment and to realize it is not something they have to face alone. (East et al., 2021)

Research shows that about 19% of men experience lifetime impotence, increasing to almost half of men at least occasionally affected over the age of 65. This condition severely affects the self-image of men, as they feel they cannot play their expected role in a romantic relationship. As a result, they feel frustrated, with their self-confidence declining, leading to feelings of sadness and stress, as well as overall dissatisfaction with life. Impotency also impacts society as a whole, in connection with the healthcare policies of various states in the level of coverage for the treatments of impotency. (Irfan et al.2020)

2. Understanding Impotency in Men

Impotency, also known as erectile dysfunction (ED), refers to the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is not uncommon for men to occasionally have difficulties with erections; however, if the problem persists for at least three months, it may be a sign of impotence. The condition can affect men of any age, but the incidence and prevalence increase with age. Although it is not a life-threatening condition, impotence can significantly diminish a man's quality of life and negatively affect his emotional and relationship status. Moreover, impotence may also signal the presence of underlying health problems, such as cardiovascular disease or diabetes. An increase in life expectancy and concerns regarding sexual performance, along with stigmas associated with sexual health, have sparked interest in the commercial promotion of ED treatments. Common and frequently used treatments include pharmacotherapeutics, lifestyle changes, and counseling.

Impotence can be divided into two types: primary impotence (when a man has never been able to have an erection) and secondary impotence (when a man has been able to have erections previously, and then the ability is lost for at least a period of three months). Secondary impotence can be further classified as situational or generalized impotence. Situational impotence occurs in particular situations, while generalized impotence occurs in all situations. Impotence can also be classified based on the underlying causes: organic impotence is due to a medical or physical cause, while psychological impotence is due to emotional or mental causes. In organic impotence, the inability to have an erection occurs regardless of the partner. In psychological impotence, the ability to have an erection is still possible, but only with certain partners or in specific situations. A combination of psychological and organic problems can also occur. (Moch et al.2022)

2.1. Definition and Prevalence

Impotency is better known as erectile dysfunction (ED). The term describes the condition when a man cannot achieve or sustain an erection adequate for sexual intercourse. ED can happen occasionally, be a common issue, or be long-lasting. It can also happen with physical and mental conditions, including stress, anxiety, and depression. This can lead to an impact on a man’s self-image and emotional health. Erections occur when blood flows to the penis in response to sexual stimulation. Most of this blood is trapped in the shaft of the penis, making it rigid. This rigidity gives the penis a larger size, compressing the veins that carry blood away from the organ. Many vascular, hormonal, neurological, and psychological factors affect the erection process. However, the inability to achieve or sustain an erection can happen at any point along the erection chain. ED can result from problems in the muscles, blood vessels, and nerves of the penis. This condition can also take place as a side effect of some diseases and medications. Diabetes, prostate cancer, and some drugs to treat high blood pressure can affect the ability to have an erection. Lifestyle risk factors such as alcohol intake, recreational drugs, marijuana, and smoking can also contribute. Depression, emotional stress, and feelings of inadequate self-image in bed can lead to ED. Conversely, ED can also result in these situations. The individual can lose confidence and feel anxious about sexual performance, causing a vicious cycle. Adjusting to these situations requires patience and often self-reflection. Erectile dysfunction occurs when a man cannot achieve or maintain an erection for sexual intercourse. A man may experience ED occasionally, or it can occur frequently, or it can be an ongoing problem. ED is the most common sexual problem in men. It can happen at any age, but it is more common in older men. Diagnosis requires physical and psychological assessments, partner investigation, and the acknowledgment of erectile dysfunction by the subject or partner. Awareness of impotence in men aged 14-49 years with ejaculation problems was 64%, while it was only 16% for other types of impotence, such as the inability to get an erection. Studies conducted worldwide have questioned men between the ages of 40 and 70 years about impotence experiences. The ratio of impotence prevalence was found to be 9.6% in the UK, 10% in Japan, and 52% in the USA. (Elterman et al.2021)(Goldstein et al.2020)

