| by
Mikayla
Erectile
dysfunction, or ED (sometimes called ‘impotence’)
is a problem that MILLIONS of men face every day. In fact,
the most conservative estimate given by the National Ambulatory
Medical Care Survey (NAMCS) “for every 1,000 men in
the United States, 7.7 physician office visits were made for
ED in 1985. By 1999, that rate had nearly tripled to 22.3.
The increase happened gradually, presumably as treatments
such as vacuum devices and injectable drugs became more widely
available and discussing erectile function became accepted.
Perhaps the most publicized advance was the introduction of
the oral drug sildenafil citrate (Viagra) in March 1998. NAMCS
data on new drugs show an estimated 2.6 million mentions of
Viagra at physician office visits in 1999, and one-third of
those mentions occurred during visits for a diagnosis other
than ED” (National Kidney and Urological Disease Center).
These men range in age from very young (18 or so) to older
men. While older men are plagued with this disorder more often
than younger men, some of the causes of ED can strike any
age man – at any time. If you are a man who is dealing
with unreliable erections or a woman whose partner is –
this article may help to shed some light on a very personal
– and oftentimes embarrassing - situation.
WHAT, EXACTLY, IS ED?
It is probably important to differentiate the difference between
ED and impotence. Impotence is a wider term that describes
all types of failure to get or keep an erection – but
seems to be more closely linked to certain psychological or
severe medical reasons. ED can also be caused by many different
causes – medical and psychological – but it is
‘dysfunction’ and impotence is often looked at
as a “no hope” type term. In this article, I will
discuss ED only.
ED is basically a range of penile issues: the total inability
to achieve erection, an inconsistent ability to achieve an
erection, or serious problems sustaining erections. In older
men, the cause can be physical – such as cancer or other
diseases, injury or most commonly, side affects from medications
such as blood pressure or blood thinning medications, antihistamines,
antidepressants, tranquilizers, appetite suppressants, and
cimetidine (an ulcer drug).
While this is not an inevitable part of growing older, the
incidence does increase from 5% of 40-year-old men to between
15 – 25% of 65 year old men. (NKUDC).
To understand the effects of ED, one must completely comprehend
the way the penis becomes erect. It is basically a blood flow
issue. Ok, time for Biology 101 (or maybe 401). The penis
contains two chambers called the corpora cavernosa, which
run the length of the penis. A spongy tissue fills the chambers.
The corpora cavernosa are surrounded by a membrane, called
the tunica albuginea. The spongy tissue contains smooth muscles,
fibrous tissues, spaces, veins, and arteries. The urethra,
which is the channel for urine and ejaculate, runs along the
underside of the corpora cavernosa and is surrounded by the
corpus spongiosum.
When a man becomes stimulated or aroused, the brain sends
impulses to the nerves in the penis and this allows the muscles
of the corpora cavernosa to relax, allowing blood to flow
in and fill the spaces. The blood creates pressure in the
corpora cavernosa, making the penis expand. This blood gets
trapped by the tunica albuginea, thereby sustaining erection.
Now, when these muscles fail to contract and stop the blood
from flowing OUT of the penis, an erection becomes weaker
or is gone all together.
To better understand this complex process, I have borrowed
a detailed picture from the NKUDC website:
This process is extremely precise and there are a lot of areas
that are sensitive to failure. If any single event is disrupted
due to injury, psychological block, or medical condition,
ED occurs. For example, as aging occurs, nerve damage also
can happen – this results in the most common reason
for ED. Diabetes, Kidney Disease, Heart Disease, alcoholism,
low testosterone levels, MS, smoking, being overweight, not
exercising or a number of vascular disorders can happen to
any age male and cause ED. Diabetes is the number one cause
of ED in males 35 to 50.
CAN IT BE ALL IN MY MIND?
The biggest non-medical cause for ED is psychological issues.
The mind is a powerful tool – and while a man’s
mind helps to get him aroused (through visual stimulation)
his mind can also be the downfall of his erection. Any number
of psychological factors – stress, anxiety, guilt, depression,
low self-esteem or the fear of constant sexual failure –
can ruin a man’s chance of achieving or keeping an erection.
It is estimated that between 10-20% of all cases are due to
such factors (NKUDC).
