It was once the male's secret shame. Now, like so many previously taboo subjects, impotence--a man's inability to perform the sex act--is coming out of the closet.
As more men bring themselves to talk about it, impotence is becoming less a matter only of private despair and more of a problem to be confronted and corrected.
Many, if not most men, experience a transitory bout of impotence at some point in their lives, brought on by any number of factors such as tension, anxiety, illness, fatigue, too much alcohol. Although the lapse in sexual functioning may be a temporary affront to the ego, it is considered a normal occurrence.
Chronic impotence, however, suffered by an estimated 10 million American men (about one out of 11), is very much a problem and can be disastrous in personal lives. Despite more openness, however, some men are still reluctant to admit any sexual inadequacy, even to a physician, or are unaware of help now available as the result of medical advances.
Impotents Anonymous, a new organization formed in the Washington area, is aimed both at helping impotent males speak up about their difficulties and providing information on how they can regain their sexual functioning. The organization is patterned after the successful group-therapy techniques of Alcoholics Anonymous.
And like AA, there is also an I-Anon auxiliary, for female (and, indeed, male) partners of impotent males. Women often go through certain physical and mental adjustments when a mate who has been impotent for a number of years can resume coitus. In a few instances, wives fear that their husbands will have affairs with other women. Some women find themselves angry once their partner has recovered because he didn't seek help earlier.
"There's a comfort in people being able to come here and talk with other people who have the same problem," says Bruce M., a 61-year-old Washington businessman who with his wife, Eileen, 57, founded Impotents Anonymous a year ago. Bruce had been impotent for several years before learning he could have the disability corrected surgically.
What Bruce and Eileen discovered in their search for a solution, they decided to pass along to other couples. Their choice of organizational format is not surprising: They had met in Al-Anon, the auxiliary to Alcoholics Anonymous, when both of their now-deceased spouses were battling a drinking problem.
The emergence of Impotents Anonymous, which meets twice monthly at a Washington-area hospital, coincides with major new developments in the understanding of male impotence that promise help for the chronic victim.
For a long time, impotence was considered primarily a psychological problem--"It's all in your head," men were told. But in recent years, doctors have concluded that perhaps 50 percent--or more--of chronic impotence cases are caused by an underlying medical problem, which no amount of psychiatric treatment can correct.
Diabetes is one of the most common physical factors in impotence. Others include diseases of the blood vessels or of the erectile tissue and hormonal abnormalities. Medicines prescribed for high blood pressure or other ailments can be at fault, as well as alcohol and drug abuse.
Meanwhile, new tests have been developed to help determine whether an individual's impotence is psychological or physical--or a combination. One bedside device measures nocturnal penile tumescence. If the impotent patient experiences an erection in his sleep--which sexually able males customarily do several times a night--chances are his problem is psychological. If there is no erection, there's good reason to start looking for a physical cause.
With attention focused on the physical problems, specific diseases can, perhaps, be cured; medications may be altered and, if everything else fails, a dramatic new form of artificial erection device is a possibility. One such device, implanted in the penis, inflates when pumped to achieve an erection. The device, used by an estimated 20,000 males, has been getting good reviews from patients and their mates.
Though implant surgery is expensive--perhaps as much as $8,000 for the device, surgeon's fee and a three-day hospital stay--the cost is often covered by medical insurance.
"Impotence is not something to be ashamed of," says urologist Myron I. Murdock of Prince George's County, who has been performing surgical implants since 1973.
"But many men feel unable to discuss it with their wife, their friends or their own physician. The average Joe Doe doesn't know that there is a way of treating the problem medically or surgically."
And, adds Murdock, the average Joe Doe is often no less informed than his private doctor. "Go into the average doctor and say you're impotent. He'll give you a hormone test. He doesn't know what treatment is available."
Murdock, who has been an unofficial medical adviser to Impotents Anonymous, suggests a man seek help if impotence persists for a month. After six months, he says, the problem becomes more difficult to treat.
Bruce's problem of impotence had developed gradually, and he was impotent when he and Eileen were married six years ago. Although they both thought it was a psychological aftereffect of the death of his wife and eventually would disappear, the problem persisted.
"I was damned ashamed," recalls Bruce. And, ultimately, says Eileen, "I was damned mad." She urged Bruce to find out what was wrong. "If you're procrastinating," she told him, "the hell with it. If nothing can be done, then I'll live with it."
Bruce first went to a family doctor, who advised the couple to consult a sex therapist. It was the sex therapist who suggested the possibility of a physical cause for the impotence, since Bruce had been under treatment for diabetes for about 10 years. A urologist confirmed that diabetes was the culprit. Bruce opted for an artificial implant, which both he and Eileen consider a blessing to their marriage.
Another organization for impotent males and their partners, Potency Restored, has been formed by Silver Spring urologist Giulio I. Scarzella, who performs implant surgery. Its members, who are considering or have had an implant, exchange concerns and information on the operation.
"They are so incredibly relieved to be helped," says Scarzella, "they want to share this with others."
Impotents Anonymous also welcomes individuals and couples seeking information, who then meet with formerly impotent men. In its first year, meetings have been attended by about 50 men, as young as 20 and as old as 70-year-old Sidney, who just underwent an implant operation.
Sometimes, says Eileen, it is the wife who shows up seeking guidance first and then her husband tags along later. Guest speakers include psychiatrists, urologists and manufacturers of penile implant devices.
"No one goes into a psychologist and says, 'I have a problem with erection,' but they will come in and tell us," say Bruce and Eileen. "Once they converse with us, they can go and talk to a doctor."
"I was very impressed with how open, how freely they talk," says psychiatrist Stephen Hershey of Walter Reed Army Medical Center, who regularly refers patients to Impotents Anonymous. "They really do a lot for each other."
With the help ranging from basic information to emotional counseling, the discussion can get exceedingly frank, even embarrassing to some. "If someone can't face a group," says Bruce, "they can come see us personally."
Members who have had implant surgery, say the couple, probably are better able than a doctor to answer such questions as: How much pain, if any, is there? Is the device uncomfortable? Does it diminish sexual sensations?
Although the group maintains a list of about 14 surgeons in the Washington area who perform artificial implants, Bruce and Eileen stress that information on a variety of alternatives is available.
Many couples who show up, says Bruce, have gone through the emotional strain of blaming each other about the male's impotence. "The woman says, 'I've lost my charm. He's no longer attracted to me.' The man says, 'Maybe I should try some new ideas,'"and then may seek sex--fruitlessly--with other women.
The organization also helps couples adjust to a restored sexual life, which--in cases where it has been months or years since intercourse--can be a major adjustment. "It's like riding a bicycle," observes Eileen. "You don't forget, but you're very wobbly."
There are intimate questions such as: How does one incorporate the necessary mechanics of inflating an implant into the sex act?
And there's the realization for women, which some find hard to accept, that their role in the male's arousal may have changed. In the past, they could feel that it was their presence, but with a surgical implant, erection is achieved mechanically.
But for people like Mike, 60, whose impotence--caused by a circulation problem--was "devastating," membership in Impotents Anonymous and a surgical implant changed his life. It is now "like a honeymoon."