There are many factors which trigger male sexual impotence, some of them are physiological, some of them psychological and some of them are only related with the lifestyle of the individual like smoking or alcoholism, smoking affects the blood flow through veins and arteries, therefore it prevents a good irrigation of penile structure during the erection. Among the diseases that trigger this condition we can find diabetes, kidney diseases different disorders of blood vessels, atherosclerosis and multiple sclerosis, these diseases are responsible for about seventy percent of the cases of male impotence. About thirty five to fifty percent of men affected by diabetes are also suffering with male impotence. Surgical interventions, for instance a prostate surgery, can damage the nerves and arteries that are located near the penis, which can also trigger male impotence. Lesions on the penis, prostate, spinal cord, pelvis and urinary bladder can cause male sexual dysfunctions by harming the smooth muscle, nerves, fibrous tissue of the corpora cavernosa and arteries. Likewise, a wide variety of medicines can cause male sexual impotence as a collateral effect, among these medicines are those employed to treat high blood pressure, the antihistaminic drugs, the antidepressants, the cimetidine (which is employed to treat the peptic ulcer), appetite suppressants and tranquilizers. Experts assert that about ten to twenty percent of the cases of male sexual impotence have their source on psychological causes. Among the most common psychological causes for this problem we can find anxiety, stress, depression, sense of guilt, lack of self esteem and the fear of not being able to please the partner. There are also hormonal disorders with a great incidence which may provoke an insufficient production of testosterone. Diagnosing male impotence It is important for the doctor to know the medical background of the patient and all the details of sexual life to help to define the degree and the nature of the impotence. The medical background can help to reveal the diseases which are triggering the condition, and with a simple description of sexual activities it is possible to distinguish the source of problems with the erection, the ejaculation, the orgasm or the sexual desire. The antecedent of the use of certain prescribed medicines or illegal drugs can indicate a source of chemical nature for male impotence. About twenty five percent of the cases of male impotence are caused by the incidence of medicines; therefore the interruption or substitution of these drugs can help to solve the problem. A physical exploration can help to identify systemic problems if there is any. For instance, if the penis does not respond as expected to the touch, the source can be located on a problem of the nervous system. The abnormality of secondary sexual characteristics such as the distribution of pubic hair can help to identify any problem of hormonal nature, which would indicate a problem on the endocrine system. There can also be found circulatory problems which might be triggering the male sexual impotence.