Often an absolutely fertile male with a completely normal sperm count might not be able to ejaculate in his wife's vagina. Because he cannot make love he cannot make babies. Many males cannot produce an erection (erectile dysfunction, ED or impotence); while others can't attain an erection which is hard enough to achieve intravaginal penetration or ejaculation within the vagina.
An older idea held that 80% of impotency issues were rooted in mental inhibition that could be treated with sex therapy and counseling. However modern day studies estimate that 50% result from physical causes which range from inadequate blood circulation to the penis, diabetes, neurologic defects, and hormonal complications.
How can a doctor suspect a physical problem? By asking a basic question - Do you have wet dreams? If males get nocturnal ejaculations (wet dreams) this means their penis works properly,, and that the issue is emotional.
Screening, consists of nocturnal penile tumescence (NPT) testing, that monitors for regular night-time erection strength; and calculating blood circulation through the arteries of the penis (using Doppler techniques). You can also do this test for yourself at home by using postage stamps!
Often the erectile dysfunction is situational. This means that while the man can masturbate, he just cannot get an erection while trying to have sex. This creates a lot of emotional discord and marital disharmony. The wife may feel that her husband is just not trying hard enough (pardon the pun!); or that he does not find her sexually attractive. Also, because ED destroys a man's self-esteem, both partners are very reluctant to discuss this or seek medical assistance. This just sets up a negative vicious cycle which makes matters worse. Either they just refuse to try; or every time they try, they fail, thus reinforcing the sense of inadequacy and incompetence. The man's mind starts playing games with him - and because he feels he is not going to be able to perform, this becomes a self-fulfilling prophecy. Failure to consummate the marriage is quite a common problem - but one few couples are willing to explicitly acknowledge.
The good news is that this is quite an easy problem to treat!
Treatment that may be recommended includes:
Medications which improve penile blood flow such as Viagra (sildenafil citrate) and Cialis (tadalafil citrate) to encourage an erection
Injections of papaverine as well as prostaglandins, (chemical substances that cause the blood vessels to dilate) could be self- injected into the penis under medical guidance These boost the blood circulation towards the penis, thus inducing an erection.
A medical implant or penile prosthesis to provide an artificial erection.
Microsurgery to plug leaks in the blood vessels of the penis, therefore avoiding the loss of turgidity from the erect penis.
The sperms may also be collected by masturbation and used for self-insemination or artificial insemination. This provides an extremely high success rate, since there is really no fertility problem as such for these patients.