The issue with these psychological factors is that they create
a dangerous circle of failure. ALL MEN at one time or another
(ALL MEN) will have erectile difficulties. It is when those
difficulties continue that there is a cause for worry. When
a man has an occasional erectile issue, he may immediately
panic. Thinking to himself, “Oh my GOD, what happened?
I was attracted to her, I was excited, what happened to my
penis!” Then, this cycle ruins chances to achieve or
keep an erection the next time he wants to have sex. Then,
he begins to avoid sex all together to avoid the humiliation
he feels. His partner gets mad, upset, worried or just plain
accuses him of certain things – like cheating or being
homosexual. This starts a very, very bad cycle of ups and
downs and often leads to depression or even dissolution of
marriage!
That is why is you are having constant erection issues you
NEED to be honest with your partner. You have to tell her
that this is happening so that she can be a support system
for you and not worry that it is her. For you women who have
partners going through this – be patient, be understanding,
be kind. Help urge him to the doctor or, if need be, the psychologist,
and find out what is behind his issues. Not every man has
to have a raging hard-on 24/7 and there are plenty of other
ways to stimulate each other – this will be discussed
later.
The mind can be so powerful in a situation such as this as
a man may avoid sex all together. One of the worst psychological
games that happens with ED is that oftentimes, a man is able
to get an erection, keep and erection and orgasm easily during
masturbation. This is because there is no pressure to perform
with solo play. The man is free to do it how he wants it –
fast, slow – and climax. This adds to the psychological
issues and often causes the man to wonder why he can not perform
in bed. He feels like he is loosing his “manliness”
and is confused by the ability to perform alone but not with
partner. This is a bad cycle to get into.
Furthermore, stress can be such an important factor in ED.
Finding ways to distress in a situation that obviously causes
an extreme amount of stress can be tantamount! Contemplate
Yoga or relaxation techniques; evaluate your life stress levels
from your job, family, children or money issues. Try to separate
this life from your sex life. It can take a powerful mind
to overcome the normal life stresses that we as humans experience
everyday!
HOW TO GET HELP!
STEP ONE – GO TO THE DOCTOR: Once you
know that your erectile difficulties are NOT just an infrequent
issue caused by momentary stress, too much alcohol consumption,
or just a fleeting moment – you NEED to seek help. There
are no doctors who have not heard this same scenario from
at least a couple handfuls of patients – do NOT be embarrassed!
The last thing you want or need is to have a serious medical
condition – like diabetes – that will go unnoticed
or treated.
STEP TWO – TESTING: Your Doctor will
take a personal history from you, check the normal vital signs,
ask about the particulars of your ED, and then order tests.
More often than not he will begin with blood tests that reveal
early diabetic signs, testosterone levels, and blood count.
If these tests come back normal – then there may be
another step.
If these tests come back abnormal (i.e. high blood sugar)
the doctor will suggest some lifestyle changes, dietary changes
or suggest you stop smoking. Then it will be a touch and go
process to see how these changes have helped your ED.
STEP THREE - UROLOGIST: More evasive testing,
or referral to a urologist, may be needed. An ultrasound or
scan (MRI) of your penis can indicate any blood flow issues,
nerve damage or other obstructions that may not be readily
felt. In some cases, nocturnal erections are monitored to
see if these are still developing normally. All these tests
help the doctor to find answers.
STEP FOUR – PSYCHOLOGICAL PROFILE:
If the above tests do not reveal an underlying cause, the
doctor may at this time refer you to a psychologist or psychiatrist.
This specialist can ask questions and come up with ideas as
to what psychological issues are causing the ED. Oftentimes,
it is simply stress or a severe fear of failure that comes
up and prevents the erections. These doctors are great at
determining underlying causes.
SOLUTIONS, IDEAS AND GETTING BETTER
Of course, depending on the reasons for your ED, help can
be easy, hard or require more drastic measures. As aforementioned,
one of the easiest ways to help ED in patients with mild issues
is lifestyle changes. Loosing weight, exercise, stop smoking,
stop drinking, change in diet – all of these can help
in those patients who have a mild, physical reason for the
ED. The doctor will give specifics for helping to achieve
a healthier lifestyle – which may include changing medications
that have ED as a side affect.
If there is a more serious medical issue – such as a
blood flow issue, nerve damage or other penile injury –
the solution may be as simple as using an erection enhancement
product such as Cialis® or Viagra® to help maintain
blood flow. These medications make the blood flow stronger
– as to overcome the leakage that happens with valve
issues.