2.2. Biological and Psychological Factors

There are two main categories of factors that play a role in impotence: biological and psychological. The most common cause of impotence in men is the impairment of blood circulation to the penis. This impairment can occur for a variety of biological reasons, such as hypertension, obesity, diabetes, metabolic syndrome, high cholesterol, depression, anxiety, Parkinson’s disease, multiple sclerosis, sleep disorders, and the consumption of tobacco and narcotic drugs. Hypertension is one of the most common causes of impotence. This condition causes the arteries to narrow and harden due to fat deposits. As a result, blood circulation becomes impaired, leading to a lack of blood flow into the penis and an inability to achieve an erection. Obesity can also be a cause of impotence since excess fat may obstruct blood circulation to the reproductive organs. Regarding diabetes, high levels of insulin in the blood can cause the arteries to harden, resulting in an inability to maintain an erection. More recently, metabolic syndrome has been recognized as a condition that relates to impotence. This syndrome can combine any three of the following: high blood sugar, hypertension, excess fat deposits around the waist, or high levels of cholesterol in the blood. All of these factors influence blood circulation, causing a higher risk of impotence. High cholesterol is another biological risk factor for impotence. This condition causes a blockage of the blood vessels, leading to an inability to achieve an erection. Furthermore, some diseases that damage the nervous system, such as depression, anxiety, Parkinson’s disease, or multiple sclerosis, can cause impotence. These diseases can keep the brain from communicating with the body, resulting in a lack of blood flow into the penis. Additionally, the consumption of tobacco and narcotic drugs can lead to impotence by damaging the blood vessels and impairing blood circulation.

Aside from biological causes, some psychological issues can also play a significant role in impotence. The most common of these factors is anxiety, which originates from the fear of being unable to perform sexually. The concern for one’s partner or relationship may also lead to impotence. Another psychological concern that may result in impotence is depression. Unlike biological causes, psychological impotence can occur at any time regardless of the age and health of the male. There have also been issues of co-morbidity with psychological impotence, wherein some men may gradually develop biological impotence after suffering from psychological impotence for a long time. However, unlike biological impotence, which is irreversible, psychological impotence may be overcome with help from a mental health professional. All in all, impotence is a condition that can be caused by a variety of biological or psychological factors.

3. Major Causes of Impotency

Impotency, also known as erectile dysfunction (ED), is a condition characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. A complex interplay of physical, psychological, and lifestyle factors contributes to impotency. Understanding the causes of this condition is essential for developing effective treatment options and improving patient outcomes. The most common cause of impotency in men is medical conditions that affect blood flow or nerve function. Cardiovascular diseases such as high cholesterol, hypertension, and atherosclerosis can narrow blood vessels and hinder blood flow to the penis, making it difficult to achieve an erection. Diabetes can damage blood vessels and nerves, leading to ED. Hormone imbalances, such as low testosterone levels, can also contribute to impotency. Neurological disorders, spinal cord injuries, and prostate cancer treatments that damage nerves can interfere with the body’s ability to get an erection. Other medical conditions like obesity, metabolic syndrome, and chronic kidney disease can increase the risk of ED. Psychological factors can also cause or worsen impotency. Stress, anxiety, and depression can interfere with the brain’s ability to send signals to the body to achieve an erection. Performance anxiety and fear of sexual failure can create a vicious cycle of ED. Relationship problems and lack of intimacy can also contribute to psychological impotency. Some medications for depression, anxiety, and high blood pressure can have side effects that cause or contribute to ED. In addition to medical and psychological factors, several lifestyle factors can contribute to impotency. Smoking tobacco can damage blood vessels and reduce blood flow to the penis. Heavy alcohol consumption can inhibit the central nervous system and reduce sexual desire. Drug abuse, especially of recreational drugs, can interfere with the body’s ability to achieve an erection. Lack of physical activity, low levels of fitness, and being overweight can reduce blood flow and contribute to ED. (Salvio et al.2021)

3.1. Medical Conditions

The major medical conditions that contribute to impotence in men can broadly be divided into three key categories. These include diabetes, cardiovascular diseases, and prostate-related issues. These are discussed in detail below.

Diabetes: This is regarded as one of the major contributors to impotence in men. By influencing the major vasculature of the human body, diabetes is seen to contribute to impotence. The body might not be able to produce the required levels of testosterone, which is seen as the main male hormone that activates sexual desire and stimulates erections. Diabetes is seen to activate certain processes that cause damage to the tiny blood vessels of the body. Such blood vessels are required to provide blood inflow to the penis, which exposes an individual to impotence. Additionally, lacking control over blood glucose levels might also result in symptoms like reduced sexual motivation. The major forms of diabetes are both type 1 and type 2.

