Erection Problems

Erectile difficulties

Erectile problems are extremely common - up to 2 million men in the U.K. have erectile dysfunction, and some studies have shown that it affects 5% of 40 year old men and this percentage increases with age.
It may seem difficult or embarrassing to discuss problems with your sex life with a doctor. It is often difficult to diagnose the exact problem that is causing symptoms - more often it is a combination of problems, both physical and psychological (see below), that can cause problems with achieving or maintaining an erection.
The history often can give a good idea about whether the cause is likely to be predominantly psychological or physical. Some men seem to have no problems with erections when masturbating, and have morning erections / erections during the night, but have problems with their erection only when they are with a partner. In these cases, it is more likely that there is a predominantly psychological cause. Nonetheless when there is an accompanying loss of libido (sex drive) physical causes for erectile problems also need to be excluded.
The physiology of how erections occur is complicated, but essentially erections occur when blood becomes trapped within the penis. This comes about by either psychological stimuli, physical stimuli or both. For erections to occur some of the muscles within the penis need to relax.
As previously mentioned, the causes of erectile dysfunction are often divided into two:
                    - psychological causes
                    - physical causes

Psychological causes include anxiety, depression, relationship problems and performance anxiety. Anxiety / fear increases the production of hormones such as adrenaline and this can prevent the muscles in the penis that need to relax to cause an erection from doing so. The problem is self-perpetuating as each time an erection fails, the anxiety levels associated with subsequent attempts at erection increase. This is performance anxiety.

Physical causes include vascular problems, diabetes, kidney problems, neurological problems (including trauma or operations to the back). Some prescribed medications can cause problems with achieving erections, and importantly so too can smoking and alcohol, as well as recreational drugs such as cannabis and cocaine.

In reality, most men with erectile dysfunction have a combination of physical and psychological elements. A man who has a physical cause for his erectile dysfunction will invariably have some psychological effects as a result of his problem - this could include depression or anxiety / performance anxiety - which can make the problems with erections worse.
Treatment will depend on what is found. There are several therapies specifically for erectile dysfunction. They include:

             - Psychosexual counseling- often a programme called sensate focusing
             - Oral medications - such as sildenafil (Viagra) and uprima that is helpful in
               50 - 88 % patients
             - Injections of medication into the penis to achieve erection (eg prostaglandin
               a type of hormone)
             - Urethral medications - a small pellet of a prostaglandin that is inserted
                into the urethra

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