Pregnancy FAQs: My Man's Problem

Premature ejaculation early in a relationship is most often caused by anxiety and overstimulation. Other psychological factors such as guilt may also be relevant. The condition usually improves without formal treatment.

Symptoms

Ejaculation happens before the individual or couple would like (prematurely). This may range from before penetration to a point just after penetration, and may leave the couple feeling unsatisfied.

Exams and Tests

Abnormal findings are unlikely to be associated with the condition. Useful information is more likely to be obtained from interviewing the person or the couple.

Treatment

In general, practice and relaxation will help you deal with the problem. Some men try to distract themselves by thinking non-sexual thoughts (such as naming baseball players and records) to avoid becoming excited too fast.

Some helpful techniques include the following:

The "stop and start" method:

This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. The stimulation is then removed for about thirty seconds and then may be resumed. The sequence is repeated until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

The "squeeze" method:

This technique involves sexual stimulation until the man recognizes that he is about to ejaculate. At that point, the man or his partner gently squeezes the end of the penis (where the glans meets the shaft) for several seconds, withholding further sexual stimulation for about 30 seconds, and then resuming stimulation. The sequence may be repeated by the person or couple until ejaculation is desired, the final time allowing the stimulation to continue until ejaculation occurs.

Antidepressants such as Prozac and other selective serotonin reuptake inhibitors (SSRIs) may be helpful because they have a common side effect of prolonging the time it takes to achieve ejaculation.

Local anesthetic creams may be applied to the penis to decrease stimulation. Decreased feeling in the penis may prolong the time before ejaculation. Condom use may also have this effect for some men.

Evaluation by a sex therapist, psychologist, or psychiatrist may be helpful for some couples.

Outlook (Prognosis)

In most cases, the man is able to learn ejaculatory control through education and practice of the simple techniques outlined. Chronic premature ejaculation may be a sign of anxiety or depression, both of which could be helped by psychiatric intervention.

Possible Complications

Very early ejaculation, occurring prior to entry into the vagina, may prohibit a desired pregnancy.
A continued lack of ejaculatory control may lead to sexual dissatisfaction on the part of either or both partners and may be a factor in sexual tension or discord in the relationship.

When to Contact a Medical Professional

Call for an appointment with your health care provider if premature ejaculation is causing a problem and does not respond to techniques such as those described above.

Prevention

There is no prevention for this disorder, though relaxation can reduce the likelihood of its occurrence.

Adropause does it exists

Female menopause has been known for centuries, but it has only recently been discovered that males also go through a similar phenomenon with identical symptoms.

The medical profession has long debated the existence of male menopause. Does it really exist ? If so, at what age does it affect men ? What are the symptoms ? Are they reversible with treatment ? What precautions can a man take to prevent/postpone its arrival ? How is it similar to/different from female menopause ?
Or, on the other hand, is it a non-existent entity ? Is it just a another ploy on the part of male-bashing feminists to emasculate men further ? Are senile eighty-year old men who are seen dating nubile young women really as capable as they appear to be or are they merely fooling both their partners and themselves ? Or are their partners fooling them ?

Until recently, the entire subject of the male menopause was steeped in confusion and controversy. While women were accused of going through middle-aged crises and menopause-related aberrations, their male counterparts got away with propagating the myth of the `ageless male' and boasted of virility all the way to their graves.

So what's the real score ?

There is no doubt that a man's sexuality changes with advancing age. The instant, anytime, `as-many-times-as-you-want' erections that are more the rule rather than the exception at 18, do not last forever. With advancing age, the urge reduces, erections take time to come on, any time is not always a good time and the penis requires more direct stimulation in order to get aroused. Besides, the erections may not be as angled and rigid, and ejaculation becomes more feeble. The refractory period (interval) between erections gets prolonged.

Is all this because of the maturation (maturity) process ? Is it because by middle age man has had enough sex so as not to be unnaturally preoccupied with it any longer ? Is this because his wife has aged a bit and is no longer as attractive/interested as before ? Or is it because of the pressures at the work-place, the demands of parenthood, or pre-occupation with the lives of grown-up children and aging parents ?

