Erectile Dysfunction

Men who are unable to get rigid enough penile erections to penetrate the vagina, or who are unable to remain hard enough to enjoy sexual intercourse are frequently deeply distressed. However, there are many treatments these days for erectile dysfunction and medical advice should be sought as soon as possible.

What types of problems is a man likely to experience with his erection?

For sexual intercourse to take place satisfactorily, the normally soft penis needs to become much larger and more rigid in order to penetrate the vagina. To achieve this state, blood flows into the penis, which then lengthens and thickens. As the penis becomes erect, it also becomes much harder and sticks out in front of the man’s body at an angle that can vary from near horizontal to almost vertical. This variation is quite normal.

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It is not uncommon for a man to have problems with his erection. Anything from being overtired to having too much alcohol to drink may lead to a temporary loss of the ability to achieve an erection. However the problem and difficulties can be more serious. If these problems have always been present and, as a result, sexual intercourse has never been achieved, then these problems are known as primary erectile problems. If however, after having enjoyed a period of normal sex, a man subsequently has problems with erectile dysfunction, then these are called secondary erectile problems.

Originally, the medical profession used the word impotence to describe not only erectile problems but also those involving ejaculating either too quickly to slowly. However this word is rather vague and is not generally used by sex therapists or medical practitioners these days.

How does penile erection occur?

One of the first things that happens to a man when he becomes sexually aroused is that he begins to get an erection. The erotic signals that will lead to a man becoming aroused can come from a variety of sources. For example being with an attractive partner, watching television or erotic videos, fantasy, physical contact in masturbation, or from sex play with his partner. Whatever the source, the brain processes this information and relays it through the nervous system to the penis. At the same time, changes also take place in the blood levels of sex hormones, that also play a part in the process of arousal.

Although the mechanism of erection is not fully understood, it is known that the first response is for arteries in the penis to expand. These arteries deliver blood to the erectile tissues, made up of three rods of elastic, spongy tissue honeycombed with spaces that fill with blood on erection. As the arteries dilate and the erectile tissues expand, the veins that normally drain blood away become compressed, slowing down the loss of blood from the penis. Since the inflow of blood is greater than the outflow, the penis will, then become hard and erect, in normal circumstances.. After ejaculation (or sometime later if ejaculation does not happen), the arteries contract, the erectile rods shrink and soften and the veins open to drain the blood away. The penis then returns to its original shape and size.

How common are problems with erectile dysfunction?

Most men can recall the odd occasion when they have been unable to obtain an erection. Very often however these were only temporary problems that sorted themselves out sooner or later. It is difficult to get reliable information about the frequency of more serious difficulties with erection because, quite obviously, the frequency of the condition will vary according to the age of the people questioned. Alfred Kinsey, the American sexologist, for example, found that in 20-year-olds, only one in 1000 reported difficulties with erectile dysfunction. But when he studied 65-year-old men, the frequency of erectile dysfunction increased to 25%. A study published in 1987, in which a large number of men with the average age of 37 were asked about their sexual problems, the result was that 7% admitted to difficulties achieving an erection. This figure has been supported by other medical studies. Sex therapists report that, after problems with premature ejaculation, problems with erectile dysfunction are the most common problem which are seen in sex therapy clinics.

What has usually gone wrong when a man has erectile dysfunction?

In the past, it was thought that erectile dysfunction was most commonly caused by anxiety, worry, or relationship problems. While there is no doubt that psychological causes are important in many cases, there is now increasing evidence that as many as about 50% of all erectile problems are probably caused by physical or medical problems.

It is not always simple to divide the causes of erectile dysfunction into physical and psychological. This is because some physical problems can reduce a man’s capacity to achieve a good erection, but not by themselves prevent him from having intercourse; however, the fact that he now has anxieties about his performance may then lead him to fail totally. In other words physical and psychological causes can interact in a complicated way.

What can go wrong physically?

For a man to achieve a good erection, at least three physiological processes must be working properly:

  • The circulation of the blood, that is the arteries and veins serving the penis, must be functioning properly.
  • The nerves that control the erectile process must be intact.
  • Hormone levels, especially those concerned with sexual responses, must be within their normal ranges.

There are probably other important factors as well, but little is known about these at present. If anything goes wrong with one or more of these physiological processes then a man’s ability to achieve an erection can be affected to a greater or lesser extent.

Problems with penile blood supply.

