1. Ignorance, myths, superstition, guilt and the stigma and taboo attached to anything sexual in the minds of the laity.

2. Abysmal sexual ignorance among most doctors who continue to believe that impotence is something that is largely psychological in origin.

These two factors account for the fact that most cases of impotence do not come to light and the few that do are grossly mismanaged by ignorant doctors. It is not surprising, therefore, that the general impression is that impotence is something largely psychological and incurable.

This is indeed unfortunate because not only are most cases of impotence NOT psychological in origin but most are eminently curable as well.

Impotence or erectile dysfunction as andrologists prefer to call it, has always been and continues to remain an extremely common disorder. It is said to afflict as much as 10 percent of the male population. Despite this staggering incidence, few cases come to light.

Contrary to popular belief, impotence is almost never an "all or none" phenomenon. Most laymen (and several doctors) believe that a man can either have an erection of very good quality or not at all. Nothing can be farther from the truth. Most men with erectile dysfunction have normal desire and can obtain an erection, only the erection is not hard enough. Hence the term erectile dysfunction (which suggests partial loss) is preferred to impotence (which suggests a total loss). Not many are aware that in most cases organic rather than psychological causes are responsible.

In as many as 80-90 percent of cases of chronic impotence, the cause is not in the mind but in the body.

However, the trend is slowly but definitely changing. This is largely due to tremendous advances in andrological research over the past few years which have conclusively established that in as many as 80-90 percent of cases of chronic impotence, the cause is not in the mind but in the body. These causes can be identified using modern andrological investigative modalities, quantified and often successfully treated using totally non-psychological methods.

In an era where so many advances have been made in nearly all other branches of medicine, it is surprising that male reproductive system research has remained so woefully neglected and backward. For instance, the branch of obstetrics and gynecology (the female analogue of andrology) which deals with disorders of the female reproductive system has been with us for several decades now and is a well recognised specialty. In fact, so advanced in the understanding of the subject that today in most countries gynecologists restrict themselves to sub-specialty areas within their subject such as gynecological oncology, high-risk pregnancies, female infertility etc. because it is so difficult to keep pace with all the developments in the subject.

The masculine ego would not admit that there could be something wrong with the male reproductive organs - that would be demeaning to 'manhood'.

It may be of interest to our readers to deliberate in passing on the reasons for this laggardness in andrological research.

Two factors are predominant. The first of these is male chauvinism. Throughout human history, most of our societies have been patriarchal and male-dominated. The masculine ego would not admit that there could be something wrong with the male reproductive organs - that would be demeaning to `manhood'. Ironically, it is these very men who researched the female reproductive system and helped evolve the branch of gynecology and obstetrics. But they refused to look into themselves.

The second is the misinterpretation of the teachings of Sigmund Freud. This led to the erroneous conclusion that most male sexual problems had their roots in the mind.

Whereas most branches of medicine have taken their roots from biology - the study beginning with an understanding of the anatomy and physiology of that part and proceeding to then figure out what happens when anatomy or physiology goes wrong thus causing disease, the male reproductive system alone took its roots from psychology, thus causing tremendous damage.

This explains why most people know that it takes a complex series of neuromuscular phenomena to lift a little finger but fail to realise that equally complex phenomena are needed to lift the penis!! Most think that all that is needed for the latter event to occur is a naughty thought.

What then causes impotence ? Although impotence can afflict anyone from 13 to 90 plus and is associated with a wide variety of clinical conditions and disease states (see box), the basic mechanisms causing impotence are only a few. All of these can be accurately identified using modern andrological investigative techniques.