Some doctors even suggest using a vacuum pump (penis pump)
to help achieve a stronger erection. While the penis pump
may work for that short session, pumps in general are not
always successful for long term treatments.
The most invasive and complicated treatment is when a doctor
suggests surgical treatment. There are a range of procedures
from repairing broken blood valves or blocking off valves
that enable blood to flow out of the penis, to inserting penile
implants that allow the man to “pump” up his erection
from inside. These procedures are drastic and oftentimes do
not offer long term help. Undertaking this kind of procedure
takes a lot of thought on the part of the man.
Finally, if the reason for the ED is found to be psychological,
the treatment is not quite so swift. Oftentimes, the doctor
will supplement the psychotherapy with an ED drug, to help
the patient get his confidence back. The doctor will also
suggest the patient tell his partner what he is experiencing
and may further suggest couple’s counseling. It is essential
that the patient’s partner understand and help with
his treatment. This includes understanding those times when
erection just isn’t happening and not judging or getting
mad at him. This is EXTREMELY hard to do, especially if the
woman has self-esteem issues herself.
HELP FOR ALL
No matter what the underlying cause of ED are, being positive
about the situation (no matter how hard) can be the biggest
benefit. Finding other ways to pleasure your partner is one
of the essential ways to overcome the fear of ED. Knowing
that oral sex, manual stimulation, or mutual masturbation
can be as fulfilling – or more so – than actual
intercourse can greatly take the stress off the situation.
There are many books available on the subject – that
I will list at the end of this article – that can help
to get a couple more intimately connected. For example, having
“touching nights” where there is no sex, just
touching. Even if the man gets aroused – no sex! This
completely takes the stress out of the situation and helps
the man see his natural reaction. Futhermore, if a couple
finds themselves in an intimate moment and are trying to have
sex but the ED rears its ugly head, the woman has to be able
to say “that’s OK” and suggest her partner
watch her masturbate or use his fingers or mouth to get her
to climax. This allows the man to feel like he is doing his
“job” and helps the couple to be intimate together.
There are also great suggestions for regaining intimacy by
using Tantric sex. In fact, Tantric Sex offers an “erection
free” way to make love that concentrates on being close
together and feeling each other’s energy source. Some
swear that the most intense orgasms for both partners need
not include an erection!
While these are just a few of the ideas and suggestions –
there are many more to be found. Reading about the subject
or talking to a profession can be the first way to help fix
the issues. ED is a bad experience at any point in life –
but it does NOT have to be the end of your sex life! Learning
why this happens, what you can do to regain control of it,
and how your partner can support you and still be intimate
with you are essential elements of regaining control.
So, if you are a man (or are with a man) who is experiencing
ED, please help yourself by not ignoring the problem. Seek
professional help, get the information you need, and make
choices on treatment. You do NOT have to suffer with an infrequent
sex life – or no sex life at all – if you are
willing to talk about the issues you are having. Take comfort
in the fact that millions – yes MILLIONS – of
men have this condition and that you are not alone in your
suffering! Take back your sex life and please get the help
you need!
Diagram and information for this article taken from:
National Kidney and Urologic Diseases Information Clearinghouse
Website
http://kidney.niddk.nih.gov/kudiseases/pubs/impotence/
For more information, go to:
American Urological Association (AUA)
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1–866–RING–AUA (746–4282) or
410–689–3700
Email: aua@auanet.org
Internet: www.auanet.org
www.urologyhealth.org
AUA
can refer you to a urologist in your area.
American Diabetes Association (ADA)
Attn: National Call Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–DIABETES (342–2383)
Internet: www.diabetes.org
ADA
can help you find a doctor who specializes in diabetes care
in your area.
American Association of Sex Educators, Counselors, and Therapists
(AASECT)
P.O. Box 1960
Ashland, VA 2 (Au3005–1960
Phone: 804–752–0026
Fax: 804–752–0056
Internet: www.aasect.org
Books
you may find helpful:
Coping With Erectile Dysfunction: How to Regain Confidence
and Enjoy Great Sex
by Michael E., Ph.D. Metz and Barry W., Ph.D. McCarthy
An Atlas of Erectile Dysfunction
by Roger S. Kirby
Rekindling Desire: A Step by Step Program to Help Low-Sex
and No-Sex Marriages
by Barry W. McCarthy and Emily J. McCarthy
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