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Erectile dysfunction (impotence)

The outlook for men with erectile dysfunction (ED) has improved enormously in the first 16 years of this century so much so that almost all patients nowadays can be assured of a return to fairly successful intercourse.

Further treatments continue to be developed, and an ingenious new one was released in 2014.

Many males feel that the new treatments for erection difficulty (formerly known as ‘impotence’ or ‘impotency’) have transformed their lives.

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What is erectile dysfunction?

First, let’s define the problem. ED means an inability to get a good enough erection to achieve satisfactory intercourse.

Some sufferers can’t get a ‘hard-on’ at all. Others get one, but it isn’t firm enough to penetrate the partner. And others can manage penetration for a bit, but then they lose it.

Why does ED occur?

ED is very common, and it occurs for a variety of reasons and at different ages.

Teenagers and young men

In younger males, the most frequent cause is anxiety particularly nervousness about having sex, about causing a pregnancy or about using a condom .

A lot of men in this age group complain that they ‘can’t get on with a condom’ because as soon as they try to put it on, they lose their ‘stiffy’. We have termed this ‘condom collapse syndrome’.

Middle age

Common causes in this age group are overwork, stress. guilt and bereavement (ED often happens when a widowed man tries to form a new sexual relationship). A few cases are due to diabetes. Alcohol. nicotine and other drugs can be factors, as can obesity. So if you’re overweight, it’s worth slimming down.

Post-middle age

In this group of men, ED gets commoner with increasing age. Nonetheless, 70 per cent of all 70-year-olds are sexually potent.

It is now clear that in a high proportion of cases, the problem is due to narrowing of the blood vessels that carry blood into the penis.

Recent research,suggests that in some older men who have erection difficulties, there may also be deterioration in the arteries of the brain or the heart.

Leading British sex expert Dr Geoffrey Hackett has repeatedly warned, ‘Erectile dysfunction is the manifestation of vascular disease in smaller arteries and can give a two to three year early warning of heart attack .’

This doesn’t mean that if you have erection problems, you’re about to have either a stroke or a heart problem.

But older men with ED should take care to protect themselves against strokes and heart attacks for example by keeping their blood pressure and cholesterol down and getting an adequate amount of exercise. Also, at all costs they should avoid smoking .

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You may be surprised to see that I have not listed ‘lack of hormones’ as a common cause of ED. In fact, lack of male hormone is quite rare. However, it can occur particularly after severe injuries to the testicles or to the base of the brain.

If you are tempted to go to one of the private clinics that make a habit of diagnosing ‘male hormone deficiency’, and then charging huge sums of money for testosterone treatment, I suggest you think twice.

Nevertheless, if you are a middle-aged or elderly guy who has erectile problems, it may be worth having a blood test to check your serum testosterone level. If it turns out to be low, then a course of testosterone pills could help you.

What is an erection?

An erection occurs when blood is pumped into the penis and stays there, making it hard. It generally happens because a guy is thinking about sex or because his penis is being stimulated or both.

The result is that signals go down the nerves that lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to open up. Blood flows in and the organ ‘blows up’ like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again a least, until sex is over.

As you can see, getting an erection is a complex process. It’s awfully easy for various factors to interfere with it for instance, worry, tiredness, too much alcohol or in later life, narrowing of the blood vessels.

Nicotine is now known to narrow those vital blood vessels which is why ED is much commoner in smokers. But often, there is nothing physically wrong with men who develop ED.

Are many cases due to psychological causes?

Yes, particularly in the young. In general, erectile dysfunction is quite likely to be psychological rather than physical if the man is still waking with morning erections and can still get a good erection by masturbation .

Common psychological causes of erection difficulties include:

  • nerves especially about performing
  • guilt notably if you’re trying to have sex with somebody else’s wife
  • relationship problems especially if you’re no longer keen on your partner
  • latent gayness for instance, if you’re a basically gay guy, trying to have sex with a woman
  • depression
  • exhaustion.

In a lot of cases, ED turns out to be due to a mixture of psychological and physical causes.

What physical causes are there?

Common physical causes include:

  • deterioration of the arteries this is a physical change which is common in older men, including those with high blood pressure
  • diabetes
  • smoking
  • excessive drinking (hence the phrase ‘Brewer’s droop’)
  • being obese and out-of-condition
  • side-effects of certain drugs, notably ones for blood pressure and depression
  • effects of recreational drugs. like cocaine
  • major surgery in the abdomen particularly on the prostate gland.

Less common physical causes include:

  • excessive drainage of blood from the veins of the penis (‘venous leak’)
  • diseases of the nervous system
  • injury to the spinal cord or brain
  • hormone problems (see above), including excess production of a pituitary hormone called prolactin (this is rare).

What should I do if I’m having potency problems?

If you have difficulty getting an erection, seek help. Don’t suffer in silence as so many men do!

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