Erection Problems /  Erectile Dysfunction (Part 3)

A Few Thoughts About Erection Problems

In young men, just thinking about sex seems to cause erections all the time! This is generally not true for a man in his forties (as you may know only too well!)

man with hand in trousers because he has erectile dysfunctionAnd erection "difficulties" can be the result of normal ageing.

There are various effective ways to get aroused as you get older: for example, porn videos - perhaps because they provide longer lasting stimulation than porn mags - can be effective in stimulating arousal, but increased physical contact and foreplay between partners is usually needed.

Reduced libido, for example, can be the result of relationship difficulties, low testosterone levels due to getting older, the use of certain drugs, and so on. That's why I repeat the suggestion: see a good andrologist (that's a doctor who specializes in male sexuality).

Another age-related change is that the length of the refractory period (the time between an ejaculation and the next erection) increases as a man gets older. In young men it can be as little as thirty minutes or even less; in an eighty year old man, it can be as much as a week.

And once an older penis has got hard, it may not stay that way as it did in its owner's youth.

An older man's erection is all too easily lost if his mind starts to wander off the subject in hand (so to speak); worse yet, an older man's penis may occasionally go soft for no obvious reason whatsoever. Oh dear. Age does really wither us. 

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Pages On Male Sexual Dysfunction

Erection problems (Part 1)
Erection problems (Part 2)
Erection problems (Part 3)
How To Stop Premature Ejaculation Now
PE - suggestions from readers
Delayed ejaculation 1
Delayed ejaculation 2
Reflections On Delayed Ejaculation
Men's problems - a summary

But then again, so do many other things, and one of the most important factors in keeping your pecker up, if you will forgive the expression, is the ability to keep a cheerful state of mind in which you believe you will overcome all obstacles, regardless of how serious they seem!

But these changes are not all bad, believe it or not.

My own experience has been that my reduced sense of sexual urgency has allowed me to be more attentive to arousing my lover, to making sure she has enough time to get really turned on.

And her arousal feeds back to me, making me much more aroused, so that when we make love, the result is often a much more powerful orgasm than those I enjoyed in my youth - and it goes on for longer too.

(One important aspect of this keeping my PC muscle well trained. A weak PC muscle means a weak orgasm and a weak ejaculation. If you want to shower her with your stuff in your forties, you gotta do those Kegel exercises. Baffled by this? This link may explain everything!)

OK. So now you've ruled out the age related factors, you're near despair? Don't be, because these problems can be fixed.

Sometimes erectile problems are caused by leaking valves in the base of the penis, so that even when the blood flow increases into the erectile chambers of the penis, the outlet valves remain open and so the blood pressure can't build up.

Another possibility is that the arterioles supplying blood to the penis are blocked with cholesterol deposits.

Then there isn't enough blood coming in to produce an erection. In either case, surgery is not recommended, in the way it once was - the results are too unpredictable.

But the good news is that new drugs like Viagra and Cialis (which has fewer side effects and lasts longer) can really help - they are well worth trying. I've used them myself, and I'd recommend Cialis - it avoids the stuffy nose and blue tinge to the vision that Viagra can induce.

And in fact there are plenty of other ways of enjoying sexual connection....

By the way, hypertension (high blood pressure), diabetes and high cholesterol levels can produce sexual problems, so it's essential to get a complete check-up even if the problem seems to be located right in your genitals.

As much as a quarter of all erectile problems may be the side-effects of prescription medications - and even some over-the-counter products can affect erectile capacity. You can find a complete list here.

The American Association of Clinical Endocrinologists lists a number of factors that they believe must be taken into account when a patient comes for evaluation of sexual dysfunction:

  • marital status
  • length of relationship
  • health of partner
  • emotional closeness (how comfortable the couple are with each other)
  • similarity of views of the couple
  • level of commitment to each other
  • effectiveness of communication between the couple
  • need for stress therapy or relationship counseling
  • sexual history of the couple - e.g., is the man simply experiencing changes related to ageing?
  • blood chemistry, particularly a hormonal profile

Written by the same experts who constructed The-penis.com, there is text on ED treatments here. General guidance on sex and sexual relationships for couples can be found here: a sex guide for heterosexual couples.

There have been a whole variety of aids to overcome erectile dysfunction developed in the last few years, all designed to keep a man hard and erect, ranging from injections into the penis, through vacuum pumps with rubber rings around the base of the penis to keep the blood in it, through drugs inserted into the urethra, to the biggest one of all - the removal of the penis's natural internal erectile chambers and their replacement with steel or plastic rods.

I think a guy would have to be in a very bad way to have such drastic surgery, and the other treatments have pretty much been replaced by Viagra and Cialis.

But even with the assistance of these two excellent drugs, much can be done to reverse the process of erectile dysfunction by ensuring that you keep sexually active and follow some psychological principles about healthy relationships and sexual techniques.

The most common complaint about sexual dysfunction from men is only being able to achieve partial erections, or rapidly going soft after penetration.

But if erections occur during the night or early morning on awakening, the cause of your sexual difficulties may well be emotional or psychological. This may mean counseling or therapy can help address the psychological issues at work.

Erectile dysfunction

older man with erectile dysfunctionAs a man gets older it is only natural for his erection is to become less firm and occasionally to disappear completely during sexual activity. 