For a man to get an erection it is essential for there to be good and rapid flow of blood into the erectile tissues of the penis. There are two types of problems that can interfere with this process.

Firstly any problem or disease of the arteries that carry blood to the penis will reduce the speed and volume of blood flow by narrowing the diameter of the blood vessels. This process is usually a very gradual one and usually only affects middle aged and older men. However, rarely, arterial disease can also affect younger men. Occasionally it is possible to cure this surgically, but the man will also have to maintain a healthy lifestyle. This healthy lifestyle involves: no smoking, eating a healthy diet, in particular avoiding foods that are high in saturated fat, and taking plenty of exercise.

Secondly a problem with the layout of the blood vessels in the penis may sometimes lead to what is known as a venous leak. This takes place when blood entering the base of the penis does not pass into the erectile tissue as it should but instead does a type of U-turn and leaks across into the veins without playing its part in the erection process. This leakage prevents a full erection from taking place, in a similar way that a puncture may prevent a tyre from inflating however hard the tyre is pumped up. It is sometimes possible to repair this type of venous leak surgically.

Problems with the nerves that control penile erection.

The primary function of the nervous system in causing an erection is to stimulate the arteries to expand and allow a good and rapid flow of blood into the penis. Any damage to this part of the nervous system will therefore interfere with this process and result in erectile dysfunction. Diseases that lead to damage to the nerves include diabetes and multiple sclerosis. Damage to the spinal-cord can also lead to erectile dysfunction. Another cause of damage to the nerves is drug abuse, especially alcohol abuse, which over a prolonged period of time can cause damage to the nerves and therefore lead to erectile dysfunction.

What is the role of sex hormones in producing an erection?

Sex hormones such as testosterone play a vital role in a man becoming aroused and developing a good erection. The process is complicated, and it is known that there are a number of different hormones which are involved, although how they work together with the nervous system is not understood fully.

Initially, there needs to be enough of the male sex hormone testosterone. This testosterone is produced by the testes and needs to be produced for the erections to occur normally. For example, if a man is castrated after puberty and the testosterone is not replaced artificially his ability to obtain an erection will gradually decline. Similarly, if a man is given medication that results in a chemical castration he will eventually lose his ability to get an erection. Whether there is enough testosterone produced by the testes depends on the presence of other hormones which are secreted by the pituitary gland. Over or under secretion of these pituitary hormones can result in problems with testosterone levels.

Other hormones which are not obviously connected with sex, such as those that are produced by the thyroid gland, may also affect sexual responses.

Psychological factors in problems with erection.

If, for any reason, a man has problems with erectile dysfunction on a particular occasion, he become anxious and start worrying. Even if the factor that caused the problem in the first place disappears, his anxiety may persist, and this anxiety may in itself cause erectile dysfunction. What develops then is a vicious circle, he is anxious because he cannot be sure that he will develop a good erection, and he has problems with erectile dysfunction because he is worrying and so on… This is referred to by sex therapists as performance anxiety and plays a very important part in a lot of cases of erectile dysfunction.

Other stresses that can lead to erectile dysfunction.

Various factors can lead to erectile problems. Probably the most important are problems that arise from the relationship with one’s sexual partner. Most of us want to please our sexual partners, when we are making love and this is fine, providing these desires do not get out of hand. Sometimes a man wants to please his partner so much that he becomes anxious and concerned about his ability to perform. The resulting stress results in erectile dysfunction. He then becomes unable to respond to his sexual partner in an assertive and positive manner. The resulting loss of confidence may lead him to feel rejected and unloved. This is not the ideal mood for making love effectively.

A man can also have problems with erectile dysfunction if he is no longer attracted to or sexually aroused by his partner. This can happen for a number of reasons: for example she may have taken on the role of a mother figure, or he might have become bored with the lovemaking because it has become repetitive, too frequent or dull. He may simply have fallen out of love with her, or fallen in love with someone else. He may be unable to get an erection because he is angry with her or because from his point of view, she is excessively demanding sexually or insufficiently responsive. Obviously the part played by relationships are a complex, and sometimes only a skilled counsellor can unravel all the causes and help solve the problem.

There are also day-to-day stresses and worries. Most people have worries as a result of daily life. For example worries about money, health, work, children, family matters and housing. These life worries and problems usually sort themselves out, but when they are present they may affect an individual’s sex life and lead to a man having problems achieving erections.

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