Often, an absolutely fertile man with a completely normal sperm count may not be able to ejaculate into his wife’s vagina. Since he can’t make love, he can’t make babies. Many men are unable to produce an erection (erectile dysfunction, erectile dysfunction, or impotence); while others cannot achieve an erection hard enough to achieve intravaginal penetration or intravaginal ejaculation.

An older idea held that 80% of impotence problems were caused by mental inhibition that could be treated with sex therapy and counseling. However, modern studies estimate that 50% is due to physical causes ranging from inadequate blood circulation to the penis, diabetes, neurological defects, and hormonal complications.

How can a doctor suspect a physical problem? Asking a basic question: Do you have wet dreams? If men have nocturnal ejaculations (wet dreams), this means that their penis is working properly and the problem is emotional.

Screening consists of nocturnal penile tumescence (NPT) tests, which monitor the strength of a regular nocturnal erection; and calculate the blood circulation through the arteries of the penis (using Doppler techniques). You can also do this test yourself at home using postage stamps!

Often erectile dysfunction is situational. This means that while the man can masturbate, he simply cannot get an erection while he is trying to have sex. This creates a lot of emotional discord and marital disharmony. The wife may feel that her husband is simply not trying hard enough (pardon the pun!); or that he doesn’t find her sexually attractive. Also, because erectile dysfunction destroys a man’s self-esteem, both partners are very reluctant to talk about it or seek medical help. This only sets up a negative vicious cycle that makes things worse. Or they just refuse to try; or every time they try, they fail, thus reinforcing the feeling of inadequacy and incompetence. The man’s mind begins to play games with him, and because he feels that he will not be able to act, this becomes a self-fulfilling prophecy. Marriage nonconsumption is a fairly common problem, but some couples are willing to explicitly acknowledge it.

The good news is that this is a pretty easy problem to deal with!

Treatment that may be recommended includes:

Medications that improve penile blood flow such as Viagra (sildenafil citrate) and Cialis (tadalafil citrate) to stimulate an erection

Injections of papaverine and prostaglandins (chemicals that cause blood vessels to dilate) can be self-injected into the penis under medical supervision. These increase blood circulation to the penis, which induces an erection.

A medical implant or penile prosthesis to provide an artificial erection.

Microsurgery to plug leaks in the blood vessels of the penis, thus preventing the loss of turgidity of the erect penis.

Sperm can also be collected through masturbation and used for self-insemination or artificial insemination. This provides an extremely high success rate, as there is really no fertility problem as such for these patients.