This change in erectile ability with age tends to be gradual and affects a man from his early 50s onwards.  Statistics show that at least one third of people in their 60s have sexual intercourse once a week or more. 

Many of these episodes of sexual intercourse will end without the man ejaculating - however, this can be seen as a normal age related change in sexual function, and not a sexual dysfunction.

The inability to get an erection - or full ED - can strike a man at any age from his 20s onwards. One episode of erectile failure is not unusual and can affect a man in many different circumstances; the usual cause of erectile failure is anxiety or stress, for example caused by the fear of being discovered having sexual relations, or the fear of getting the woman pregnant. 

Another common cause of erectile dysfunction is some issue of conflict with one's sexual partner. 

Particularly in young men erectile failure is often a good indication that they are not actually ready for sex or that they have an issue with their sexual partner usually that they don't want to be having intercourse with her) which is causing them stress and anxiety.

Even so, if a man fails to get an erection for the second time in sequence when he is having sexual intercourse he is likely to experience considerable anxiety around his impotence.

The problem is compounded by the fact that impotence or erectile dysfunction is very often seen as a shameful or secretive condition, which means that few men actually seek help for it; this is a shame since the cause of impotence is often completely curable. 

Lack of sexual information, embarrassment, stress or anxiety are all possible candidates to provoke sexual dysfunction of one kind or another.

Even when erectile dysfunction is related to a physical problem such as diabetes, the emotional issues associated with this can be dealt with and this often significantly resolves the erectile difficulties.

Erectile dysfunction and YOU, the man!

  • Most men experience erection problems in their lives because of alcohol, stress or mental problems. A problem once in a while is not a sign of long term problems or recurrent problems.

  • Physical health factors affect a man's ability to get and keep  an erection. You can lose erections just by worrying about your sexual ability - sexual performance anxiety.

  • Many men view erectile dysfunction as a real challenge to their self-esteem.

  • A man may have feelings of sexual inadequacy or sexual guilt because he no longer sees himself as a man. And erectile dysfunction can seem like the first sign of his physical decline toward maturity, old age and inevitable death.

  • Most men are reluctant to ask for help with erectile dysfunction. These false beliefs are all likely to affect a man's ability to get an erection, especially as he gets older:

  • Men should express feelings of warmth, love, intimacy and continue to maintain connection with a partner.
  • Intimate physical contact with a partner does not have to lead to sexual intercourse and if a couple can accept this, the pressure to get erect is reduced.

Treatment for erectile dysfunction

  • Yohimbine was once a useful first-line treatment for some men with erection problems. It helps about a fourth of all men but side effects include sweating, anxiety, a racing pulse.

  • Penile Injection Therapy, too, was once a very effective treatment for many men, and side effects were reduced with the mix of prostaglandin E-1.

  • Currently, Viagra or Cialis are more useful, more pleasant to take, and more acceptable to most men.

  • Devices that produce penile erection by vacuum suction are safe, effective, and economical.

  • In general, though, the most effective cures for ED are the psychologically based approaches, either behavior therapy or counseling and sexual psychotherapy.

  • Penile implants are a last resort, and should only be installed surgically when everything else has failed. 

Psychological issues that come up with erectile dysfunction

  • Relaxation helps the whole process of recovery from erectile dysfunction. The substitution of relaxation over anxiety about sexual performance helps to maintain an erection.

  • With erectile dysfunction, both members of the couple need to be considered. She may, for example, see her partner's erection failure as an emotional lie detector (if she believes he is having an affair, for example.)

  • Or she may see an erection as evidence her man loves her or desires her. If so, for her, the absence of his erection may seem to show he doesn't find her attractive. Then, erectile dysfunction can become a major issue really quickly.

  • A man who has an erection problem may feel ashamed, certainly embarrassed, probably "less of a man," and so he may withdraw from his partner.

  • With the lack of ability to get erect and sexually perform, he may have a drop in sexual desire or libido. This can escalate into a refusal to kiss, hold or even hug her; he may find reasons to avoid sexual encounters.

  • He may refuse to discuss the issue, believing it to be more of a character trait or personal failing, so his partner feels rejected, neglected, and undesirable - she may be filled with self-doubt and wonder about her own attractiveness.

  • A woman may think her partner does not care for her and come to the conclusion he is having an affair.  Or she may be afraid to bring up the subject and so each partner becomes more isolated and miserable.

  • Women whose partners have erection problems may feel feel inadequate. A woman may even blame herself and feel hurt and angry about her partner's physical and emotional withdrawal.

How does stress affect erectile dysfunction?

Stress is something you see as harmful or threatening, something which makes your flight or fight response kick off, and produce adrenaline - which is an erection inhibitor.

Continuing stress can cause the body to produce long-term stress hormones like cortisol, which are even more likely to inhibit erection. 

If you have a medical condition which interferes with your erectile capacity, that is even more likely to make your erection disappear: drugs used to deal with high blood pressure, sedatives, anti-acid medications like ranitidine, anti-depressants, tranquilizers, and some pain pills will all have a role in inhibiting erections.

Fortunately, the side effect of impotence is reversible when the dosage is altered, or a different medication is prescribed by the physician.

Medical conditions associated with impotence are diabetes, kidney and liver disease, some heart conditions and various surgical procedures such as cancer surgery of the bowel, bladder, and prostate gland.

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