Erectile Problems and Erectile Dysfunction (ED)
Since the advent of Viagra in 1998, the topic of erectile dysfunction (ED) has received a great deal of media attention. With all that exposure, it may be no surprise that men and their partners sometimes worry when a guy can't get or maintain his erection. Some think that a man's sexual excitement and attraction to his partner can be measured by the strength and frequency of his erection, but that is rarely the case. Partners may take it personally when a man has erectile problems, and men may feel embarrassed or ashamed if they're not able to get an erection on demand. Erections are typically not under a man's control, however—and just about every man will experience trouble achieving or maintaining an erection at some point in his life. The vast majority of the time, erectile problems have nothing to do with a man's lack of arousal or his attraction to a partner.
A man's ability to get or keep an erection may be influenced by a variety of factors including his physical health, his psychological health and also what's going on in and outside the bedroom—whether at work or at home. Hormones, stress, fatigue, performance anxiety, health problems, medication side effects, relationship issues, alcohol and drugs can all affect a man's erections. Like any sexual problem, good communication is a major part of addressing the issue. If approached with an open mind, issues with erectile ability can be an opportunity to start a sexual dialogue and bring a couple closer together by talking about fears and concerns, getting healthy and expanding an often intercourse-focused sexual repertoire to include a wider range of pleasurable sexual activities. A change in erectile function, whether once or as an ongoing issue, does not signal doom for a man, his partner or their relationship. It is a natural part of sex that nearly everyone will experience at one time or another.
Fortunately, there's a lot of great help available that promises relief to men and their partners, encouraging them to approach ED as a learning experience.
Table of Contents
- What happens during an erection.
- What can interfere with erectile function.
- Erectile problems vs. erectile dysfunction (ED).
- How to decipher if the cause is physical or psychological.
- What type of expert to see for help.
- Why not to take a partner's erectile problems personally.
- Erectile function and alcohol.
- When condoms interfere with erectile function.
- Penile Implants
An erection can occur in response to physical, mental or emotional stimulation; however, young boys and men may get erections for no readily identifiable reason. Physical causes of an erection include a partner's touch, masturbation, or some other type of contact with the penis or other part of the body. Mental and emotional causes of an erection may include fantasy, thoughts about a partner, pornography or simply gazing at a sexy billboard. Virtually anything can provide emotional fuel for an erection, depending on what a guy finds arousing.
Whatever the cause, once stimulated a man's nervous system sends a flurry of signals to trigger the release of nitric oxide, which relaxes the smooth muscle lining of the penis. The spongy tissues in the penis, the corpora cavernosa and the corpus spongiosum, expand and fill with blood, as blood flow to the genitals increases with sexual arousal. Another structure, the tunica albuginea, prevents blood from flowing out of the penis. As the tissues grow and continue filling with blood, so does the penis, swelling and becoming hard (thanks to the pressure created by a good deal of blood flowing into the penis, and very little flowing out of the penis)—thus becoming what we call an erection.
When erection ability fails or begins to decline, many men and women are all too quick to take it personally or worry that an erection problem means that sex has to end. Not so! The truth is, an erection is the result of an intricate dance between the brain, the nervous system, a man's emotions, and the body's network of blood vessels. As soon as one gets off balance, the whole dance can be affected. Just about anything that interferes with brain function, nerve function or blood flow can lead to trouble with erectile function.
Perhaps the most common cause of erectile problems—at least among young, healthy men—is performance anxiety. Many cultures place pressure on men to be the "experts" when it comes to sex, which can make men feel like they have to be responsive for sex or know how to please their partner every time. This pressure can be stressful and make it more difficult to get or maintain an erection.
Health issues can also cause erectile problems, particularly among middle-aged and older men (though health-related erectile issues can occur at any age). Common age-related health conditions such as high blood pressure, diabetes and prostate cancer can interfere with erectile function, as can the medications and procedures used to treat them. High blood pressure and heart disease often limit blood flow to the penis. Diabetes, if left untreated, can cause nerve damage, making adequate physical stimulation of the penis more challenging. Surgery for prostate cancer can affect blood flow and the mechanics of erectile function. Hormonal disorders that interfere with testosterone production and a variety of other health conditions also can be the culprit, which is one reason it's important to get checked out by a physician. Recent studies have found that difficulty getting or maintaining an erection might be an early sign of heart disease. Lifestyle choices can affect erectile function, too, mainly by interfering with blood flow to the penis. Excess weight, a lack of exercise, poor eating habits, cigarette smoking, and alcohol and drug use can all contribute to erectile problems. Often, treating the underlying physical problem goes a long way towards resolving erectile problems.