Is there really something called a middle-age crisis ? If so, how is it different from male menopause ?

Yes, there is something known as a mid-life crisis.This is often a time in life when stability has been achieved and the struggles that were once a large part of life are now at an end. This new awareness that a life change has taken place can sometimes trigger a crisis. For some men, new-found stability may signify an end to vitality or youth. Many men find that after spending a lifetime working towards the goals of family and peers, the end result is unfulfilling. This is also often a time of change. Major shifts in career, marriage and parenting often occur during this time period. And, along with the physical signs of aging comes a realization of impending old age, retirement and eventually death. This time of life will only become a crisis if the changes become too difficult to cope with.

Mid-life crisis, thus, is essentially a problem of psycho-social adjustment. It need not necessarily have a bearing on a man's sex life. It is thus not synonymous with the male menopause although there is frequently a superimposition of male menopausal factors in middle-aged men going through crises and this makes the picture hazy.

Male menopause, on the other hand, is a distinct physiological phenomenon that is in many ways akin to, yet in some ways quite different from the female menopause.

Menopause is a condition most often associated with women. It occurs in a woman when she ceases to menstruate and can no longer become pregnant (usually). Men experience a different type of `menopause' or life change. It usually occurs between the ages of 45 and 60 - but sometimes as early as age 30. Unlike women, men can continue to father children, but the production of the male sex hormone (testosterone) diminishes gradually after age 40.

Testosterone is the hormone that stimulates sexual development in the male infant, bone and muscle growth in adult males, and is responsible for sexual drive. It has been found that even in healthy men, by the age of 55, the amount of testosterone secreted into the bloodstream is significantly lower than it is just ten years earlier. In fact, by age 80, most male hormone levels decrease to pre-puberty levels.

One hundred and fifty years ago, a German Professor called Berthold showed that transplant of a cock's testis prevented atrophy of the comb after castration. In 1944, what we now describe as the male menopause was reported in a key article by two American doctors, Carl Heller and Gordon Myers. They compared the symptoms with those of the female menopause, and did a blind controlled trial showing the effectiveness of testosterone treatment. Unfortunately, like many pioneering efforts, these went unnoticed. Men were unwilling to accept that they could attain `menopause' and such research was often hurriedly brushed under the carpet. Men with genuine symptoms were told that `this is just a mid-life crisis' - just like men with erectile dysfunction were told that `it's all in the mind'. Besides, testosterone therapy had come into disrepute because of its abuse by athletes and the concept of testosterone replacement therapy for male menopausal symptoms was not received very well. Further, there was much hype about the side effects of testosterone, especially prostate cancer.

It was only after HRT (Hormone Replacement Therapy) with estrogens produced tangible symptomatic improvement and `aging reversal' in post-menopausal women that men sat up and, not wanting to get left behind their womenfolk, began to take notice !!

SYMPTOMS

The symptoms of male menopause are similar to the ones women experience and can sometimes be as overwhelming. However, the male menopause does not affect all men, at least not with the same intensity. Approximately 40 % of men between 40 and 60 will experience some degree of lethargy, depression, increased irritability, mood swings, hot flushes, insomnia, decreased libido, weakness, loss of both lean body mass and bone mass (making them susceptible to hip fractures) and difficulty in attaining and sustaining erections (impotence).

For these individuals, such unanticipated physical and psychological changes can be a major cause for concern or even crisis. Without an understanding partner, these problems may result in a powerful combination of anxieties and doubts, which can lead to total impotence and sexual frustration. A recent aging study showed that 51 % of normal, healthy males aged 40 to 70 experience some degree of impotence - defined as a persistent problem attaining and maintaining an erection rigid enough for sexual intercourse. This problem cannot be attributed to the aging process alone, however, because well over 40 % of males remain sexually active at 70 years of age and beyond. Other factors, notably the co-existence of degenerative or other diseases, are culpable.

