Erectile dysfunction

Erection Problems / Erectile Dysfunction

Most men seem to have trouble getting hard from time to time.

Believe it or not, the “official” statistics say an episode of erectile dysfunction occurs once 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 lost my erection during sex, 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 another 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.

Read more about erectile dysfunction here.

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 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!

B ut 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.

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. 

By the way hypertension, diabetes and high cholesterol levels can produce sexual problems, so it’s a good ideal to get a complete check-up even if the problem seems to be firmly 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.

The AACE 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

There is a book on ED treatments here. 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 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.

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.

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.

Erectile dysfunction

As 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 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 psychological.  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.

Top of the list of therapy strategies for a cure for erectile dysfunction are: constructive discussion with a partner; enhancing communication and knowledge about the condition; performing an accurate diagnosis of both the physical factors involved and emotional factors involved; assessing various treatment alternatives for erectile dysfunction, together with the risks and expected outcomes of each course of treatment; assisting a man to make a plan for his sexual and emotional recovery from erectile dysfunction; and continuing support for any ongoing issues.

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. If you or your partner have a  sexual problem, successful treatment is readily available.

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 shouldn’t express feelings of warmth, love, intimacy or some other “feminine” feelings. Sex is a performance which a man must orchestrate; and of course he is always able and ready to have intercourse.

All intimate physical contact must inevitably lead to sexual intercourse. Naturally, a man must have an erection and it ends in an orgasm…..and so on. These are all false beliefs. 

Symptoms of erectile dysfunction and sexual maturity in men

A longer time to reach an erection, and once obtained, the erection is less firm than previously; a less strong ejaculation than when he was younger; a decrease in volume of semen; erection being lost more quickly after orgasm – or even before orgasm; an increase in the refractory period;

Diagnosis of erectile dysfunction


Assessing sensitivity and nerve function is done by pinprick testing for sensitivity and testing reflexes; blood flow is checked with pulse and penile blood pressure assessment; hormonal status by checking testicle size; prostate through a prostate exam

There will also be blood tests for hormone levels, thyroid function, diabetes and cholesterol level. There may be a stress questionnaire and a simple snap gauge to check for erections during the night.

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; side effects include sweating, anxiety, a racing pulse.  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 is 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 erectile dysfunction 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 approaches to dealing 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. Among the effects of erectile dysfunction, the needs of the partner must be considered.

Women will have questions and insecurities, and a need for information and reassurance. She must have her anxieties and concerns addressed.

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 “All men are always ready for it”.)

She may see an erection as evidence her man loves her or desires her. If so, the absence of his erection means he doesn’t find her attractive.

An erectile dysfunction problem can become a major communication issue really quickly.

A man has an erection problem; he feels 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.

She may think her partner does not care for her and come to the conclusion he is having an affair.

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.

What causes an erection?

An erection is caused to develop when the arteries of the penis open up when smooth muscles in the walls of the blood vessels relax. The swelling constricts the veins which drain blood from the penis; they stop blood from escaping.

Clearly, the arterioles which supply the penis must be adequate, and the veins of his penis must not leak. Also, the nerves which coordinate the increase in blood pressure in the penis must function perfectly, and the man must have enough testosterone to feel sexual desire and  get an erection.

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.