Just Can't Get It Up?

My old friend Jake told me recently that he's under constant pressure "to keep things up." I assumed he was referring to his law school grades, but he lowered his voice and confessed he was suffering from what he called "the limp noodle syndrome." The poor guy sounded so defeated, you'd think he'd just failed the bar exam for the fourth time.

At 27, Jake's had a healthy, problem-free sex life for the past ten years -- maintaining an erection has never been an issue. In fact, if memory serves, he was the priapic jock in tenth grade algebra who was always embarrassed to stand up when the teacher called on him to solve an equation on the blackboard. Trust me, it wasn't because he didn't know the answer.

Just Can't Get It Up Impotence, also known as erectile dysfunction, occurs when the penis does not become firm enough for vaginal penetration or loses firmness following penetration. It affects the sex lives of up to 30 million American men and their partners and may happen at any age, although it's more common in older men. In men of middle age and beyond, common causes of impotence are removal of the prostate and chronic disease of the lungs, kidney, heart, nerves, arteries, or veins. But a host of other causes that are not age-related can also cause the dreaded limp noodle, including the following:

  • Some prescription medications
  • Diabetes
  • Low testosterone levels
  • Long-distance bicycle riding
  • Injury to the pelvic region and spine

Alcohol and marijuana use can also be the culprit. Their use dulls the senses, diminishing the sensation a man feels during sex. Take it from Shakespeare, who said, "Drink provokes the desire but takes away the performance." Cigarettes are no aphrodisiacs, either. They contain nicotine, which causes the narrowing of blood vessels and thus prevents maximal blood flow to the penis.

What About Jake? But what about Jake, who doesn't fall into any of the above risk categories and just got a clean bill of health from his general practitioner? Most likely, it's in his mind. "In the young age group, under 35, the most common cause is psychologic," says Jed Kaminetsky, M.D., clinical assistant professor of urology at NYU School of Medicine. And while the Mayo Clinic reports that psychological factors account for 10 to 15 percent of impotence cases in all age groups, this may be a conservative estimate.

Like many other men suffering from impotence, Jake was reluctant to discuss the problem with his doctor -- it's still a taboo (especially for young men, who don't necessarily identify with Viagra pitchman, Bob Dole) and a source of shame. Had Jake mentioned his condition to his doctor, he most likely would've been referred to a psychologist or psychiatrist with experience in treating sexual problems, where they'd be able to examine the underlying sources of his impotence.

How Does Woody Work? Sporting serious wood is not the simple process one might assume that it is. In fact, it's about as complex as a NASA rocket launch. Kaminetsky explains the inner workings: "Within the penis are two spongy cylinders that run parallel to the urethra. When a man becomes sexually aroused, his nervous system communicates the arousal to his penis. Blood vessels that supply the penis relax, allowing more blood to fill the spongy cylinders. That produces an erection." In other words, for an erection to work, it has to be all systems go, from your head to your toes.

Outside stress can also negatively affect your performance. Kaminetsky notes that "when the stock market is low the rate of impotence rises." (Urologists must have made a killing in the early "90s.)

Rising to the Occasion In this boom economy, some young men are coming to Kaminetsky's private practice in New York City under false pretenses. "I see a lot of young guys in my office who tell me they're impotent, and I know they're not," he says, "They just want a Viagra prescription." Have we entered a brave new world in which healthy young men wish to transform themselves into biologically engineered marathon lovers? Actor Ben Affleck recently told Playboy that he uses Viagra. It was unclear, of course, as to whether his usage was out of necessity or a desire to copulate like Dionysus.

I'm happy to report that Jake is doing the right thing. He has begun to see a therapist, and although the impotence hasn't completely gone away, he reports that he and his girlfriend are making a lot of, um, headway.

Impotence Facts

  • Note: Most cases of impotence are temporary and treatable. For example, when a guy is nervous about impressing a new partner with his dazzling technique and enormous manhood, nerves can act on the ol' Johnson and prevent him from getting out of the starting gate (the opposite of Beginner's Luck?).
  • It's safe to say that every man experiences impotence from time to time. Medically speaking, impotence is defined as the inability to sustain an erection sufficient for intercourse during at least 25 percent of attempts.
  • There's no doubt about it, clean and healthy living insures you the best chance of avoiding impotence (regardless of how many groupies Mick Jagger may have shagged in his lifetime). The Canadian government is proposing that cigarette packs sport the following warning: "Cigarettes may cause sexual impotence due to decreased blood flow to the penis. This can prevent you from having an erection."