Impotence types

Arteriogenic

Where the arteries supplying blood to the penis do not bring in enough blood to cause an erection. This can occur because of a narrowing of the arteries such as occurs in the elderly, diabetics and those with high blood pressure or because of injury to the genital region which causes a block in the artery to the penis.
The last is very common in the young. The injury can be major and sudden as after a vehicular accident causing a fracture of the pelvis or pubic bones, or low grade and gradual, as in bicycle and other riders, and occurs because sustained friction in that region causes a clot-like substance (thrombus) to develop in the artery to the penis. This clot gradually grows and ultimately blocks the blood supply to the penis completely.

Venogenic

Where the veins of the penis leak blood and prevent the development of a rigid erection. In a normal man during full erection the veins close down almost completely and practically no blood flows out from the penis. This allows blood to accumulate in the sinusoids of the penis, thus raising pressure and allowing for the development of rigidity or hardness.
Venogenic impotence is extremely common. It is said to account for as much as 30-70 percent of all impotence. Some men have venogenic impotence from birth (primary). Such men have never had a rigid erection all their lives. Others develop venogenic impotence suddenly after years of normal sexuality (secondary).

Neurogenic

The nerve supply to the penis is very complex. A proper conduction of impulses along these is basic for the initiation and maintenance of an erection. It is these nerves that activate the arteries and the veins and alter the dynamics of blood flow within them.
Many things can go wrong with the nerve supply to the penis. Injuries to the back, especially if they involve the vertebral column and the spinal cord can cause impotence. So also can injury to other nerves supplying the penis such as occurs after pelvic or perineal trauma. A wide variety of operations performed for other conditions can cause incidental injury to the nerves of the penis and cause impotence. These include operations on the rectum, prostate, urethra, spine, retroperitoneum, urinary bladder etc..
Of course, disorders of the nervous system such as multiple sclerosis, myelitis, tumour etc. are wont to cause impotence if they involve the nerve supply to the penis.
Another disease affecting the nerves to the penis is diabetes mellitus. Impotence is extremely common among diabetics. 


In fact, as many as 50 per cent of all diabetics are impotent. Impotence in diabetics is almost always organic in origin. Appropriate therapy for diabetes can never restore erectile function because the basic diabetic process can never be reversed. Only the blood sugar levels and the complications of diabetes are controlled. Modern andrology, however, can offer a cure to nearly all patients with diabetes-related impotence. This is another fact that is, unfortunately, not known to most people. Few diabetologists address erectile dysfunction (ED, impotence) in their patients.


Many drugs also cause neurogenic impotence by affecting the neurotransmitters at the nerve endings. Notable among these are anti-hypertensives (BP lowering) and psychotropics. The list is very large. Often, it is not known that the medicine (which is prescribed for some unrelated disease, such as duodenal ulcer) is the culprit.

Endocrinologic (or hormonal)

This occurs when there is an imbalance or insufficiency of sex
hormones in the blood stream. It accounts for about 5 to 10 per cent of all organic impotence. Generally, hormonal changes affect the libido (or sex drive) rather than the quality of the erection per se. A variety of disease conditions can cause these changes.

Mixed

Sometimes, more than one factor can be operative in the same patient. Such patients generally have systemic disease. Notable examples are diabetes, kidney failure and liver failure.
Another group where mixed factors operate is where long standing impotence has led to secondary psychiatric disorders such as depression etc.. Here, the basic causative factor is organic but being unrecognised and untreated (or maltreated) it eventually takes its toll on the mind, often because the patient thinks or has been led to believe that the condition is incurable and that it's all in his mind.

Psychogenic

When there is no organic factor and the problem lies purely in the mind, it is labeled a case of psychogenic impotence. But before such hasty labeling it is necessary to prove by andrological investigation that no organic or bodily cause exists.
Only then can treatment proceed in a scientific and systematic manner.