Let’s get technical: Erectile Dysfunction (ED), or impotence, is the inability to get and keep an erection firm enough for sex. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. ED can result from a problem with any of these. Stress and mental health concerns can also cause or worsen erectile dysfunction. Sometimes a combination of physical and psychological issues causes ED; a minor physical condition that slows your sexual response might cause anxiety about maintaining an erection, and resulting anxiety can lead to or worsen ED.
In many cases there is a physical cause like:
• Heart disease
• Clogged blood vessels (atherosclerosis)
• High cholesterol
• High blood pressure (hypertension)
• Diabetes (diabetic neuropathy)
• Metabolic syndrome is a condition involving increased blood pressure, high insulin levels, body fat around the waist and high cholesterol
• Parkinson’s disease
• Multiple sclerosis
• Kidney disease
• Certain prescription medications including antidepressants, antihistamines, and medications to treat high blood pressure, pain or prostate conditions
• Tobacco use which restricts blood flow to veins and arteries causing chronic health conditions
• Peyronie’s disease is a development of scar tissue inside the penis
• Alcoholism and other forms of substance abuse
• Sleep disorders
• Treatments for prostate cancer or enlarged prostate
• Surgeries or injuries that affect the pelvic area or spinal cord, particularly if they damage the nerves or arteries that control erections
• Low testosterone
Put your big boy pants on and get a physical exam. Your doctor will listen to your heart and lungs, check your blood pressure, and examine your testicles and penis. They may also recommend a rectal exam to check your prostrate.
The brain plays a key role in triggering the series of physical events that cause an erection. A number of things can interfere with sexual feelings like:
• Depression, anxiety or other mental health conditions
• Post-traumatic stress disorder (PTSD)
• Relationship problems due to stress, poor communication or other concerns
Talk therapy can help here by discovering:
• major stress or anxiety factors
• your feelings around sex
• subconscious conflicts that could be affecting your sexual well-being
Some questions that you may be asked include:
• How long have you been experiencing ED? Did it come on suddenly or gradually?
• Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
• How often do you have sex? Has this frequency changed recently?
• How firm are your erections? Is this affected by particular situations or types of stimulation?
• Do you wake up in the morning or in the middle of the night with erections?
• How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
• Have you recently been experiencing a lot of stress?
• What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
• Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?
ED can be caused by only one of these factors, physical and psychological, or by several of them. Consult your doctor so that they can rule out or treat any underlying medical conditions.
As you get older, erections take longer to develop and might not be as firm. You might need more direct touch to your penis to get and keep an erection. Also, sorry lads, your penis does naturally shrink.
The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions:
• Work with your doctor to manage diabetes, heart disease or other chronic health conditions
• See your doctor for regular checkups and medical screening tests
• Stop smoking, limit or avoid alcohol, and don’t use illegal drugs
• Exercise regularly
• Take steps to reduce stress
• Get help for anxiety, depression or other mental health concerns
Your doctor may prescribe medication to help. The following oral medications stimulate blood flow to your penis:
• Avanafil (Stendra)
• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra, Staxyn)
• Alprostadil (Caverject, Edex, MUSE) can be administered as a penile suppository or as a self-injection at the base or side of the penis.
• Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.
• Vacuum pumps uses the creation of a vacuum to stimulate an erection by blood being drawn into the penis by a device. A plastic tube is placed over your penis, then a pump creates the vacuum by drawing air out of the plastic tube, an elastic ring at the base of your penis functions to maintain the erection by holding the blood in the penis and preventing it from returning to circulation.
• Ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
• Nocturnal penile tumescence (NPT) test. A portable, battery-powered device, worn on the thigh, is used to evaluate the quality of your nocturnal erections. Data is stored in the device, which your doctor can access later.
• Injection test. During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts.
• Urine tests can be used to check for diabetes or other underlying health conditions.
• Blood tests can be used to check for conditions such as diabetes, heart disease, thyroid issues, and low testosterone.
Now where are those big boy pants? If your butt is puckering at the thought of your doctor’s probing, then start with diet, exercise, and healthy lifestyle (including yoga, meditation, and massage) changes first.
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