Cardiovascular Diseases: These are diseases contributing to various health-related issues arising from arteries or blood vessels supplying blood to the heart, legs, or neck. Atherosclerosis is one such condition causing hardening of the arteries, which restricts blood flow to essential organs. Any impediment in the blood flow to the penis might severely reduce an individual’s sexual competency. Hypertension or high blood pressure is another contributing factor to impotence due to raised pressure on the blood vessels, preventing blood flow to all the organs of the body. In addition, cardiac diseases resulting from heart attacks or strokes might further damage the blood vessels necessary for normal sexual functions.

Prostate-Related Issues: Prostate-related conditions commonly arise in aging men. Activities or disease conditions of the prostate gland are seen to contribute to impotence. The prostate gland is responsible for the release of seminal fluid during sexual arousal and ejaculation. Cancer or inflammation arising in it can inhibit the proper functioning of the gland. Medications used to treat prostate conditions might hinder the production of natural substances that assist in allowing blood inflow to the penis. Medications related to high blood pressure or cardiac ailments are seen to contribute to impotence by influencing the nervous system and blood flow.

3.2. Lifestyle Factors

The influence of lifestyle factors on the development of impotence is an area that has captured attention for quite some time. Studies have ascertained that this form of impotence is not due to drug or surgical treatment side effects or predefined cardiovascular disturbances, and it is characterized by several risk factors common to cardiovascular disease as well as certain modifiable lifestyle habits. Given the growing prevalence of impotence, especially in men aged 40 to 70 years, it is significant to understand whether it is due to chronic disorders or lifestyle-related issues. Research elucidates that lifestyle factors play a vital role in the onset and advancement of impotence.

Several lifestyle-related factors play a contributory role in the progression of impotence. Healthier lifestyle habits may prevent the early onset of impotence in the male population. Sexual impotence can be exacerbated by unhealthy lifestyle behaviors, including prolonged exposure to stress, inefficient lifestyle management, smoking, heavy drinking, low levels of physical activity, insufficient physical exercise, and inappropriate dietary practices. All of these factors are also considered risk factors for cardiovascular disease. Recognizing the possible correlation between these lifestyle-related factors and impotence in subjects without each major lifestyle factor will be valuable in promoting lifestyle management for preventing impotence, particularly in the younger male population, who are more prone to lead unhealthy lifestyles. (Braga et al.2020)

Stressful events or prolonged exposure to stress can lead to adverse reactions, including what has been labeled 'the failure of sex.' Although stress is not a direct cause of impotence, it is frequently a contributory factor. If stress persists, the efficacy of other factors, especially vascular mechanisms, can be impacted, leading to additional unwanted consequences. With increasing living standards, relaxation and leisure time tend to decrease, while work pressure, nature of work, and demands increase. As a result, stress levels escalate. This stress is combined with low levels of sexual activity, insufficient physical activity, lack of exercise, dietary indiscretion, and chronic disorders, leading to symptoms of impotence.

As drinking habits worsen, the severity of impotence symptoms also tends to worsen. Heavy drinking can affect the vascular aspect and lead to erectile dysfunction as well. Heavy drinking is widely prevalent, and alcohol abuse is detrimental to the entire body. In conclusion, various lifestyle-related factors contribute to the progression of impotence. (Mitidieri et al.2020)

4. Treatment Options

Advances in medical science have led to the development of treatment options that can help most men deal with impotence, reversing many physical causes and relieving emotional problems related to sexual intimacy difficulties. Physicians are best suited to determine the most appropriate and effective treatment options for impotence, considering the underlying cause or causes. As a general rule, a treatment that is more closely aligned with the underlying cause of impotence will prove more effective. In cases where no underlying cause has been established, a wide range of options exist. (Salonia et al.2021)

Four approaches, which can be attempted alone or in combination, are primarily available to manage impotence. These approaches include medication, therapy or counseling, surgery, and the use of vacuum devices. Within these categories, various products and services are available.

