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The American Association of Clinical Endocrinologists has put together some guidelines for the treatment of sexual dysfunction, and this page is based on that document. Sexual dysfunction includes erection problems (also known as "erectile dysfunction"), impotence, premature ejaculation, inability to ejaculate during sex, and low libido (sex drive). Now, I've only had an episode of erectile dysfunction once in my life, though I think this may be a bit unusual. Most men seem to have trouble getting their cock hard from time to time - believe it or not, the "official" statistics say on average there's a soft penis problem once in every five times people make love. I can't say I believe that; at least from my own experience it certainly seems unlikely. But there are two issues to separate here - the time I had a soft penis and a waiting woman with a juicy vagina, it was because we were in a semi-public place, and I thought someone was watching us: this was more than enough to kill the excitement, and, try as I might, I couldn't get an erection. But most men who have a problem getting hard will be experiencing this because they are either getting older and their testosterone level is dropping, or they have a physical problem such as diabetes, or they are in some emotional distress, such as being depressed, or they are in a relationship they don't want to be in, or....well, you get the idea, I'm sure: there are many possible causes of erection problems. And the same is true of reduced libido, a lack of sexual energy, and of the unusual problem of not being able to ejaculate during sex. Premature ejaculation, by contrast, usually involves too much testosterone and a horny young man! So let's start with the low testosterone issue. It's a fact that men's testosterone goes down as they get older (by about 1.2% per year), and this has some part to play in erection problems and low sex drive. I have several older friends who are on testosterone replacement therapy, and I recommend any man who thinks his problems may be due to hormonal issues to get a check up with a good endocrinologist or andrologist (a nice word for a male hormone specialist). At the very least, read this book: Maximizing Manhood by Dr Malcolm Carruthers. It's true to say that testosterone replacement therapy is very controversial. But for some men at least it appears to be a godsend: that is, for those men who instead of experiencing the more normal slow decline of testosterone as time goes by, have a sudden drop around their late thirties to mid forties. These men find their whole sexual life changes in a very short space of time, and they usually do not understand what is happening to them physically or emotionally as they experience symptoms very like those of the female menopause. There's a lot of information on this, so I won't repeat it here. For effective treatment, though, all the various aspects of a man's condition must be identified and then sorted out as a collection of symptoms. Reduced libido, for example, can be the result of relationship difficulties, low testosterone levels, 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). 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 I know only too well!). Thus, 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. 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. 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 to a really turned on place. And her arousal feeds back to me, making me much more randy, 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. Instead, there are new drugs like Viagra and Cialis (which has fewer side effects and lasts longer). These options 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. By the way, without meaning to depress you any further, I should add that hypertension, 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 firmly (or, I suppose, softly) 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 of the offending products on the AACE website. Go here to get it. The AACE lists a number of factors that they believe must be taken into account when a patient comes for evaluation of sexual dysfunction:
The most common complaint about erectile dysfunction is only being able to achieve partial erections, or rapidly going soft after penetration. Men who have had a problem for a long time need counseling or therapy because they have more psychological changes to address. If erections occur during the night or early morning on awakening, the cause of sexual difficulties may well be psychological. There have been a whole variety of aids 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 suppositories 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. For more information on erectile dysfunction see one of these excellent websites which deal with erectile dysfunction treatments and ways to cure erection problems. |
