My Penis Stuff

For many men, psychological issues play a role in erection problems (erectile dysfunction). Careful attention to these issues and attempts to relieve sexual anxieties should be a part of therapy for all men with these problems.

The type of therapy and how long it lasts depends on what type of problem (depression, anxiety disorder, or another mental disorder) you have.

Group or individual therapy may be indicated. Involving your partner in counseling is often helpful.

Psychological treatment is most likely to be helpful for men who:

• Have an erect penis when they wake up in the morning.
• Can get a firm erection when masturbating.
• Have gone through a stressful major life event, such as divorce, separation, death of a loved one, change in job, or moving.
• Grew up in an environment where sex and sexuality were considered negative, wrong, or “bad,” or who were sexually or physically abused as a child.
• Lost their mother or father during early childhood.
• Have a history of serious relationship problems.
• Have a history of anxiety disorders or physical problems that have a psychological component (such as irritable bowel syndrome, migraines, asthma, or nervous bladder).

Treatment Overview

A vacuum device, which is sometimes used to treat erection problems (erectile dysfunction), is a tube made of plastic that fits around the penis. You coat the base of the penis with lubricant and insert it into the tube. Air is pumped out of the tube, which creates a vacuum. The vacuum helps blood flow into the penis, producing an erectionlike state in about 5 minutes. A constrictive band is placed around the base of the penis to maintain the erection, and the tube is removed.

See an illustration of a vacuum device below

The constrictive band may be left in place for up to 30 minutes. If you want the erection to last longer, you may remove the band for a few minutes and then repeat the process.

Vacuum devices block ejaculation. You still have an orgasm but do not ejaculate (release semen).

Some men say the erection is “wobbly” or has a “hingelike” feeling, since the tissues beneath the ring on the base of the penis don’t get hard. A small number of men consider this a major problem, and it may make penetration difficult.

A prescription is not needed to buy these devices. They are reusable and should be cleaned after each use.

What To Expect After Treatment

The device usually produces an erection, which goes away when the constrictive band is removed.

Why It Is Done

Most men who have erection problems from physical causes can use vacuum devices. Men who have erection problems because of psychological causes may also use these devices.

These devices can be used by men who take medications to prevent blood clots (anticoagulants, such as warfarin [Coumadin]).

How Well It Works

Studies indicate that more than 90% of men using these devices are able to get an erection that is satisfactory for sexual intercourse. 

Most men and their partners are satisfied with the device and the quality of the erections. Studies have reported satisfaction rates ranging from 70% to 94%. However, some studies report that only 26% to 30% of men are satisfied with the erections they receive from a vacuum device. 

Most men who stop using the vacuum device do so for a variety of reasons, including inconvenience and interruption of foreplay (the man has to take a brief “time-out” to use the device to get an erection). Your satisfaction with the device may be better if you meet with a representative of the manufacturer who can show you how to use the device correctly. Your doctor can arrange a meeting.

Regular use may improve success and satisfaction. Most men who use the device successfully for 3 months continue to use it. With regular use, the time it takes to get an erection decreases.

Men who have erection problems from psychological factors may regain the ability to have unaided erections after using the device for a time.

The cause of the erection problem (blood vessel, nerve, or psychological) does not appear to affect the results. The device also may produce erections in men who have had a failed penile implant.

Risks

The risk of side effects is low and they are usually minor. Possible problems may include:

• Bruising.
• Pain or discomfort.
• Numbness or loss of sensitivity. This occurs occasionally in about half of men but is a major problem for only a few men.
• A sensation that the penis is cold.
• Pinching scrotal tissue in the device.

No significant side effects or complications have been reported.

What To Think About

Be sure to discuss using a vacuum device with your partner. It is important that both of you have realistic expectations of what the device can do. The vacuum device gives you an erection that may be suitable for sexual intercourse but is not the same as a normal erection.

A trial period at home is helpful. The device can be difficult to learn to use, and about four tries are needed to learn to use it successfully.

Some men find the band around the base of the penis distracting or irritating during sex. Also, the band may prevent ejaculation.

