Male impotence refers to a variety of sexual problems, including the inability to get or keep an erection firm enough for sexual intercourse, a lack of sexual desire, and/or problems with ejaculation or orgasm. Erectile dysfunction(ED) is a more precise term, meaning the inability to sustaining an erection. The problems getting or keeping an erection may not occur all the time but may happen inconsistently. Premature ejaculation is a related problem. It is difficult to determine how widespread these problems are, because many men do not seek medical help for such personal sexual problems. It is estimated that more than 15 million men may be affected by some sort of sexual problem such as male impotence or erectile dysfunction. Impotence and ED can be caused by a number of things, including illnesses such as high blood pressure, diabetes, and cardiovascular disease, injury, and side effects of certain medications, including many antidepressants. Sexual problems such as these are not an inevitable part of aging. There are a number of treatments for sexual problems such as impotence and erectile dysfunction. Doctors sometimes recommend psychotherapy to treat any anxiety related to sexual situations. There are several types of drug therapies available as well. Oral drugs work by increasing blood flow to the penis, which allows improved sexual response. There are other drugs that are injected into the penis or inserted into the urethra, but these are less commonly used. While impotence may cause difficulty with sexual intercourse, which is necessary for conception, it is not the same thing as male infertility. Male infertility is a problem involving the man’s sperm or semen. Most commonly, veins in the scrotum are enlarged, which heats the scrotum and reduces sperm production. There can be other things that reduce sperm count as well. Sometimes sperm are abnormally shaped or do not move correctly. Other times there is a blockage somewhere in the man’s reproductive system. If couples have trouble conceiving, both the man and the woman should be tested for infertility. In about 40% of all cases, the cause of the infertility lies with the man. Fortunately, there are a number of treatments for male infertility. If there is a blockage in the reproductive system, sperm can be obtained from the testes or epididymis (the duct where sperm is stored). A surgeon makes a small incision in the scrotum and removes some of the sperm. If there is a low number of healthy sperm, sperm can be “washed” by separating them from the other ingredients in the semen, making them more concentrated. Sperm obtained in these ways can be used in procedures like in vitro fertilization (IVF- a procedure in which the sperm and egg are combined in the laboratory and the resulting embryos are implanted in the woman’s uterus). Sperm can also be injected directly into a mature egg in a process known as intracytoplasmic sperm injection (ICSI). It is important for men to learn and take an active role in their reproductive health. Men should not be hesitant to talk to their doctors about issues like impotence, erectile dysfunction, and infertility. These are common issues related to men's sexual health and nothing to be ashamed about - there is treatment available.