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Independent expert answers
on psychiatry and psychology

Erectile dysfunction/erectile disfunction

Abstract: An overview of the diagnosis, causes and treatment of erection problems (erectile dysfunction) in one combined article.

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Erectile dysfunction/erectile disfunction

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Written by: Written by: Wendy Moelker, psychologist in charge of Emergis, Goes, the Netherlands.
First version: 22 Jul 2008.
Latest revision: 19 Jan 2010.

Introduction to erection problems (erectile dysfunction/disfunction)

Men with an erection disorder often do want to have sex, but their penis doesn't get stiff enough or doesn't get stiff at all. It can also happen that the penis is stiff at the beginning of making love, but gets soft after a while. When a man has drunk too much or is very tired it is common that these problems occur. It is when the complaints are regular or are always present that one can talk about a disorder. An erection problem may reduce the desire to make love and the fun in making love. Men often fear that it will happen again next time. The partner may also have problems with it, like being afraid of not being attractive anymore or being disappointed.

Diagnosis of erection problems

It is important to know whether the body functions effectively. When an erection is possible: for example, in the morning, while sleeping or when masturbating, physical problems for the erection disorder can be excluded. An erection disorder is characterized by insufficient swelling and stiffness of the penis or being unable to maintain the stiffness. These complaints must be present for a long time.

How common are erection problems

52% of men between 40 and 70 sometimes have erection problems. 9,6% of men always have an erection problem. Between 18 and 55, 2% of men have erection problems when making love and 16% sometimes suffer. The higher the age, the higher the average of erection problems. People who are dependent on alcohol, patients with diabetes mellitus, Alzheimer's, heart and vascular diseases have erection problems more often.

Young men can have erection problems because of anxiety over the capability to perform. Erection problems from other causes than performance anxiety, starts to become more and more common från 40 years of age. 60 % of men older than 75 years have erection problems.

Physical causes of erection problems

Erection problems are often caused by a combination of physical and psychological factors. The following causes are possible:

Physical:

  • When older, it takes longer before the penis gets stiff and the man needs to be sexually stimulated for longer.
  • Anomalies in the vessels, for example due to heart and vascular diseases like arteriosclerosis and high blood pressure.
  • Surgery of the prostate.
  • Diseases and medication for heart and vascular diseases, diabetes mellitus, multiple sclerosis and Parkinson's disease can be a cause. Medicines for depression and high blood pressure may cause erection problems (see also other question).
  • Smoking, drugs and alcohol dependence.
  • Anomalies of the penis.
  • Hormonal anomalies.

It is important to know whether the body functions well. When an erection is possible: in the morning, while sleeping or when masturbating then physical problems can be excluded.

Erection problems are often a symptom of some other illness. Thus, if a man starts having erection problems, he should always get a general medical examination.

Psychological causes of erection problems

Various causes are possible for erection disorder. It can happen after a night out with a lot of alcohol or drugs. The next time after this incident the man may expect that it will go wrong again, causing him to focus more on not getting an erection. This takes away attention from the love play and the sexual stimulation and reduces the arousal, which confirms his expectation. This creates a vicious circle of expecting to fail, focusing too much on getting an erection and not on making love and therefore a reduction of arousal and thus the erection. Men with erection disorders may more often than other men:

  • Expect to fail.
  • Be distracted from making love.
  • Avoid it.

Many men with erection problems who look for help have suffered from the problem for years. The problem may get worse over time because psychological factors may start to play a role. There is often a strong tendency to avoid sex or to develop feelings of helplessness, anger or reproaches to the partner who would not stimulate him enough or would say or do the wrong things. Some people are so absorbed by the erection while making love that they hardly notice their partner or other arousing stimulations.

Treatment of erection problems

The treatment of an erection disorder can be divided by a specialist into a psychological treatment, a medicinal treatment or a treatment with devices. A psychological treatment looks at the possible psychological causes. The partner, if any, is usually involved. There are different forms of psychological treatment (see sex therapy). Depending on the problem, attention can be given to certain exercises e.g relaxation and caressing exercises, the communication between the partners, the thoughts and feelings when making love and the sex pattern. Furthermore, attention is given to any other focus of attention when making love, especially physical perceptions. Changing the existing thoughts and feelings around the problems is also important. For many people, concentration and sexual fantasies are important to get an erection.

The medicinal treatment consists of the administration of Viagra or other similar medicines. This substance may help with physical and psychological causes. It only helps when there is sexual stimulation. If this stimulation doesn't exist, no erection will follow. One tablet starts to work after about an hour. Generally the results are good. The medicine is only available on prescription. Medical injections in the corpus cavernosum are also used. A specialist or doctor teaches the patient how to inject the substance. After five to ten minutes the penis is stiff. The injections work best if both partners feel like making love and have already started.

There are also devices like an elastic ring, the vacuum pump, the artificial penis or the extension condom.

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