SYMPTOM CHECK LIST

The St. Louis ADAM (Androgen Deficiency in the Aging Male) questionnaire asks for the following symptoms:
1. Decrease in sex drive.
2. Lack of energy.
3. Decrease in strength and/or endurance.
4. Lost height.
5. Decreased "enjoyment of life."
6. Sad and/or grumpy.
7. Erections less strong.
8. Deterioration in sports ability.
9. Falling asleep after dinner.
10. Decreased work performance.

Men experiencing problems 1, 7, or a combination of any four or more might be candidates for replacement therapy.
This symptom score, however, is only a rough set of guidelines and is not absolute.

CAUSES

Although all the causes of male menopause have not been fully researched, some factors that are known to contribute to this condition are hypothalamic sluggishness, hormone deficiencies, excessive alcohol consumption, obesity, smoking, hypertension, prescription and non-prescription medications, poor diet, lack of exercise, poor circulation, and psychological problems, notably mid-life depression. A general decline in potency at mid-life can be expected in a significant proportion of the male population. A relative increase in circulating levels of estrogen (which competes with testosterone for cellular receptor sites) can tilt the testosterone- estrogen balance unfavourably and can reduce the availability of testosterone to target cells.

TIPS TO COPE WITH CHANGE

· Find new ways to relieve stress.
· Eat a nutritious, low-fat, high-fiber diet.
· Get plenty of sleep.
· Exercise regularly.
· Find a supportive friend or group and talk to them.
· Limit your consumption of alcohol and caffeine.
· Drink lots of water.

TREATMENTTestosterone Replacement Therapy (TRT) must be always administered only by very responsible physicians and under strict case selection criteria and supervision. Testosterone must not be used as a tonic for vague complaints as it can cause serious side effects, including prostate cancer. The risk of prostate cancer with TRT has been much hyped. Recent evidence suggests that the fear of prostate cancer is perhaps exaggerated, since prostatic disease is estrogen-dependent rather than testosterone-dependent. However, it is true that testosterone administered to a patient who already has cancer of the prostate can cause a flare up and aggravation of the disease. Hence the importance of thorough check-up and investigation before starting testosterone.

Patients with significant `menopausal' complaints should be taken up for investigation. Serum FAT (Free Available Testosterone) is measured in a pooled early morning blood sample and, if low, testosterone therapy can be considered. Before starting testosterone, a complete general check up including a rectal examination is conducted followed by tests like the hematocrit, lipid profile, cardiac function tests, liver function tests, measurement of PSA (Prostate Specific Antigen)and a trans-rectal ultrasound (TRUS). The important side effects of testosterone are thrombophlebitis and hypercoagulability of blood, liver toxicity (with some oral testosterone preparations) and prostate cancer. These tests must be repeated at 3 or 6 monthly intervals for as long as treatment is continued.

Testosterone is available in many forms - oral, injectable, trans-dermal and implants. The oral route is generally not recommended because of the high risk of liver toxicity. Some newer oral forms of testosterone are purportedly absorbed through the lymphatics. These bypass the liver and cause much less toxicity. Injectable testosterone is safe but the blood levels are not uniformly maintained and any excess is converted to estrogens, which is counter-productive since it might alter the testosterone- estrogen balance. Doses must be tailored to the needs of the patient in order to achieve normal blood levels of FAT. A significant improvement in symptoms can be expected with proper therapy. More recently, patches, pellets, creams and gels have entered the fray. The choice of route and preparation will depend on availability, safety, the socio-economic status of the patient, proven long term safety and efficacy and the preference of the patient and the prescribing andrologist.

In conclusion, it may be stated that the male menopause does exist. It affects many men over 40 years of age (sometimes earlier). It is not synonymous with the mid-life crisis though the two can co-exist and compound one another. Symptoms are gradual and usually not as pronounced as in the female. Early diagnosis and hormone replacement therapy can improve symptoms

For Women in relation with an Impotent Male

A Six-Step Survival Guide for any woman who finds herself in a relationship with an impotent male. Based on the experiences of several women who came through it all - and survived.

