This is a male sexual dysfunction which is characterized by the ina bility of a male to maintain or develop an erection. The penis is unable to remain erect during sexual intercourse. There are many causes that can be physical and psychological as well. Circulatory problems due to diabetes and cardiac disease are usually very common causes as well as hormonal insufficiencies and drug related causes.
Psychological impotence occurs when penile erection or penile penetration fails because of thoughts and/or feelings. The reasons behind this erectile dysfunction are psychological reasons and not physical impossibility. This type of erectile dysfunction is less frequent than that caused by physical causes, and it is often treatable. The psychological consequences of erectile dysfunction can be very severe as it may cast doubt on ideas of being physical well.
Signs and Symptoms:
Erectile dysfunction occurs when a person is unable to maintain an erection on a regular basis and the person is unable to indulge in sexual intercourse. Erectile dysfunction can be analyzed in the following ways:
- Erectile dysfunction due to psychological reasons: the analysis of this can be done when a full erection can be maintained at some times like when a person is asleep and bothersome psychological issues are at bay. This suggests that the physical structures of the body are optimally functioning but psychologically the problem needs to be treated.
- Physical causes such as diabetes mellitus, cardiac conditions and other causes need to be investigated if a psychological cause is not the reason erectile dysfunction is occurring.
Causes of Erectile Dysfunction:
Some of the most common causes of erectile dysfunction are:
- Drugs: Anti-depressants such as Selective Serotonin Reuptake Inhibiters and nicotine due to smoking are the most common causes.
- Injuries to the Brain or Spinal Cord: Neurogenic disorders which include brain and spinal cord injuries and, nerve disorders including Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, and stroke.
- Cavernosal Disorders: Peyronie’s disease.
- Psychological Causes: Stress, performance anxiety, mental disorders such as schizophrenia, clinical depression, substance abuse, generalized anxiety disorder, panic disorder and personality disorders.
- Surgery: A person who has undergone radiation therapy, or a surgery involving the prostrate, rectum, bladder or colon may have a damaged nerve or blood vessels that are involved in the process of erection.
- Natural Aging: Some men with age tend to develop erectile dysfunction.
This condition occurs when a man tends to have an orgasm before intercourse begins or during intercourse it occurs much sooner than he or his partner desires it.
Premature ejaculation occurs very commonly and it may very rarely occur due to actual physical causes. It usually occurs when a person is under too much stress and may suffer from over stimulation. Another psychological factor such as guilt may be involved as well. This problem usually does not require treatment and improves with time. Premature ejaculation is usually seen early in a relationship and can also be due to relationship anxiety.
Premature ejaculation often leaves a couple feeling unsatisfied as a man may ejaculate prematurely, before penetration or right after penetration.
Usually there are no findings that may seem abnormal with this condition. An interview of the patient or the couple by a health care provider may be better at assessing the cause of the condition. Usually stress and anxiety tend to be the biggest causes.
- A person suffering from pre mature ejaculation due to stress needs to practice relaxation techniques in order to combat the stress or anxiety he feels during sexual intercourse.
- If the cause is overstimulation, thinking thoughts that are non sexual in nature can also help decrease the frequency of the problem until it becomes more in control. This helps men avoid getting over excited and ejaculating prematurely.
- Techniques such as “the stop and start method” and “the squeeze method” are also helpful at resolving the condition.
- Medicines such as Prozac and Selective Serotonin Reuptake Inhibitors also help with the condition if self help techniques fail as they usually prolong the time one takes to reach orgasm. (A side effect of these medicines however, is erectile dysfunction).
- Local anesthetic creams are also available that can be applied to the penis directly. These reduce feelings and also decrease penile stimulation, thus delaying ejaculation.
- Some men also find using condoms an effective way to delay ejaculation as they may also decrease penile stimulation.
- If the problem is still not resolved by the above mentioned techniques or other self hel0p techniques, medications that help one maintain an erection may need to be prescribed.
- Some couples find evaluation by a trained sex therapist or psychiatrist or psychologist, helpful. This is especially true if the main cause is stress, anxiety or depression.
If the problem remains untreated, it can cause a couple from being unable to achieve pregnancy. Premature ejaculation can also cause a single partner or both the partners feel unsatisfied and make their relationship suffer.
Heidelbaugh JJ. : Management of erectile dysfunction. Am Fam Physician.
Lue TF, Broderick GA. Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 22.