What You Need To Know About Erectile Dysfunction

Definition of erectile dysfunction

Impotence, otherwise known as erectile dysfunction, ED or “erection problems” is a male sexual dysfunction which involves the inability to develop an erection firm enough to enable a man to enjoy sexual intercourse. It’s not necessarily a complete loss of erection, for it can involve partial loss of erection in certain situations. It also implies that under certain conditions and may lose his erections during sexual activity.

What you need to know about erection problems

It’s absolutely astonishing how common erection problems actually are. Loss of erection can occur under many different circumstances, the most common of which would be when a man is attempting to engage in sexual activity and experiences anxiety.

Video – what are erection problems?

If an erection problem is ongoing it certainly can damage a man’s sexual self-esteem and sexual self-confidence. It may also disrupt the fabric of his relationship with his partner, who may regard this problem as in some way reflecting his opinion of her desirability.

Even when there are obvious physical causes, the psychological contribution is profound. It isn’t just about circumstances in the relationship, nor is it just about stress or anxiety. It’s a combination of deep rooted feeling of sexual inadequacy and a physical problem in the body. It is identifying the problem in the body that is often the easy part of the solution (and treatment) for erectile dysfunction.

One key indicator of the cause of erectile failure is whether or not a man experiences erections during the night. These involuntary erections are a good indication of whether or not his body is capable of sustaining erection.

Fortunately it’s not difficult to check whether a man is experiencing firm erections during the night — the so-called nocturnal penile tumescence test involves placing a measuring device around this shaft of the penis and seeing if it expands in erection during the night. 

Ejaculation problems such as premature ejaculation or delays in ejaculating have only a very limited connection with erectile dysfunction. For example, premature ejaculation is sometimes closely associated with erectile dysfunction (read about that here), but the first is often contingent upon the second: the way it works is that a man realizes he’s losing his erection so unconsciously speeds up his arrival at orgasm and ejaculation for fear of coming too soon.

Causes of erection problems

As we’ve observed before, penile erection is a complicated process that requires the interaction of many different parts of the body, the nervous system, the circulatory system and the mind. Any interruption at any part of this rather complicated process can lead to significant difficulty in erection during sexual activity.

Main causes of ED below:

  • the most well-known condition that causes erectile failure is diabetes, but other conditions such as high blood pressure heart disease and neurological disorders can also be implicated. 
  • prescription medications including those issued for high BP – and in particular the beta-blockers – are implicated in erectile failure.
  • unfortunately for men who have prostate surgery, and for those who have pelvic injuries which required deep surgery, nerve damage during such surgery may be followed by erectile failure.
  • Smoking, drinking alcohol, and the use of illegal drugs such as cocaine
  • on the emotional side of things, poor communication within a relationship, lack of desire for your partner, emotional resentment, anger, depression, anxiety and a host of other stressful emotions and situations can cause erectile failure. There is a good book on the involvement of anxiety in the onset of erectile dysfunction here.
  • when bad feelings are repeatedly expressed within a relationship, as measured by the proportion of negative talk between partners compared to the proportion of positive and reinforcing talk between partners, this can accentuate erectile problems.
  • Spinal cord injury is a major cause of erectile failure although an involuntary erection may still be possible for a man who is paraplegic.
  • in simple terms the emotions that cause erectile failure are anxiety stress anger and depression. Also, sexual guilt is a major contributor to ED.
  • and finally for those men who have high sexual performance standards, or whose view of sex is governed by the view that the man must perform, give the woman an orgasm, satisfy the woman at all times, and only then take pleasure, anxiety about being good enough lover can often produce erection difficulties.

It is true that erection problems become more common as a man gets older. However, problems can strike a man at any age: the physically-based problems are more common in older men, and the emotional/psychologically-based problems or more common in younger men.

If you are a man who is experiencing erectile failure or complete ED then the first thing to do is to check out your lifestyle. For example are you consuming large quantities of alcohol, are you smoking, or are you taking illegal drugs? 

It’s worth mentioning at this point that good communication between the partners in an committed relationship is absolutely essential. You have several alternatives that you can take up here: one is counseling or therapy.

What to Expect If You Visit The Doctor With Concerns About Your Erection

In general the doctor will perform several examinations which include checks on blood circulation, a penile examination, perhaps some kind of nerve function tests, and possibly a prostate examination.

He may also run tests for hormone levels and cholesterol levels in your blood to ensure that there isn’t a circulatory issue affecting your penis. In addition he will ask questions about your erectile failure which might include, for example: have you been able to achieve erections in the past? How long has the difficulty been present? Do you experience nocturnal erections or emissions? what are your energy levels? Are you anxious about sexual activity because of your erectile failure? Have there been any recent changes in your relationship, sexual activity, life changes, health, energy levels, stress levels? Have you recently had surgery, any treatments for your circulation system, your heart, your kidneys or any other aspect of your well-being? Do you have other symptoms? Do you have problems urinating?