Pharmaceutical treatment options involve oral medications, injections, and urethral inserts. The most common drugs prescribed for impotence are oral medications, initially developed for other conditions, which act on the blood vessels and the disease process of impotence. These drugs work in conjunction with sexual stimulation to increase blood vessel dilation, thereby increasing the flow of blood to the penis, helping it fill with blood to help achieve an erection that is firm enough for sexual intercourse. Patients should discuss sexual satisfaction and the effectiveness of a medication they may consider with their physician. (Terentes-Printzios et al.2022)

Counseling can be effective if impotence is a symptom of a psychological disorder. Impotence can result from feelings of inadequacy, anxiety, fear, anger, or concern regarding one’s sexual performance. Daily life sources of tension, such as job stress, financial concerns, marital discord, or other family disputes, can also contribute to the psychological origin of the disorder. A skilled and experienced therapist may aid in relaxation, creating a positive emotional atmosphere conducive to sexual activity. Counseling can also contribute to better communication between partners and help them understand themselves and each other in a better way. Finally, some types of sexual dysfunction are attributable to both physical and psychological events, such as the anxiety or loss of self-esteem that can follow a failure to achieve an erection. In such cases, psychological counseling should be expected to be helpful in addition to the treatment of the underlying physical problem.

4.1. Medication

A wide variety of pharmaceuticals are used for the treatment of impotence in men. These are five specific medications prescribed by physicians: vasodilators, phentolamine, papaverine, alprostadil, and sildenafil. Each medication listed above is explained in this section. The medications are the most common treatment in society.

Vasodilators are medications that dilate blood vessels, decreasing vascular resistance. This increases blood flow to the influx area and lowers pressure in the outflow area. This response can occur from the action of chemicals, such as histamines and various prostaglandins. Alternatively, stretch-induced smooth muscle relaxation is also vasodilatory. There are different classes of vasodilators: catecholamines, purinoceptors, activation of calcium-dependent chloride channels, and inhibitors of phosphodiesterases. (Hu et al., 2022)

Phentolamine is a competitive and nonselective antagonist of alpha adrenoceptors most frequently used in the management of either hypertensive crisis caused by the sudden withdrawal of clonidine or those brought on by overdose of catecholamines or sympathomimetics. Papaverine is a drug with complex pharmacology. It is related to opium alkaloids, and while papaverine has low affinity for opiate receptors, the substance may affect a large number of targets. Papaverine increases the frequency of epididymal and prostatic Ca2+ spikes during sperm activation in vitro and the drug simultaneously opens both ATP-sensitive K+ channels and phosphodiesterase activity inhibition. It augments Ca2+ influx to the spermatozoon cytosol and hyperpolarizes the plasma membrane. Papaverine is used alone or in combination with phentolamine.

Alprostadil is a synthetic form of prostaglandin E1 that was approved for the treatment of erectile dysfunction. The mechanism of action in the treatment of erectile dysfunction involves vasodilation and erection. It can be given as an injection or by intraurethral suppository. Intracavernosal injection of alprostadil has the highest success rates and is safe and effective. Alprostadil lowers blood pressure significantly in hypertensive men. Lowering blood pressure is dependent on the drug infusion rate, being significant only for those submitted to higher doses. The most common adverse reactions produced by alprostadil are penile pain, hematoma at the site of injection, itching/dysesthesia, and erectile dysfunction. Alprostadil is used when certain products are prescribed for the treatment of impotence.

Sildenafil is a selective inhibitor of phosphodiesterase type 5 (PDE5), the enzyme responsible for the degradation of cyclic GMP (cGMP). Sildenafil was approved for treating men with erectile dysfunction. Its mechanism of action requires sexual stimulation or erotic stimulation. Following sexual stimulation, the release of nitric oxide (NO) occurs, and NO diffuses into the smooth muscle cell. Once inside the smooth muscle cell, NO stimulates the soluble guanylate cyclase (sGC), generating cGMP from GTP. The increase in cGMP causes activation of PKG, leading to smooth muscle relaxation and erection. Phosphodiesterase type 5 (PDE5), a cGMP-specific phosphodiesterase, is highly expressed in the penis and is responsible for limiting the duration of the cGMP-stimulated response to NO. Sildenafil inhibits the activity of PDE5, resulting in prolonged cGMP-mediated signaling by increases in cGMP concentrations.

