Impotence, according to Miller and Keane (1997), is the inability to maintain an erection of sufficient rigidity to perform sexual intercourse. Otherwise known as erectile dysfunction, it requires interference with the co-ordination of one or more of vascular, neurologic, hormonal and psychological factors (Brock 2002), with vascular being responsible in about 70% of cases. Brock (2002) points out that where erectile dysfunction has previously been an accepted consequence of aging, it is now recognised that organic causes play a much more significant etiological role. As a result it becomes a condition requiring a multifactorial approach that would include androgen deficiency, lowered vitality, anxiety/stress levels, circulatory considerations as well as smoking habits, age, pelvic surgery and the presence of additional endothelial dysfunction-associated medical conditions (Barada 2004). With this current patient, there are further complications surrounding his heart attack eighteen months previous, his poor sleep quality and constant tiredness and the possibility that any or all of his cardiovascular medications are causing the erectile dysfunction.