My Penis Stuff

You may be able to avoid erection problems (erectile dysfunction) related to anxiety and stress by taking a more relaxed approach to lovemaking. Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner talk about your lovemaking, it will help reduce your stress and anxiety and you may become more relaxed.

Erections may gradually become more difficult to get and maintain as you get older. However, foreplay—erotic stimulation before intercourse—and the right environment can help increase your ability to have an erection, regardless of your age.

Other things you can do that may reduce your risk for developing an erection problem include:

• Quitting smoking.
• Avoiding use of excess alcohol and illegal drugs.
• Keeping your cholesterol level low to reduce the risk of hardening of the arteries (atherosclerosis).
• Treating high blood pressure.
• Keeping your blood sugar in a safe range if you have diabetes.
• Exercising regularly.
• Lowering stress in your life.

Your risk of developing an erection problem (erectile dysfunction) increases with age.

• About 40% of men in their 40s report at least occasional problems getting and maintaining erections.
• 52% of men between ages 40 and 70 report erection problems.
• About 70% of men in their 70s report erection problems.

Diseases, physical or psychological problems, and certain activities also may increase your risk.

Diseases that affect blood vessels include:

• Diabetes. About half of men with diabetes develop erection problems. ²
• High blood pressure or other blood vessel diseases.
• High cholesterol or low HDL (high-density lipoprotein) cholesterol.

Diseases or procedures that affect nerves include:

• Diabetes.
• Multiple sclerosis.
• Stroke.
• Parkinson’s disease.
• Having had surgery involving the prostate, bladder, rectum, or urethra. These procedures may cause injury to nerves involved in achieving and maintaining an erection.

Other conditions include:

• Thyroid problems.
• Low levels of the hormones needed for the normal development and function of the sex organs (hypogonadism), leading to low testosterone levels.

Injuries or treatment include:

• Injury to the penis or pelvic region.
• Injury to the spinal cord or nerves to the penis.
• Pelvic surgery.

Medications and other substances that increase your risk include:

• Medications to treat high blood pressure or depression.
• Long-term (chronic) alcohol abuse.
• Drug abuse.
• Tobacco use.

Psychological risk factors include:

• Depression.
• Anxiety or stress.
• Relationship problems.
• A recent major life change (birth of a child, retirement, job change, loss or death of a partner, divorce, or marriage).

Activities that constrict blood flow to the penis—such as frequent long-distance bicycle riding on a hard, narrow saddle—may increase a man’s risk of developing an erection problem. However, experts continue to debate this issue.

A vasectomy usually does not cause erection problems. However, pain after the operation may affect sexual performance for a time, and if a man was not comfortable with his decision to have a vasectomy, or is having second thoughts, it could affect him psychologically.

Erection problems (erectile dysfunction) may be caused by physical problems related to the blood vessels, nerves, and hormones or by psychological issues. Current evidence suggests that physical causes account for about 80% of erection problems.

Physical causes of erection problems include long-term (chronic) and short-term (acute) injuries and complications of prostate or other surgery that interfere with nerve impulses or blood flow to the penis. Physical problems are often the cause of erection difficulties in men 50 or older.

• Problems with the blood vessels (vascular problems) may prevent blood from filling the penis or from remaining there long enough to maintain an erection.
• Problems with the nerves (neurologic problems) may prevent arousal signals from traveling from the brain and spinal cord to the penis. Nerve disorders such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and stroke may interfere with a man’s ability to have an erection and may lower sexual desire. Nerve damage from diabetes, complications from surgery, and spinal cord injury also may cause problems.
• Problems with the structure of the penis or its surrounding tissues may prevent an erection.
• Hormonal factors, such as a low level of the hormone testosterone, may be involved in causing erection problems.
• Side effects of medications (for example, those taken for high blood pressure or depression) may cause erection problems. In some cases, it may be possible to change the dose of the medication or to use another medication.
• The use of tobacco, alcohol, or illegal drugs can lead to erection problems. Stopping or reducing the use of these substances may reduce the severity of a man’s erection problem.

Activities that restrict blood flow to the penis also may result in erection problems. Some doctors have observed that men who regularly ride bicycles over long distances are more likely to have erection problems than men who ride only occasionally, especially if they ride on a narrow, unpadded saddle. However, the possible link between bicycle riding and erection problems has not been proven.