While the majority of erectile problems are related to performance anxiety or a man's physical health, other psychological factors can be at work, too. Depression, stress, grief, anxiety, and fear or guilt about sex all can cause erectile problems, as can relationship problems. ED medications are effective for about 70 percent of men overall, and for fewer men with certain medical conditions, such as diabetes. The mind and the relationship often need attention, too, especially if erectile problems prove psychological in nature or if they've affected a couple's relationship, as they commonly do.
We'll say it here: Erectile problems happen, and they happen more often than we usually talk about. Just about every man will experience the occasional problem getting or maintaining an erection. In many cases, it is a fleeting, situational event that shouldn't be cause for concern, and doesn't indicate a lack of attraction to a partner or loss of sexual function. In other cases, erection problems may signal a health problem—why ongoing erection problems should always be brought to the attention of a health care provider. Ongoing erectile problems can damage a man's self-esteem, his partner's self-esteem and the relationship—particularly if they don't talk about the issue together, leaving each of them alone to wonder what they might be doing wrong. Discuss sexual problems with each other so they don't turn into larger issues.
Erectile problems that happen every now and then are not a problem, unless the couple considers it a problem. Erectile problems that happen in more than 25 percent of sexual encounters over a period of time may be considered erectile dysfunction (ED), though healthcare providers typically ask men a range of questions and may perform tests to rule out health conditions before making such a diagnosis. As with any sexual function complaint, ED is not a problem unless a man or his partner considers it to be. However, because of the association between ED and heart disease, a man should always tell his health care provider about erectile problems so that they can rule out other health conditions.
When dealing with erectile problems or erectile dysfunction the cause may not be clear. However, there are some basic ways to gain a better sense of what might he might be experiencing. To do this, a man can think about how his body responds in various situations.
The first assignment is to assess what medications a man is taking that may interfere with his sexual functioning.
The second assignment is to take note if he has an erection during the night or upon awakening. This body response is known as nocturnal penile tumescence and can indicate that he's able to have an erection. If a guy isn't sure, he can wrap a very thin and narrow piece of tissue paper around his flaccid penis, secured with a little bit of scotch tape. It's likely that if he has an erection when he's sleeping the paper will break to some degree. If a guy easily gets an erection during sleep, but not in other situations, the cause is likely psychological. If however, he can't tell or an erection isn't happening, the reason is likely physical.
The third assignment is for a man to consider his experience with masturbation. If a guy can get aroused when he's alone and not when he's with a partner, the cause is psychological.
While these are only three basic facets of physical and psychological causes they can help determine what type of expert to contact in an effort to understand what is going on and who to see for help.
It can take a lot of courage to seek help for erectile issues. Some men may get help on their own, and others may go with their partner for support and to work through the issue together.
If a man thinks something may physically be wrong, it can be helpful to see a doctor. Making an appointment to see a urologist to do some general tests can help narrow down or rule out the cause.
If the cause may be psychological in nature, it's helpful to see a sex counselor or sex therapist. In general, sex counselors and sex therapists tend to get specific training about sexual issues that sabotage sexual satisfaction, like erectile issues. It is important to find a counselor or therapist who is certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). As, experts with this certification have had training related to both relationship issues and sexual concerns.
A sex coach can also help individuals and couples. They tend to work on issues in the present, and through communication and home activities help get to the root of the issue providing education, support and guidance for an individual or couple to set and reach their goals. In regard to erectile issues, when the cause is not deeply psychological in nature, coaching can be helpful. Since many people can call themselves a "coach," it is best to find one that has a graduate or doctoral degree in human sexuality and certification from AASECT as a sexuality educator, counselor or therapist.
Following is a quick reference guide for the various academic degrees and licenses a mental health professional might obtain:
- Psychologist: Usually has a PhD, PsyD or EdD in psychology or other mental health specialty.