Penile implants to treat erection problems (erectile dysfunction) replace the spongy tissue (corpora cavernosum) inside the penis that fills with blood during an erection with rigid, semirigid, or inflatable cylinders. The implants come in a variety of diameters and lengths.

Rigid and semirigid implants are always firm. The semirigid models can be bent into different positions (outward to have sex; back toward the body to conceal under clothing).

The cylinders in an inflatable implant are hollow. You get an erection by pumping them full of saltwater, or saline, stored in a reservoir in your lower abdomen. A release valve on the pump drains the saline out of the cylinders and back into the reservoir.

See an illustration of a penile implant below

Surgery will be done using regional or general anesthesia. The implants are inserted through an incision made in the penis, lower abdomen, or scrotum. A thin, flexible tube is inserted briefly up the urethra and into the bladder to drain urine.

A three-chamber implant (with a cylinder in the penis, a reservoir in the abdomen, and valve in the scrotum) is usually more reliable than a two-chamber implant (with a reservoir and valve in the scrotum). Inserting the three-chamber implant is a slightly more complicated surgery.

What To Expect After Surgery

Generally, you stay 1 or 2 days in the hospital. You will take antibiotics for up to 2 weeks after surgery to prevent infection.

The urinary catheter is used for about 1 day after surgery.

Do not wear tight underwear or clothing until the surgical incision has healed. Men with inflatable implants may need to avoid tight clothing for 6 weeks to avoid pushing the saline reservoir out of position.

You can generally return to strenuous physical activity and sex after about a month. Inflatable implants usually are not inflated for a month.

Why It Is Done

Penile implants are an option when other, less invasive treatments for erection problems have not been successful and further treatment is desired.

Implants may be the treatment of choice for young and middle-aged men with erection problems from physical causes. Penile implants may be appropriate treatment for men with erection problems caused by:

• Diabetes.
• Pelvic surgery.
• Blood vessel disease.
• Injury to the pelvis, genitals, or spinal cord.
• Peyronie’s disease, curvature of the penis caused by scar tissue.

Because implants permanently change the tissue in the penis, they are not used for men whose erection problems are psychological.

How Well It Works

The satisfaction rate for most men is high for both noninflatable and inflatable implants. ¹ An erection with a properly working implant may seem more natural than one from other, nonsurgical methods, such as a vacuum device. The head (glans) of the penis is not made fully rigid by the devices. Semirigid implants do not increase the size of the penis or produce the fullness of a natural erection.

Implants do not interfere with ejaculation, though ejaculation and orgasm are not ensured. Implants neither increase nor decrease sexual desire.

Noninflatable implants and inflatable devices can last indefinitely.

Risks

The site of the implant may become infected. The risk of infection is higher in men with diabetes, spinal cord injuries, or urinary tract infections. If the infection is severe, the implant must be removed.

Pain may occasionally require removal of the implant.

The most common cause of failure is leakage from the cylinders. Other, less common complications include the following:

• Tissue near the implant (erosion) may be injured.
• The implant may break through the skin.
• The implant may break.
• The implant may be positioned incorrectly.
• The implant may be defective and not work.

What To Think About

When considering surgery for erection problems, it is important to include your partner in your decision.

It is important that you have realistic expectations about the type of erections you can have with an implant. The use of penile implants is declining as men consider the risks of surgery—including infections—and as other options become available, such as vacuum pumps, injections, and medications.

No problems have been reported from the shedding of silicone particles from the implants.

Semirigid implants are the least expensive option. This surgery is usually covered by insurance policies and by Medicare.

Surgery to repair blood vessels may be done for some men who have erection problems (erectile dysfunction).

Venous ligation

In an erection, blood fills chambers in the penis, causing it to expand and become rigid. The veins that would normally drain blood from the penis are constricted, trapping the blood inside and maintaining the erection. Some men are unable to sustain an erection because the blood drains out too quickly through the veins. If this occurs, the veins that drain the penis may be tied off. This surgery is called venous ligation.