This article is a female-focused, step-by-step guide for women in relationships with men who are impotent. The sexual, psychological and medical issues you confront are addressed. This guide will be helpful to women who desire an intimate relationship that includes having sexual intercourse or whose relationship is challenged by the loss of sexual intimacy. If you are willing to work together with your partner to restore and enhance his sexual potency, the suggested six-step process will facilitate successful problem-solving.

MALE ERECTILE DIFFICULTIES

Impotence, transient erectile problems and premature ejaculation occasionally occur in all relationships. Chronic impotence (erectile dysfunction) is the inability to achieve or to sustain an erection long enough to complete sexual intercourse. It is an extremely common disorder affecting 10% of the male population. In the US alone, there are 30 million afflicted men.

Premature ejaculation is the inability to exercise voluntary control over the ejaculatory process. Although premature ejaculation is not an erectile disorder, it is discussed in this article because some of the treatments mentioned can be of assistance in resolving this problem, too. Any sexual dysfunction, including premature ejaculation, can deprive a woman of sexual pleasure and result in subtle but significant personal and psychological distress.

SIX STEPS TO SUCCESS IN OVERCOMING MALE IMPOTENCE

Your decision to read this article affirms your commitment to take the first step in overcoming male impotence. New opportunities for achieving satisfying and successful intercourse open up to you as you progress through each additional step. Although there are many ways to express and experience love, chronic male impotence can be a profound and often painful loss in the lives of women.

The SIX STEPS TO SUCCESS in renewing intimacy through sexual intercourse are :

1. Admit the effects of impotence on you and your relationship.
2. Consider your physical and psychological health.
3. Explore the relationship factors that predict successful treatment.
4. Learn about the causes and treatments for impotence.
5. Discuss this problem with your mate and determine your true sexual needs.
6. Seek medical consultation

STEP 1. EXAMINE THE EFFECTS OF IMPOTENCE ON YOU AND YOUR RELATIONSHIP

As you begin to think about resuming sexual intercourse, it is important to understand the influence that impotence has on you and your partner. Feelings, thoughts, and behaviors in relation to impotence reflect on your physical and psychological well being. STEP I considers these factors.

ADMIT THE PROBLEM

THE CASE OF HELEN AND JOHN

Helen has been married to John for 35 years. One year ago, John had triple by-pass surgery. Since that time, their sexual relationship has silently dwindled. Helen tearfully described a recent evening together, "John and I were finally alone after a busy week - no telePhone, no distractions, no interruptions. I'd been looking forward to this special time together to share a fulfilling, intimate experience. But in spite of my caresses and cuddling, John couldn't seem to respond. The more I tried, the more anxious we both became. He was embarrassed and apologetic. Feebly, John admitted, 'I just haven't been myself lately.' I felt disappointed, frustrated, and frankly, a little angry. This wasn't the first time this had happened. Sometimes, in the middle of intercourse, he'd lose his erection and we'd have to stop. So, once again, I tried to be supportive, ' It's OK, John, it doesn't matter, being together is enough.' But it isn't...I know it...and so does he."

Any woman who has tried to have intercourse with an impotent man can identify with Helen's feelings. It isn't just men who experience frustration and disappointment. Women do too.

Many couples maintain a conspiracy of silence surrounding the problem of impotence. Helen and John both knew that there was a problem, but typically were reluctant to talk about it. John didn't want to accept the reality of his impotence, and neither did Helen. They were caught in a double bind. If they openly addressed the issue, much anxiety and stress would be generated. If they chose to ignore the problem, opportunities for emotional and sexual closeness were lost. As they became more physically distant, the quality of their marital relationship began to deteriorate. Over time, they gradually began to drift apart. Silence reinforced their estrangement.

If having intercourse is important to you, admit it to yourself and to your partner. Don't pretend it doesn't matter.