You may find that the doctor orders a series of tests which will include blood tests, hormone profiles, cholesterol profiles, prostate specific antigen (PSA), erection rigidity monitoring, stress tests and so on.

The treatment of erection problems

This all depends on the cause. If your difficulty is caused by some kind of hormonal imbalance, then whatever underlying endocrine disorder exists must be treated first. If you have an abnormality of the penis such as Peyronie’s disease, then then this may need treating first. And if you’re a heavy smoker, drinker, or eat excessively, then you will need to make some lifestyle changes before you start addressing the issue of your erectile dysfunction.

The treatment of Eerectile dysfunction in recent times has been revolutionized by the advent of new treatment options. Viagra and its associated compounds are highly effective treatments which work for a large percentage of men with erectile dysfunction. (Men for whom these drugs do not work may wish to consider addressing the emotional/psychological aspects of their relationship and the emotional issues that may be causing them difficulty in achieving and sustaining erection.) 

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are not aphrodisiacs. That is to say they do not promote sexual desire, they only work to stimulate rigidity of the penis in a man who is already aroused. They do have side effects which can be disturbing if you are not aware of them in advance: these include flushing of the face, a blueish tinge to your vision, and they need to be avoided if you are taking certain types of heart medication. For example when taken with nitroglycerin they can lead to a dangerous fall in blood pressure.

The contraindications for PDE5 use include any of the following medical conditions (Subject to medical advice):

  • stroke
  • moderate to severe heart disease including unstable angina, cardiac arrhythmia or a recent heart attack
  • heart failure
  • hypertension (high blood pressure)
  • diabetes
  • low blood pressure (hypotension)

One of the best combinations of medication for erectile dysfunction is testosterone replacement therapy and Viagra. This works for men who are experiencing a drop in hormone levels due to the mid-life andropause.

Viagra for Treatment of Erectile Dysfunction

What is Viagra?

Viagra (sildenafil citrate) is a drug formulated by Pfizer Pharmaceuticals. It was the first drug approved for treatment of erectile dysfunction and was approved for sale in March 1998. It was developed by Pfizer as a drug which was designed to help men experiencing chest pain. That was aborted in 1992 because it did not show any promising signs of effectiveness as a heart medication. However, ancedotal information about the effects of sildenafil citrate caused Pfizer researchers to consider it as a treatment for erectile dysfunction. When re-evaluated as a treatment for erectile dysfunction it showed considerable promise: studies on more than 3500 men aged between 19 and 87 years have demonstrated that Viagra works effectively in a number of conditions associated with erectile dysfunction including:

  • diabetes
  • injury to the spinal cord
  • prostate surgery
  • unknown cause
  • hypertension and coronary artery disease

Viagra was so effective that the FDA approved the drug only six months after submission, because there were no issues of any significance, including adverse side-effects associated with it. (Although we know that Viagra must not be taken with various heart medications, with which it can interact adversely.)

When taking Viagra

The data from the clinical trials and experience over ten years indicated that Viagra is a very effective treatment for ED: however, if you are considering using Viagra then it is important to emphasize that there are some men who do not respond to it, and it does not increase libido or sexual desire.  This is because it works on the physical response to nerve impulses produced by sexual arousal in mind or body.

General precautions before taking Viagra should be observed as follows:

  • anyone taking nitrates, such as nitroglycerin, must not use Viagra. These compounds in combination can lower blood pressure too far.
  • Viagra is only suitable for use by adult men.
  • the use of Viagra shows be preceded by a complete medical examination.
  • any man at risk of priapism or sustained erection (for example men with conditions such as sickle cell anemia, leukemia or multiple myeloma), or a man who has any penile abnormality should not take Viagra.
  • you need to be aware that medications can interact with Viagra and therefore should consult your doctor about any existing prescriptions that you are using.
  • Viagra Should not be used in combination with any other form of treatment for ED.

What are the side effects of Viagra?

Viagra has been found to have the following side effects in the clinical studies referred to above:

  • headache – 16 percent
  • flushing – 10 percent
  • indigestion – 7 percent
  • nasal congestion – 3 percent
  • urinary tract infection – 3 percent
  • less than three percent:
  • mild and temporary visual changes (blue/green color perception changes and/or blurred vision), with possibly increased sensitivity to light
  • diarrhea
  • dizziness
  • rash
  • other side-effects included respiratory tract infection, back pain, flu and joint pain

Side effects that occurred less than 2 percent included respiratory tract infection, back pain, flu syndrome, and arthralgia (joint pain).