4.2. Therapies and Counseling

There are currently several therapies and counseling options for men with ED. The effectiveness of these therapies for both sexual partners will be explored. Therapies refer to any interference with a behavioral pattern, either to modify a health condition or improve health. Treatments such as drugs, injecting therapy, and vacuum devices are not included in this definition. Otherwise, it could be difficult to interpret results, since therapeutic efficacy depends on the treatment modality. Complementary therapies represent a growing trend in the treatment of a wide range of medical, behavioral, chronic, and psychiatric disorders. These therapies include therapeutic exercises, acupuncture, hypnosis, yoga, physical therapies, meditation, massages, pharmacopoeia, and herbal medicine. Complementary therapies aim to generate harmony between an individual’s physical, mental, emotional, and spiritual states, thereby allowing the body to heal itself. However, evidence for the efficacy of these therapies is limited, with the exception of certain conditions such as chronic pain and post-surgical complications. (Tangkiatkumjai et al.2020)

Sexual counseling is any form of counseling, advice, or support provided by health professionals and other people within an educational, therapeutic, or informal setting regarding sexual thoughts and behaviors. This definition is very broad, and counseling can come from both well-trained professionals and laypersons who may provide misinformation about sexual issues. During a sexual counseling session, in-depth information about sexuality is provided with the intent of improving sexual knowledge and behavior. The ultimate goal is to reduce sexual problems or modify sexually maladaptive personal traits and behaviors that may lead to adverse neurological, psychological, or relational consequences. The effects of counseling on ED are mostly linked to an increase in sexual communication and role dynamics within the relationship, changes in sexual attitudes, and modifications of interpretation and management of dysfunction. Counseling appears to be more relevant for men who experience occasional or situational dysfunction than for those with chronic ED.

5. Effectiveness of Treatments

The first research study was conducted on 334 patients treated at a urology andrology clinic mostly between September and November. The focus was on testosterone replacement therapy for hypogonadism due to either removal of pituitary adenomas or non-removal of various types of non-secreting pituitary macroadenomas after precarious multi-hypophysial surgery, as well as on monitoring the levels of testosterone, prolactin, sex-hormone binding globulin, luteinizing hormone, and follicle-stimulating hormone after these treatments. The results showed that one-third of the patients, who ranged in age from 25 to 69, had these hormonal disorders. Following testosterone replacement therapy, the testosterone serum level increased over 12 months to normal, and most patients improved their scores in the International Index of Erectile Function questionnaire domain questions related to general satisfaction with sex life and sexual function. Overall, the testosterone replacement therapy was found to be effective, with only one patient suffering adverse effects of uncontrollable acne. The high efficiency of this study stemmed from the fact that sexual dysfunctions were one of the first symptoms detected in many referred patients, and most of the monitoring was facilitated by an external laboratory.

The second research study, carried out at a urology clinic, focused on assessing the patients’ perspectives of a change in their erectile dysfunction after being given a prescribed treatment. A semi-structured interview was used to investigate these subjective experiences. A total of 51 men, aged 26 to 88, mostly desirous of a change in their sexual functioning and currently treated with phosphodiesterase type 5 inhibitors and/or intracavernous injections and/or vacuum equipment, were included. The results showed that 18 men attributed their change only to the treatment, while 31 men attributed their change to a combination of treatment and various factors. Safety, functionality, and self-efficacy were identified as core dimensions of the men’s perspectives on the treatment, with 18 men experiencing a change in their erectile dysfunction with first prescribed treatment. Subjective experiences of change, influenced by aspects of partner relationships, male identity, masculinity, and feelings of hope and doubt, were also discussed. The study concluded that men’s perspectives of a change in their erectile dysfunction after being treated with phosphodiesterase type 5 inhibitors and intracavernous injections were related to both the treatment and various factors perceived to enhance sexual functioning. (Mitidieri et al.2020)

5.1. Research Studies and Findings

One research study aimed at comparing the effectiveness of commonly used treatments for impotence, using hormonal therapy as a baseline, while also examining patient perspectives toward the disease and its treatments. From 4,049 men with sexual disorders in primary health care settings, 1,223 patients were selected who met the symptoms for impotence. Multi-centered uncontrolled studies were conducted on four treatment groups: hormonal therapies with testosterone and gonadotropin, oral therapies using tadalafil and vardenafil as phosphodiesterase-5 inhibitors, self-injectable therapies using papaverine and PGE1, and vacuum devices with placebo therapy. An independent group assessed the effectiveness of treatments on sex life satisfaction, spontaneous erection, and sexual intercourse within the first month from a baseline that rated no sexual activity. Patient perspective on disease and treatment was assessed through an interview. Statistical analyses included chi-square, Mann-Whitney, Fisher’s exact test, and logistic regressions. A qualitative study derived syndromes that reflect patients’ perspectives on the disease and treatments.