A vasectomy usually does not cause an erection problem. However, pain after the operation may affect sexual performance for a time, and if a man was not comfortable with his decision to have a vasectomy, or is having second thoughts, it could affect him psychologically.

Psychological causes of erection problems include depression (which also has a physical component), anxiety, stress, grief, or problems with current or past relationships. These interfere with the erection process by distracting the man from things that would normally arouse him. Erection problems in men younger than 40 who have no physical risk factors are more likely to be caused by psychological factors than physical causes.

• Relationship problems can lead to erection problems. This may happen when a man has been widowed or loses sexual interest in a particular partner.
• Some men develop erection problems when they contemplate marriage.
• Some men may have difficulty having sexual intercourse with their partner after their first child is born.

What is erectile dysfunction?

Erectile dysfunction, sometimes called impotence, refers to a man’s consistent inability to get or maintain an erection sufficient to have satisfactory sex. It does not mean a lack of sexual interest or desire or the occasional difficulty achieving or maintaining an erection that affects all men at some time in their life.

Normally, an erection occurs when your imagination or one or more senses (vision, hearing, touch, smell, taste) are stimulated and you become aroused. Your central nervous system sends nerve impulses that increase blood flow to your penis. Four requirements for a normal erection are:

• A properly functioning nervous system that sends the necessary signals to the penis.
• An intact system of blood vessels to allow blood to flow into and out of the penis.
• Normal smooth muscle in the penis, which must relax so the penis can fill with blood and enlarge.
• The ability to trap the blood in the penis so that it stays firm.

See an illustration of the male reproductive system below.

Illustration copyright 2000, 2003 Nucleus Communications, Inc. All rights reserved.

The male reproductive system consists of the penis, two testicles, two epididymides, two vas deferentia, two seminal vesicles, and the prostate gland.

Erectile dysfunction can occur at any age but is more common in older men, who often have additional health problems or who may be taking medications that may interfere with normal erectile function. Treatment of erection problems in older men can be as effective as in younger men.

Doctors prefer to use the term erectile dysfunction instead of impotence. A man’s sexual function involves more than an erection, and the term impotence often carries negative implications. For ease of reading, this post uses the term erection problems to refer to erectile dysfunction.

Erection problems can affect your sexual life and your relationship. Discussing the issue with your partner and exploring other forms of intimacy can help improve your relationship and the erection problem.

What causes erection problems?

The cause of erection problems may be physical (such as injury to nerves or loss of blood supply to the penis) or psychological (such as anxiety or depression). Medications you are taking for other conditions, alcohol consumption, smoking, or illegal drug use also can cause erection problems.

Certain conditions may affect the nervous system or blood flow to the penis, increasing the risk for erection problems. These include diabetes, high blood pressure, high cholesterol, atherosclerosis, multiple sclerosis, and Parkinson’s disease.

What are the symptoms?

The only symptom of an erection problem is the inability to have or maintain an erection that is firm enough to consistently have sexual intercourse. This inability may or may not be related to sexual interest or the ability to have an orgasm and to ejaculate.

How are erection problems diagnosed?

A health professional can diagnose an erection problem using a medical and sexual history and a physical examination. Your health professional will want to know whether the erection problem occurs all the time or occasionally. The initial exam, laboratory tests, and possibly psychological tests can help determine whether the problem is physical, psychological, or a combination of the two.

How are they treated?

Treatment often includes lifestyle changes, such as avoiding tobacco, drugs, and alcohol. Discussing the issue with your partner, participating in sensual exercises, and seeking counseling may help. Further treatment may include oral medications (such as Viagra, Levitra, or Cialis), vacuum devices, or injection of medications into the penis. Surgery to place an implant in the penis also is an option.

Do not take Viagra, Levitra, or Cialis if you are taking nitrate medications—such as nitroglycerin—for heart problems. The combination of nitrates and any of these medications can lower your blood pressure to a dangerous level. You also should not take certain alpha-blockers (used to lower blood pressure and to treat an enlarged prostate) with these medications because of the risk of a dangerous drop in blood pressure. Check with your health professional to see whether you can take Viagra, Levitra, or Cialis with your alpha-blocker.

Can I prevent erection problems?

To reduce your risk of developing an erection problem, avoid smoking, drinking too much alcohol, and using illegal drugs.

