Erectile Dysfunction: Varieties, Causes and Relationship Implications
Before Viagra, the term usually used to describe erection problems was "impotence," literally "powerlessness." This
term reflected the common view that men who couldnít raise erections were failures as men, making many men reluctant to
discuss their erection difficulties.
As a result, research suggested that erection problems were not particularly common, typically affecting men over sixty
and younger men with chronic medical conditions such as depression or spinal cord injuries. But in reality, erection
difficulties are fairly common among men of all ages. The good news: The vast majority of cases can be treated successfully,
allowing the man to enjoy lovemaking.
The Varieties of ED
Today, the term erectile dysfunction (ED) is used to describe a broad range of erection issues, from severe ED to balky
erections. Severe ED is the chronic inability to raise or maintain an erection sufficient for intercourse, despite vigorous
penile stroking, and the inability to experience spontaneous night-time erections.
However, many men of all ages experience mild erection balkiness, and for men over thirty, instant, firm erections are the
exception, not the rule. If a man can still raise erections sufficient for intercourse, it is not truly erectile
dysfunction, but simply erection dissatisfaction. This condition includes:
Erections that are less firm and reliable than the man would like.
Inability to raise an erection from fantasy alone, without being stroked.
Not being able to take erections for granted.
Prevalence of ED
How common is ED? Some of the best information comes from the Massachusetts Male Aging Study, an ongoing survey of 1,709
men over 40. More than half the participants (52 percent) report at least some erection difficulty.
Note: This study did not include anyone under forty, but with almost one forty-year-old in five reporting erection
dissatisfaction, itís clear that a significant proportion of younger men also share this problem. And in a 1999
University of Chicago survey, 7% of men aged 18-29 and 9% of men aged 30-39 reported having had erection problems
in the previous year.
Causes of Erectile Dysfunction
ED is caused by a combination of factors, both physical and psychological. In healthy men under fifty, the leading
causes are emotional stress and sexual misinformation. In older men, physical ailments play an increasingly prominent
role. Here are some of the many causes of erectile problems:
Stress. When stressed, the body initiates the "fight or flight" syndrome, which sends blood from the abdomen out to
the arms and legs for escape or self-defense. As a result, less blood is available for erection. Stress also constricts
the arteries, including the ones that carry blood into the penis. Stress can include problems with relationships, family,
job or finances.
Aging. Erection problems can develop at any time, but the likelihood increases with age. After fifty -- and often
younger -- erections can become balky even in the absence of other factors.
Acute Illness. Donít expect your penis to stand up if you canít. Any illness or injury can impair erection. Decreased
sexual function is the bodyís way of directing its energy toward healing.
Heart Disease and High Blood Pressure. The clogged arteries that result from heart disease and the damaged blood vessels
associated with high blood pressure both limit blood flow into the penis.
High Cholesterol or a High-Fat Diet. High cholesterol leads to deposits on artery walls that limit blood flow around the
body, including into the penis. And a diet based on fatty meats, cheeses and junk food is associated with high cholesterol,
high blood pressure and obesity.
Smoking. Smoking accelerates arterial narrowing, limiting blood flow into the penis.
Diabetes. Diabetes accelerates the arterial damage that limits blood flow into the penis. It also damages the nerves
involved in erection.
Neurological Disorders. Multiple sclerosis, spinal cord injuries and other conditions can damage the
nerves involved in erection.
Hormonal Imbalances. Hormonal disorders other than diabetes are rare, but man-made hormone imbalances -- notably, the
ones caused by athletes taking anabolic steroids -- are increasingly common. These hormones increase muscle mass, but
often cause erection problems.
Alcohol. Alcohol is a leading erection-killer. Shakespeare wrote that the substance used worldwide to coax reluctant
lovers into bed "provokes the desire, but takes away the performance."
Depression. About one person in eight suffers serious depression at some point in life. In men, depression may cause
deep melancholy, an inability to get out of bed, anxiety, angry outbursts, and alcohol or drug abuse. It also impairs
Antidepressants. The selective serotonin reuptake inhibitors (SSRIs) used to treat depression -- such as Prozac, Paxil,
Zoloft, Luvox and Celexa -- cause sexual side effects in about half of users and ED in about 10 percent.