The surgery generally works only when the veins that are not working can be identified. However, the results of tests used to assess blood vessel problems are difficult to interpret, and it is difficult to know which men will benefit from this surgery. Success of this surgery depends on the severity of the problem and the experience of the surgeon.

Penile revascularization

This surgery generally is done in younger men who have injuries that affect blood flow to the penis. During surgery, a portion of a blood vessel from elsewhere in the abdomen is used to bypass the damaged portion of artery that supplies blood to the penis.

In some cases you can treat occasional episodes of erection problems (erectile dysfunction) at home, without a health professional’s help. However, involve your partner in the process, and don’t be embarrassed about seeking professional help if erection problems are consistent and troublesome. You may be able to help yourself by:

• Changing lifestyle factors that may affect erections. These factors include alcohol, smoking, and using illegal drugs.
• Examining your relationships and life events.
• Talking with your partner.
• Trying sensual exercises with your partner.

Some men may try methods available in health food stores or through magazine advertisements. Most of these methods have never been medically proven to work, may be unsafe, and are often expensive. They are not recommended.

Sensual exercises may help with erection problems (erectile dysfunction). Doing these with your partner may help you relax and focus more on the pleasurable touching of lovemaking than on the erection itself. Focusing too much on having an erection may make it difficult to have one.

Sensual exercises may be most helpful if done in a soothing, relaxing, and playful atmosphere. Put on some pleasant music, turn off the phone, and concentrate on your partner.

• Nongenital pleasuring. Remove your clothes. Have your partner lie face down. Beginning at your partner’s neck, slowly caress and/or kiss from head to toe. Then, have your partner turn over. Repeat the caressing and kissing. Avoid touching the nipples or any part of the genitals. Concentrate on how good touching your partner feels. Then, trade places. Lie on your stomach while your partner caresses you. Do not have intercourse the first day. Enjoy holding, relaxing, and laughing.
• Genital pleasuring. After you and your partner are comfortable with nongenital pleasuring, include genital touching as part of the exercise. Again, do not have intercourse. If sexual tension from any erection that occurs is too much to stand, masturbate to relieve the tension.
• Nondemanding intercourse. When both partners are ready, continue a session of genital pleasuring by having intercourse. Do not force lovemaking too soon. Rather, fully enjoy the genital pleasure leading up to it.

Talking with your partner may help your erection problems (erectile dysfunction). Couples often assume that they each know what the other person likes when it comes to sex. Sometimes they are wrong.

• Don’t assume. Tell your partner what you do and don’t find pleasurable.
• Make time outside of the bedroom to talk about your sex life together. If you withdraw sexually because you are afraid of having erection problems, your partner may worry that you are no longer interested or that you are involved in another sexual relationship.
• In some cases, you may find that your partner is less concerned about intercourse and is more concerned and interested in foreplay and other forms of sexual satisfaction.
• Discuss the strong and weak points of the whole relationship, not just the sexual relationship. Identify positive areas, areas of conflict, and areas that need improvement. Come to agreement on how or if you will both make changes.
• If you have difficulty discussing sex with your partner, see a person who can help facilitate communication, such as a certified therapist.
• Read books with your partner on sexual health.

The following lifestyle changes may reduce the risk of erection problems (erectile dysfunction):

• Limit alcohol to fewer than 2 drinks per day, or eliminate alcohol if it seems to interfere with erections. Even small amounts of alcohol can result in erection problems.
• Stop smoking. Smoking interferes with the ability of the blood vessels in the penis to relax and allow blood to flow in, which can affect your ability to have an erection.
• Avoid the use of cocaine, heroin, and other illegal drugs.
• Check your medications. Many medications can cause erection problems. Ask your doctor or pharmacist whether the medications you are taking have any sexual side effects.
• Relax. Worrying about sexual performance may only worsen erection problems.
• Talk to your partner about your problems and concerns. Sexual intimacy is a form of communication. If you and your partner aren’t talking outside of the bedroom, it’s unlikely that you will have good sexual intimacy.
• Reduce stress. A heavy workload or stressful job can reduce your interest in and energy for sex. Regular exercise and other stress-relievers can help.

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.