I have stressed the psychological causes of impotence, but I must also stress that these should not be accepted until an impotent man has been checked physically to make sure that he has no disease which may cause impotence. A physical check and a careful history will exclude diabetes, high blood pressure, alcoholism, drugs, and those nervous diseases which cause impotence; and impotence resulting from extensive pelvic surgery. Tests on the blood and urine will exclude diabetes, liver damage, and low levels of testosterone, or perhaps raised levels of another hormone called prolactin. In most studies of impotent men between 10 and 20 per cent have a physical cause, but the majority of men are found to be free from disease or drugs.
Another way of differentiating between impotence due to disease d that caused by psychological problems is to find out if a man gets nocturnal erections. In men who normally get erections and men who are impotent for psychological reasons, erections occur about every ninety minutes during sleep. The erections coincide with rapid eye movements (REM sleep). Men whose impotence is due to physical disease get no or few erections during REM sleep. If an impotent man is prepared to be investigated in this way, it can be established if his impotence is due to physical disease or to psychological problems, and this knowledge makes treatment easier.
*247/16/1*