EXAMINE YOUR FEELINGS

Men and women have similar feelings about impotence; yet they rarely acknowledge it to themselves, let alone one another.

Feelings Women Experience Feelings Men Experience
Disappointment Despair
Frustration Frustration
Embarrassment Embarrassment
Fear of rejection Fear of failure
Anger Anger
Guilt & betrayal Guilt & shame
Fear of abandonment Fear of rejection
Self-blame Self-blame
Depression Depression
Grief & loss Grief & loss

Helen looked in the mirror. At 57, she thought that her beauty was definitely fading. New wrinkles seemed to appear on a daily basis. A recent, unwelcome weight gain testified that her body was losing the war with gravity. The prospect of aging disturbed her, as it does most women, and she was left with a vague sense of unhappiness.

When Helen realized that John's sexual interest had diminished, she began, as many women do, to blame herself. Although Helen loved John a great deal, she felt emotionally insecure and ambivalent about their sexual problems. She tried to cover her confusing feelings by focusing her energies on family, friends and career. Other matters slowly assumed greater priority in her life.

Many women, like Helen, blame themselves and the effects of aging on their partner's decreased sexual interest. The distractions of life serve to only temporarily dissipate the feelings of loss and grief over diminished sexual intimacy.

John longed for the emotional and sexual satisfaction he used to receive from making love with Helen. He recalled a talk with his physician who reassured him that sexual activity would not endanger his physical health, but this reassurance did not assuage his anxieties. 'It's not fair to burden Helen with my problems. How can I tell her I'm not sexually capable anymore? Now I'm only half a man.

Men's feelings of sexual insecurity can cause them to question their masculinity. As a result, low self-esteem can generalize to other areas of the relationship. After repeated failed attempts at intercourse, men may feel powerless, defeated, and hopeless. They may cope by unwittingly desexualizing their partner to protect themselves against fears of abandonment and rejection. They are apprehensive about acknowledging this and worry about being perceived as failures in the eyes of their partners.

These negative feelings can be intense and illogical. Even when there is an understanding about why we feel the way we do, this insight does not necessarily help us to change our behavior. Impotence can be perplexing and requires examination of the differences in how men and women think and behave.

EXAMINE YOUR THOUGHTS AND BELIEFS

WHAT WOMEN THINK ABOUT IMPOTENCE

When confronted with their partner's sexual dysfunction, women begin to explore possible reasons for this problem. After initial feelings of self-blame, women share many of the same concerns.

"Maybe he's sick and there's a medical reason for this problem."

Approximately 85% of all cases of impotence are caused by specific, diagnosable, physical conditions. Most of these problems are treatable and some are curable. Men who are sexually impaired should have a medical evaluation.

"I wonder if something is wrong with our relationship?"

Sometimes potency problems are a screen for more serious emotional or relationship issues. If there is loving affection and a committed friendship between partners, almost all problems can be a good place to begin problem-solving and bridging communication gaps.

"Maybe he's angry with me. Maybe I'm angry with him, too."

Anger, whether or not openly expressed, interferes with sexual desire in many couples. Anger evoked by daily irritations or disagreements is present in almost all relationships. But profound anger, fear or anxiety related, must be resolved in order for medical treatment to be effective.

"Is he having an affair? Is he going to leave me?"

Women who measure their self-esteem, femininity and desirability by how well men respond sexually are particularly vulnerable to fears of abandonment and rejection. Men's emotional detachment feed into the fears. Women may worry that their mates may be impotent with them, but potent with other women, leaving them with fantasies of betrayal and infidelity.

"Honestly, I'm secretly relieved. I don't miss not having sex any more."

Some women are quietly relieved that their partner is impotent. For a variety of reasons, they have never found sexual intercourse to be emotionally gratifying or physically satisfying. Strong negative attitudes or previous negative sexual experiences may undermine the success of any medical or psychological intervention.

WHAT MEN THINK ABOUT IMPOTENCE

"If I can't have normal sex with my wife, I'm a failure as a man and lover. I feel like a real loser and I can't stop thinking about the problem."