Other drugs. Hundreds of drugs are associated with ED. Among over-the-counter medications, the ones most often linked to
ED include antihistamines (Benadryl, Dramamine) and stomach-soothing drugs (Pepcid, Tagamet and Zantac). Prescription
drugs associated with ED are too numerous to list here. Whenever you get a prescription, ask if it has sexual side effects.
And if you develop erection difficulties shortly after starting a new drug, consult your physician to see if another drug
can be substituted.
Prostate Cancer Treatment. A common treatment for prostate cancer is removal of the gland (radical prostatectomy).
Unfortunately, this operation often damages the nerves involved in erection.
Sexual Myths and Misinformation
An additional cause of erection problems in many young men and some older men is stress caused by belief in erection myths.
Here are the most common myths, and the truth about them:
Myth: Erection is something a man "achieves." Truth: Erection occurs not through will or work, but as a result of
sensual relaxation and fondling. The more sensual your lovemaking, the more likely you are to become erect.
Myth: Men have to "perform" in bed. Truth: Great sex is adult play. Itís best when the two lovers feel deeply relaxed
and when the focus is entirely on giving and receiving pleasure -- not on reviews of the performance.
Myth: Men are sex machines, always ready. Truth: Some young men can raise instant erections. But as they get older,
men develop a list of conditions that need to be met before they can become erect; for example: privacy, relaxation,
emotional closeness with the woman, no interruptions and specific types of sexual stimulation. Menís belief that theyíre
supposed to be ever-ready sex machines causes stress and deflates erection.
Myth: Guys in pornography get instant erections; I should, too. Truth: Movies are make-believe, especially porn. The
fact is, men in pornography have a great deal of trouble raising and maintaining erections because of the stress involved
in having sex on camera. Today, most men in porn use Viagra -- and some still have unreliable erections.
Myth: During sex, you only get one erection. Truth: Erections often wax and wane during sex, especially in men over
forty. This is normal and no cause for alarm. Don't become so stressed that you canít get hard again. If an erection
subsides, relax, breathe deeply, and ask for more penis fondling. Your erection should return.
Myth: I lost it last time; Iíll never get it up again. Truth: If you miss a shot in basketball, does it mean youíll
never make another? Of course not. Reasons you might not get it up from time to time include exhaustion, alcohol and
Myth: I can't sexually satisfy my partner. Truth: Most women enjoy intercourse, but their main source of sexual
pleasure is the clitoris. You can still bring a woman to orgasm by providing direct clitoral stimulation with your hand,
your tongue or a sex toy.
Myth: With age, all men develop ED. Truth: Erection balkiness becomes common with age, but even among men over 70,
severe ED affects only a minority. ED is not an inevitable part of aging.
Talking to a Lover about ED
Men and women have different feelings about ED. Men typically feel like failures and withdraw into brooding silence, or
they might even blame the woman. Furthermore, they tend to view ED as a mechanical problem and look for a quick fix,
such as Viagra.
Women tend to view ED as a relationship problem and want to work on the coupleís issues. They may also blame themselves
for the situation. When men withdraw, it only aggravates the problem because it interferes with communication and makes
the woman feel more isolated and responsible. For most women, a manís lack of erection is less of a problem than his
anxiety, depression, anger, confusion and withdrawal because of it.
Donít blame your lover and donít withdraw. Instead, talk about how you feel and ask her how she feels. Review the causes
and see if any apply to you. If you have any medical problems that might contribute to ED, consult a physician. If you
have sexual issues or relationship problems, discuss them, try to work them out and perhaps consult a couples counselor
or sex therapist. ED can usually be resolved, but couples need to work together.
If youíre a woman in a relationship with a man suffering ED, donít say, "It doesnít matter." It may not matter to your
sexual satisfaction, but it matters a great deal to him. Donít blame yourself for the problem. You and your lover may have
some issues to work out, but his problem is not your fault, nor is it proof that something is terribly wrong with your
relationship. Reassure the man that his ED can be resolved, that you still love him and that you donít consider him less
of a man. Encourage him to confide in you. Offer to contact doctors and/or therapists to explore the causes of the
problem and work toward a solution.
To learn more about the treatments of erectile dysfunction,
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