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
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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 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. Furthermore, 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
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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