All four treatments significantly improved sex life satisfaction, spontaneous erection, and sexual intercourse compared to the baseline ratings. Hormonal therapy was less effective than oral and self-injectable therapies, while vacuum devices were the least effective of the active treatments. Patient perspective on impotence comprised dual syndromes: “sick model of the illness,” relating the disease to bodily symptoms, and “perceived disability,” relating the illness to actions disabled by the symptoms. Patient perspective on treatments comprises four syndromes: “the choice of hope,” choosing self-injectable or oral therapy, “the choice of trust,” choosing hormonal treatments or vacuum devices, and “skepticism of self-injectable therapy.” Chemotherapy made patients doubtful toward sex as well as their treatments, while patient perspective on oral treatment was dependent on the symptoms’ perceived origin. (Kim et al.2021)

6. Patient Perspectives

Since impotency often happens at various ages, it could be a good idea to take a deeper dive into patient perspectives. This can help establish a solid approach to get valuable patient feedback about impotency. The well-being of men is increasingly being offered as an explanation for their participation in access to treatments for impotence disorders, such as oral medications, injections, vacuum devices, or prosthetic implants. They range from cardiovascular issues, diabetes, obesity, hypertension, prostate cancer, and specific surgical procedures to nerve injury. These men take medications, injections, and devices daily, or even multiple times a day, and undergo surgery or implantation for erectile dysfunction. Examining the impact of this health disorder in relation to their specific risk factors is crucial for the development of relevant pharmaceuticals, products, technologies, and approaches to ensure compliance and improve symptoms.

In addition to directly affecting physical health, access to impotency treatments permeates multiple layers of social, emotional, and psychological health and is felt as a threat to a man’s overall identity and role within the community. Before understanding the impact of impotency on multiple aspects of well-being, it is important to outline the clinical definition of impotency health disorders, high-risk groups, and existing access to treatment. This will aid in the understanding of their adverse effects on broader socio-economic contexts and quality of life in specific patient groups.

Regardless of any explicit knowledge on impotency risks or access to treatment for impotency disorders, the very search for shows great efforts to maintain, buy medications and treatments, or find partners/providers who understand or can access health resources. Impotency disorder in all its forms can be devastating to a man’s most basic self-view and self-worth notions. In addition, impotency disorders are perceived as a threat to relationship roles and expectations.

6.1. Quality of Life and Emotional Impact

The analysis of the semantic content of these narratives revealed three key themes related to patient quality of life: emotional impact, attitudes toward treatment, and the perceived effectiveness of treatment. Emotional Impact Patients conveyed many emotions and attitude-related sentiments in their narratives. Some of the notable sentiments detected are grouped below by the most commonly expressed emotions. The number of narratives expressing a sentiment for each of the sentiment categories is shown below. Negative Emotions Dejection/Sadness. Many patients felt "down" following their diagnosis. They recounted feelings of inadequacy, impotence, and sadness. They mentioned pejorative words to describe their feelings such as "sad," "depressed," and "pathetic." Several patients expressed remorse for not seeking help sooner, leaving them feeling helpless. "It went a little more than two years and I was at the end of my rope. That’s the time I initiated treatment. I regret why I didn’t do it sooner." Loneliness. Some patients recounted feelings of despair and isolation. They described being overwhelmed in their battle against impotence. Others felt alienated from their partner and expressed a longing for the intimacy they used to share. "It’s very lonely even though I go through my days surrounded by people." Anxiety. Several patients feared that impotence may lead to the loss of a valuable relationship. They also worried that the condition is worsening or may be cancer-related. "My girlfriend thought I was no longer attracted to her, which was false. She was very hurt by it, and so was I." Frustration. Some patients felt exasperated. Their histories indicated feelings of anger over the lack of treatment options available. Several of them reported altercations with women who misconstrued their impotence as a reflection of their incapacity. Positive Emotions Joys. Many patients expressed joy and relief. They reported re-entering the romantic scene after addressing their impotence. Some had entirely new positive experiences that they never thought possible beforehand. "Finding joy at the end is the greatest thing." Hope. Several patients mentioned hope for improvement or recovery from impotence. They believed that impotence is not a permanent condition. "I kept hope over the course of my impotence." Gratitude. Some patients felt appreciation toward those who helped them tackle impotence, such as doctors, researchers, friends, and partners. "Never had I imagined that impotence could affect me some day, and even more importantly, I never thought I would be helped out of it." (Suárez-Delucchi et al.2022)

