The Aga Khan University Hospital, Pakistan > Diseases and Conditions

​Impotence

The inability to achieve or maintain erection, sufficient for satisfactory intercourse, is termed ‘Impotence’ (also known as erectile dysfunction). You may come across it occasionally, in which case there is nothing to be bothered about. However, if it is frequent and persistent then it can be a source of concern and stress. The normal process of arousal is a coordinated effort of the brain, emotions, nerves, blood supply, muscles and hormones. So a problem in any of these aspects can lead to erectile dysfunction. There are two types of impotence:

  • Psychogenic – the disorder presents suddenly in a random manner. It varies with different situations and is usually seen in the younger age group.

  • Organic – this type is related to physical problems with the blood supply of the penis. The onset is gradual, coming forth in almost all circumstances and generally seen in older individuals. 

Anxiety and stress form a vicious cycle with impotence. If one is tense or worried about something, it affects performance during intimacy and possibly disables adequate erection. This in turn heightens the anxiety and embarrassment, while lowering one’s confidence. Furthermore, depression, post-traumatic stress disorder, Widower’s syndrome and relationship problems are psychologically linked to the triggering mechanism.  On the other hand, here are some physical (organic) causes of erectile dysfunction:

  • Heart or vascular disease​ – blood supply to the private organs may be diminished or blocked due to clogged blood vessels. This is known as atherosclerosis can result from smoking, high blood pressure, diabetes, high cholesterol and/or peripheral vascular disease  

  • Neurological disorder – nerves of the male organ may be damaged by diseases such as multiple sclerosis, stroke, diabetes, spinal cord injury, Guillain-Barre syndrome, Parkinson’s disease or peripheral neuropathy.

  • Trauma – Any injury or surgery of the pelvic region or spinal cord. Prolonged bicycling can also compress nerves and affect blood flow to the penis. This may lead to temporary or permanent erectile dysfunction

  • Peyronie’s Disease – scar tissue develops inside penis

  • Medication induced - antidepressants, antihistamines and remedies of high blood pressure, pain or prostate disease or radiation treatment for cancer

  • Being overweight (obesity​) 

  • Drug abuse – heavy drinkers of alcohol or long term street drug use​

Impotence exhibits itself through the following symptoms:

  • Inability to obtain an erection

  • Having trouble keeping an erection

  • Lowered sexual desire​

It is important to understand that erectile dysfunction could be a symptom of an underlying illness, such as heart disease or diabetes. So if you have constant issues getting or maintaining an erection, do not hesitate to contact the Kidney and Bladder Service Line​ at The Aga Khan University Hospital.

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.​​

Some detailed questioning and a physical examination will be the starting point. You may have other symptoms or a pre-diagnosed medical disorder. If so, remember to inform your doctor about such factors. Expect certain personal questions regarding intimacy and relationship with your partner. All this will allow your physician to evaluate your complaints accurately. Depending on the initial assessment, one or more of the following may be ordered:

  • Blood test: a sample of your blood may be taken to test for testosterone levels, diabetes or possibility of a heart disease.

  • Urine test: like blood tests, a urine test may be used to check for diabetes or a heart disease

  • Doppler Ultrasound: an ultrasound of your pelvis may be done to evaluate the flow of blood to your genitalia

  • Psychosocial examination: you may need to undergo psychological testing to identify whether the disorder is caused by depression or emotional reasons

  • Overnight erection test: the test measures the frequency of erections you may have during your sleep

It is possible that your health care provider may request to speak with your partner too.​

The cause of impotence determines who and what will be required for treatment. Your family doctor may refer you to the Kidney and Bladder Service Line at The Aga Khan University Hospital if a surgical/traumatic issue is suspected, or they might involve the Mind and Brain service line​ to target psychogenic factors. More than one discipline may work in coordination to make sure you receive quality management. Treatment options are:

  • Medical therapy ​will include administration of

    • ​Oral pills  

    • Injectable medicines

    • Suppository (soft jelly like preparation inserted into urethra, the urinary tube)

    • Hormone replacement

  • Mechanical remedies ​may include

    • ​Penis pump – vacuum devices and constriction rings

    • Penis implants

    • Surgery of blocked or leaking blood vessels (stent placement or bypass)

Your preference and your partner’s opinions would be taken into consideration and due respect shall be given to maintain confidentiality. ​​​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage​
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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.​