In our discussions with impotent men and their partners a number of questions have repeatedly arisen. Our response to these are shown below.

Being impotent makes me feel very depressed and hopeless. How can I have a normal sex life?

Your question implies that there is something which sex ought to be. There is. It ought to be a satisfying experience between two affectionate people from which they both emerge feeling good and that they would like more. This definition recognises that people differ enormously in what they need and in their capacity to be satisfied. Your negative feelings about yourself will change when you find the right woman who co-operates with you and reassures you. It seems more important that you both decide what you want together rather than judge yourselves against some vague notion of what is 'normal'. Besides there are many exciting sexual activities apart from 'normal' sexual intercourse!

But can I have a 'normal' relationship?

Having a 'normal' relationship does not guarantee good sex and there is probably less sex in many long-term relationships than you imagine. If you want good sex you may find that an 'abnormal' relationship is better and as long as it is mutually satisfying and it doesn't harm anyone there is nothing wrong with it.

Are you saying that I must just learn to live with it?

A hard dick does seem to be very important to man's self-esteem. But it is often unclear whether the floppiness or the poor self-esteem comes first. Sometimes the onset of impotence can be linked to a failed relationship, which is a blow to the man's self-confidence. Very often a downward spiral occurs in which the impotence and poor self-esteem are mutually reinforcing and there seems no way out.

The only solution is to stop thinking of impotence as a problem. This is different from 'learning to live with it'. It is more about being absolutely certain that it is OK to be impotent. In order to feel this way you need to consider how your feelings have been shaped by attitudes in society. Our society is full of images of the swaggering, macho male who is confident of his own virility. Although you may consciously reject this stereotype, it is so pervasive it may still influence your self-image. Even women who have apparently rejected this stereotype may, when they become involved with a man, slip back into traditional ways of thinking about male sexuality. However, your whole identity and sexuality is not determined by your ability to sustain an erection.

In addition, you may feel that masturbation was acceptable when you were a teenager but now that you are grown-up you must forget that and perform penetrative sex. In reality masturbation is used in our adult sex lives to a greater or lesser extent and some men admit that penetrative sex is not what they enjoy most. If you want a 'grown-up', happy, loving relationship with a woman it is not important to have penetrative sex.

My wife /partner is very understanding but doesn't a woman really need penetrative sex to be satisfied?

Some women do, some women don't. However, you should find out what she wants. It can be fun to explore all the senses to find out what can be a turn-on for her i.e. tastes, smells, sounds,sights and touch. Most women want affection - holding hands, cuddles, hugs, kissing, dancing romantically - as a first step. They may enjoy being stroked, fondled, caressed and kissed on various parts of their bodies, including breasts and nipples, ear lobes, neck, back, buttocks and between their thighs. This can be enough to arouse some women but for others genital stimulation is also necessary. To reach orgasm a woman needs continuous, rhythmic stimulation of the clitoris and this does not need a thrusting penis. It is important to know that the clitoris is more sensitive than the vagina and therefore a more crucial area for sexual pleasure. Penetration of the vagina by fingers may be pleasurable and an aroused vagina may hug the man's fingers as they move back and forth. To reach orgasm during penetration most women need clitoral stimulation before penetration and some need it also during penetration. In other words, all orgasms originate in the clitoris though they may be felt elsewhere. The belief that a vaginal orgasm is the ideal for the sexually mature woman is generally regarded as a myth.

There is still the question of whether penetration by fingers, or an object, can be as satisfying as a penis. The answer to this will depend on the couple and their ability to be clear and honest about their needs. With practice a man can learn techniques for giving a woman the sensation of a penis and a woman can use fantasy to imagine she is being penetrated by a penis. In other words, if their overall sexual needs are being adequately met, then there is no reason why his impotence should be a frustrating experience for them.

Many women seek sexual fulfillment on a more emotional level than men and use the language of 'lovemaking'. They understand the pleasure of simply being intimate and open with a man and don't feel the same pressure as a man to perform. They enjoy sex because it gives them a general feeling of well- being and affirms their womanliness.

Can you suggest ways that we might 'play' together in a sexual way so that we can add to our repertoire?

Play comes naturally to children but to engage in 'adult play' takes courage. Often it can be very exciting to verbalise your sexual thoughts and fantasies in a playful way. For example, a woman may fantasise about being fucked by a virile man, and her partner may fantasise about watching this; or you may both imagine other men looking at her naked body and being aroused by it. You could also try role-playing. For example, she could play the part of a strict, demanding, dissatisfied woman who tells him off for being useless and pathetic and not a 'real man'; he could play the part of a powerful man who disapproves of her sexual hunger and calls her a slut, an animal, wanting to be fucked!

Another suggestion is to try a naturist/nudist lifestyle. Nudism can provide a liberating experience for impotent men and their partners. You will soon shake off any feelings of shame, inadequacy or embarrassment about your bodies. There is no greater sensual pleasure than feeling the air on your naked body. You may also enjoying taking nude photos of each other to record the occasion.

Yes, 'normal' people like you do all of these things!

My wife and I are both excited by the idea of finding a younger man who could satisfy her. Is this a possibility?

This is certainly a possibility for the more liberated couple. You would have to discuss it fully and be absolutely sure that your relationship is strong and secure and that you agree this is something you both want. You might need to discuss whether you want a one-off experience or an on-going relationship. Some couples find that their relationship can be refreshed by this kind of encounter. They may discover new and exciting things they can do to spice up their own sex life!

In a new relationship how and when do I raise the subject of my impotence?

There is no point in raising this unless you are already in a significant emotional relationship. During the initial phase of a relationship there are so many things to negotiate subtly that this is likely to be one of many areas that will need testing out. It is probably a good idea to limit yourself initially to heavy petting. As you develop an increasing level of physical intimacy this may be an appropriate time to raise it. Obviously, it helps if your both in a relaxed mood, in a pleasant environment, and it may help if you have had a few drinks! Her initial reaction will indicate whether this is likely to be a problem within the relationship. Having raised the subject once you can then proceed on another occasion to discuss the practical implications.

I cannot get an erection that is rock hard and my performance is unpredictable. Am I impotent?

No. This is an experience that many men have at some time in their lives.

Some men (and women) believe that a man should be ready to 'perform' in every sexual encounter, at all times, without any stimulation from a woman but, in fact, everyone needs arousing. It may be that a more leisurely pace to your lovemaking, or a more comfortable and relaxing location, or a more sexy atmosphere would help.

Is impotence actually quite common in older men?

It is definitely more common in older men than younger men. There may be some young studs who cannot imagine ever being unable to get it up on demand but, sooner or later, all men are affected by the natural ageing process and must come to terms with the inevitable changes in their bodies. In fact, some men find they get more enjoyment out of sex as they get older because they are less driven by their hormones and may even be relieved that there is not the same pressure to 'perform' as there was in their youth. Besides, with maturity, some men develop a better understanding of the pleasures of simply being intimate and open with a woman.