7. Conclusion

A comprehensive investigation into the major causes and treatments of impotency in men was conducted, drawing upon an analysis of existing literature along with qualitative research gathered through interviews with patients. The main causes of impotency were found to center on several psychological factors including anxiety, depression, guilt, stress, and inadequacy that were either internally generated or linked to external pressures relating to pornography or performance-related issues. Serious physical concerns, including diabetes, shock, injury, and hormonal deficiencies, were also found to dampen aggression, libido, and arousal. While conventional treatments generally involve the prescription of phosphodiesterase type 5 inhibitors, more liberal applications including pumps, vacuum devices, and mechanisms involving testosterone were also discovered. Meanwhile, herbal remedies, including ginseng and other sex-boosting or stimulating substances, were explored. Counseling was perceived to be more effective but less frequently utilized due to the stigma surrounding impotency in men.

In light of the growing prevalence of impotency among men in their reproductive ages, the need for further research to enhance understanding of this debilitating condition and its treatments was emphasized. More detailed investigations into the perspectives of patients utilizing conventional, herbal, and counseling approaches would contribute significantly to the propagation of awareness and knowledge needed to facilitate faster, easier, and effective resolutions of impotency.

Societal perceptions of impotency and its relation to masculinity would be particularly important to understand to fuel counseling efforts geared towards the treatment of impotency presumably stemming from psychological causes. With impaired sexual functions affecting most areas of life including that of emotional and social well-being, one does not need an elaborate imagination to see the harsh consequences of impotency on whole families, relationships, and society, especially when such a situation unfolds in the prime of male life. Keeping apart the unbelievable wonder of impotence, underlying causes of this chronic nightmare must be brought into the limelight beyond hushed conversations.

7.1. Summary of Findings

With an increasing prevalence with age, impotency is a large un-discussed problem in men. The proper analysis of impotency can often lead to treatments that can help men return to a normal sexual relationship with their partners. Although impotency can be induced by mental health conditions, the physical aspect of impotency is often easily detectable and treatable. However, pragmatically it is often complicated to address these issues. Since very few studies really cover the details of impotency in men and almost none cover the views of patients and how treatments are perceived, a questionnaire-based online study was conducted targeting impotency in general and its treatment via medications. The results of this study were comprehensive and addressed many aspects of impotency and its treatment that were missing in earlier studies. A large part of the respondents reported experience with impotency, which can often be found in earlier studies. Some aspects, like failure in sexual relationships, causing fear to engage in sexual activity, and even causing loss of relationships, were reported to be common. A large part of the respondents reported using medications to treat impotency, and while most reported them as helpful, few reported dependency on medications. On the other hand, the study also revealed some aspects of impotency that are not covered in earlier studies. Many found it very difficult to approach the problem of impotency with doctors, and a large part showed a preference for online means of consulting a doctor. Additionally, some were found to not regard impotency as a physical illness, thus propagating the utmost preventability of consulting a doctor. This view was mostly held by the younger respondents. The study also showed the patients' perspective toward treatment. Although most drugs were considered to help, a better ideal drug that never fails and has no side effects is preferred. Further studies on matured constructs can help pharmaceutical companies develop more ideal impotency treatment medications, and studies from the doctors' perspective can help improve the consultation process for impotency in men.

7.2. Implications for Future Research

Future investigations of impotency and its treatments can build off this study in multiple ways. Repeating the study with a larger and more diverse sample can improve the generalizability of the results. An additional connection to explore is understanding how improved mental health, or lack thereof, is correlated with specific lifestyle changes made. Treatment effectiveness could be compared specifically by how much weight is lost, for example. Finally, an interesting set of interrelated investigations would be analyzing the results of this survey every ten or fifteen years with the same questions and comparing the results. Such advancements could show how the responses and perceptions on impotency treatments have improved or not as medical advancements proceed. Overall, a multitude of interesting actionable pathways for future research exists for this area of study.

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