- Social Worker: An MSW pr PhD in social work.
- Counselor/Therapist: An MA or MS in clinical psychology, counseling, mental health, or sexology.
- Psychiatrist: An MD in psychiatry, generally licensed to prescribe medication. Some, not all, psychiatrists are trained to provide therapy, in addition to prescribing medication. Many people see a psychiatrist in conjunction with a therapist.
- Sex coach: Ideally have a M.A., M.S., or Ph.D. in human sexuality.
Problems achieving or maintaining an erection during sex can be as difficult for a man's partner as it is for him. Some worry that a partner's erectile problems are a sign of inadequacy on their part. They may worry that the sex isn't good enough, they're not attractive enough, that their partner has lost interest in them or is cheating on them. Both partners may feel awkward and insecure, and unsure what to do when erectile ability fails. Erections and arousal do not necessarily go hand-in-hand, however; men don't have complete control over their penises or their erections. A man may be turned on and want to get an erection, but can't. Numerous factors may be the culprit—physical, psychological and otherwise.
It can be helpful for both partners to avoid jumping to conclusions, especially if they've never had this problem before. The fact is, some cases of erectile problems have a physical health component. Men also suffer from the same sense of pressure to measure up in bed that women do and, sometimes, this pressure can interfere with erectile function. So can what's going on outside the bedroom, whether it be financial worries, a long day at work or simple exhaustion. So don't sweat it. Move on to other enjoyable activities (such as kissing, breast stimulation, sensual massage, oral play) or call it a night. If problems with erections become chronic, then it's important to start talking about it and make a visit to a health care provider.
A couple of drinks can loosen inhibitions, allowing people to explore their sexuality in a relaxed manner. However, alcohol can also impair sexual functioning. Alcohol is a depressant. It works on the nervous system by slowing down brain function, breathing and pulse. The effect is often psychologically stimulating, since emotions and desires flow more freely. However, while alcohol may boost sexual desire by helping a person to relax, it can decrease performance, especially where erections are concerned.
During a typical erection, blood flows to the penis where more of it stays in than is released. Alcohol works to dilate blood vessels in the body, including in the penis. As a result, blood vessels in the penis stay open, blood flows out and the penis does not become rigid or achieves some degree of hardness but has difficulty staying firm. Limit alcohol intake to 1-2 drinks (or none at all) for optimal sexual function. Alcohol consumption that regularly interferes with sexual function may be a sign of a problem; counseling or therapy may be useful.
Many guys have problems maintaining an erection when putting on a condom. The interruption of sex play is often distracting, as is the stress of putting on a condom. Other times, deeper concerns, like guilt or performance anxiety, manage to seep into a guy's consciousness when there's a pause in sexual activity.
It's often helpful to incorporate putting on a condom as part of sex play—what some people refer to as "eroticizing" condom use. A partner can continue rubbing or stimulating a guy in other ways while he puts on the condom, instead of both people stopping and focusing on the condom. Or, let a partner put on the condom, using the hands or the mouth, to keep the stimulation and the sexual rhythm going. Adding some store-bought lubricant to the outside of the condom, after it is already on and completely rolled down the penis, can also help to increase a man's sensation, which may help him to keep his erection.
Men who complain that they can't maintain an erection during intercourse because of a condom, which often reduces sensitivity, can try a thinner latex condom, like the Kimono brand, or a condom that properly fits the size of their penis. Condoms are available in "snugger fit" and larger sizes to accomodate a range of penis sizes more comfortably. Condoms remain the most effective means of reducing the risk of sexually transmitted infections (STIs) and HIV/AIDS between partners, and they are an important part of many couples' sex lives.
Until the advent of Viagra in 1998, and Levitra and Cialis shortly after, penile implants were the treatment of choice for erectile dysfunction (ED). These days, penile implants are often a last resort for men who don't respond to ED medications or can't take them because of health problems, because of the risk of infection or malfunction of implants.
Penile implants are surgically inserted into the spongy tissue of the penis, the corpora cavernosa, where they remain permanently. Implants can be semi-rigid or inflatable, with a corresponding device inserted into the scrotum to be used when a man wants to achieve an erection.
Studies show that 70 to 80 percent of men are satisfied with their penile implants, which makes them a useful option for men who can't take ED medications.