More than half of all cases of impotence are due to psychological problems. Stress, anxiety, and depression can make one lose interest in sex and eventually trigger episodes of impotence.

"Psychological causes of impotence usually develop as a result of some specific anxiety-producing event, as, for example, a recent heart attack, the fear of contracting a sexually transmitted disease, loss of interest in one's long time sexual partner, depression, overwork, fatigue, business worries whatever. In these circumstances, counseling, reassurance, and review of sexual techniques and expectations may be helpful," revealed Dr. Isadore Rosenfeld of the New York Hospital - Sloane-Kettering Cancer Center in The Best Treatment.

"The important thing is not to assume that an episode of impotence means that you have a permanent problem and should expect it to happen again during the next sexual encounter. Because thought processes are so important in erection, such a negative assumption can, in some cases, bring the problem about. The best thing to do if you experience an episode of impotence is to forget it and expect a more successful experience at another time. Such an episode is not a lasting comment on a man's virility or masculinity," added Dr. David E. Larson, editor-in-chief of the Mayo Clinic Family Health Book.

It's also important to remember that not all bouts of impotence are psychological in origin. Physical problems account for a great number of cases. These include diabetes and vascular disease (the most common causes), surgery of the prostate gland for cancer or any major abdominal operation in which the blood supply or nerves in the area are damaged.

Impotence can also follow nerve injury associated with multiple sclerosis or a stroke, hormonal disorders, prostate infection, smoking, alcohol and drug abuse. Other possible causes are structural abnormalities of the penis and circulatory problems that can interfere with blood flow to the penis.

"Previously, it was said that it was all psychological. But as diagnostic tests were developed, more often a physical cause was found such as nerve damage, arterial blockage, or fibrous tissue in the penis itself," revealed Dr. Edward John Keogh, medical director of the Reproductive Research Institute at Queen Elizabeth II Medical Center in Nedlands, Western Australia.

Sometimes, impotence can be a side effect of certain medicines. Over 2OO medications are known to cause impotence. These include antihypertensives, tranquilizers, sleeping pills, and narcotics.

"Most medications which are used to control high blood pressure interfere with erectile function. But when as person has hypertension, how can he stop using the drug? When he stops the drug, he could have a stroke. If he changes his medication, who can tell whether or not it will produce impotence? How do you know the second drug isn't as harmful as the first? That's the dilemma of drug users," Keogh said.

"Medication is high on the list (of impotence). - My cardinal rule holds as true for impotence as it does for virtually every other symptom: When you wonder what's causing it, look into your medicine cabinet first. Except for antibiotics, almost any drug can render a man impotent," Rosenfeld said.

How is impotence treated? Find out in the third part of this series. If your partner has a diminished sex drive, help her recover with Fematril, a safe and natural female sexual enhancer that can stimulate your mind and body. For details, go to