Because erection difficulties are most often caused by a physical problem, maintaining good health through diet and exercise is very important. A relaxed approach to lovemaking and good communication with your partner can help prevent erection problems caused by psychological factors.

Author: Marianne Flagg

A number of medications are associated with erection problems (erectile dysfunction). Let your doctor know if you are taking any of these medications. If they are affecting your ability to have an erection, your doctor may be able to modify the amount you take or find an alternative.

Medications with a high incidence of causing erection problems include:

• Leuprolide acetate (Lupron), which is used to treat prostate cancer.
• Flutamide (Eulexin), which is used to treat prostate cancer.
• Clomipramine hydrochloride (Anafranil), which is used to treat obsessive-compulsive disorder.
• Naltrexone hydrochloride (Trexan), which is used to treat alcohol dependence.

Other medications associated with erection problems

Other medications that may have an effect on erections include medications for:

• Hepatitis C or human immunodeficiency virus (HIV), such as interferon alfa-2a or recombinant (Roferon-A).
• Parkinson’s disease, such as levodopa (Sinemet).
• Nausea and vomiting, such as prochlorperazine (Compazine) and promethazine (Phenergan, Promethegan).

Cholesterol is a type of fat (lipid) that the body needs for many important functions, such as producing new cells. High cholesterol increases the risk of developing heart disease and stroke.

High cholesterol is caused by eating a diet that is too high in cholesterol and saturated fat or by having an inherited condition that causes elevated cholesterol levels.

Treatment includes eating a more healthful diet, increasing physical activity, and possibly taking cholesterol-lowering medicines.

A blood test can determine whether you have high cholesterol. Cholesterol is measured in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

• A total cholesterol level of less than 200 mg/dL (5.17 mmol/L) is desirable.
• 200 to 239 (5.17 to 6.18) is considered borderline-high cholesterol.
• 240 (6.21) or higher is considered high cholesterol.

Hormonal factors may play a role in erection problems (erectile dysfunction). Men who produce low levels of the hormone testosterone (a condition known as hypogonadism) may have decreased sexual desire. A blood test is usually done if your doctor suspects this problem. However, few men with erection problems have low testosterone production.

Producing high levels of the hormone prolactin (hyperprolactemia) also may be a factor. High levels of prolactin interfere with testosterone production, resulting in a form of hypogonadism.

Medications are available to treat low testosterone production and excess prolactin production.

A vasectomy is surgery to make a man sterile (permanently unable to father a child). During a vasectomy, the tube that carries sperm from the testicles to the urethra (called the vas deferens) is cut and tied off, preventing sperm from being released during ejaculation.

Atherosclerosis, sometimes called “hardening of the arteries,” occurs when fat (cholesterol) and calcium build up in the inner lining of the arteries, forming a substance called plaque. Over time, the fat and calcium buildup narrows the artery and blocks blood flow through it.

• When atherosclerosis affects the arteries that supply blood to the heart, it can restrict blood flow to the heart muscle, causing heart pain (angina), irregular heartbeats (arrhythmia), and other problems. Plaque may damage the artery lining, causing blood clots that can block blood flow, which in turn may cause a heart attack and cause damage to the heart muscle. Atherosclerosis in the heart (coronary) arteries is called coronary artery disease.
• When atherosclerosis affects the arteries that supply blood to the brain, it may cause a transient ischemic attack (TIA) or stroke.
• Atherosclerosis can affect arteries in other parts of the body, such as the pelvis and legs, causing poor circulation, slower healing of skin injuries, and erection problems.

A major part of treating atherosclerosis and coronary artery disease involves lifestyle changes (such as quitting smoking) and medications to help reduce high cholesterol, control high blood pressure, and manage other factors that increase a person’s risk of heart attack, stroke, and other complications.

Because an erection is caused by the penis filling with blood, problems with the blood vessels may result in erection problems (erectile dysfunction). These problems include:

• Hardening of the arteries (atherosclerosis) in the penile arteries, which may block blood flow into the penis or into the arteries that fill the penile arteries.
• Side effects of medications that affect the blood vessels (such as some diuretics or other high blood pressure medications), which may interfere with the filling process.
• Leaking of blood from the spongy chambers (corpora cavernosa) in the penis to the veins that carry blood from the penis. This may lead to the inability to maintain an erection.