Men who equate sexual satisfaction solely with performance may think of themselves as failures. This problem causes a lapse of confidence and a crisis in self-esteem. Men commonly report that the problem occupies a lot of their mental energy and that they can't seem to stop thinking about their problem.

"If I show her affection, she'll want to have intercourse and then what?"

Men with erectile difficulties tend to emotionally and physically withdraw from their partners. They fear that any physical affection will precipitate a request or desire for intercourse from their mates and remind them of their inability to achieve an erection. Compounding the problem, women may also cease being affectionate.

"Something must be wrong with me. I feel that I have no control over my own body and now that sex is out, I'm lonely. She won't touch me anymore."

Many men, especially older ones, think that it is inappropriate to need nurture and affection. So, they frequently do without the warmth, comfort and emotional support often more available to women. It is frequently considered inappropriate for a man to admit that he needs a hug and someone to hold him. When a man cannot perform intercourse and satisfy his own(and his partner's)sexual needs, he feels emasculated, devastated and very much alone.

"If I can't meet her sexual needs, she will leave me."

Men, too, share fears of abandonment. Younger men, particularly, feel vulnerable and concerned that their partner will seek a new, more fulfilling, less problematic relationship. To some extent their fears are realistic. A younger woman may want to have an active sexual life and over a long period of time be less patient and supportive.

"Before I developed my erectile problem, I found my partner sexually stimulating. Not any more. The thrill is gone. I wonder if I've fallen out of love? She just doesn't appeal to me anymore."

When a man or woman loses a loving sexual relationship due to impotence, either or both individuals may choose to "desexualize" their mate. John describes his feelings about Helen. "I used to be very frustrated about being impotent. I'd feel excited, but my body wouldn't respond. I'd think about how wonderful our relationship was for so many years and get so damned depressed. Now I try to block everything out and think of Helen as my sister."

Feeling enormously guilty, John could not confide in anyone about his lack of sexual desire and his fear that he had "fallen out of love."

Intellectually, he just turned himself off. Sometimes women do the same thing. After experiencing the pain associated with rejection and partner apathy, women divert their attention to other matters in order to compensate for the loss of their sexual partner.

It may take counseling intervention before couples can rekindle romance and "reprogram" themselves and once again think of each other as desirable, stimulating sexual companions.

EXAMINE YOUR BEHAVIOUR

Men and women are socially conditioned to behave in different ways. The process of gender role socialization prescribes appropriate male and female behavior regarding sexuality. Individuals absorb these values and appropriately comply with acceptable standards of behavior. Most people naturally go along with their assigned roles. Sometimes, these roles are contrary and detrimental to getting interpersonal needs met. What you really feel and need sexually is frequently in conflict with how you are supposed to think and behave. Consequently, impotence tends to divide and distance couples, creating conflict and pain.

Men and women also share similar behaviors when dealing with impotence. These behaviors, although sometimes dysfunctional, enable couples to cope with the stresses they experience. These behaviors include :

IGNORING, DENYING OR MAKING EXCUSES FOR THE PROBLEM

Impotence generally does not respond well to neglect. Some erectile disorders do improve with the passage of time, but chronic impotence usually has an organic basis and requires medical attention. Couples sometimes intentionally, or unintentionally, choose to ignore or deny the problem, prolonging recovery and decreasing chances for a positive treatment experience.

WITHHOLDING AFFECTION AND AVOIDING SEXUAL SITUATIONS

Erectile dysfunction can cause a warm and loving partner to withdraw affection and avoid any situation that might stimulate romance or a sexual encounter. The man doesn't want to start something he can't finish. The woman doesn't want to remind her mate of past failures or create additional tension.

GIVING AND RECEIVING "DOUBLE MESSAGES"

Women sometimes pressure reluctant partners to seek treatment. When an ambivalent woman feels she cannot be honest about her feelings and misgivings, double messages are sometimes communicated to the partner. Situations are occasionally created where a seemingly cooperative female partner will inadvertently speak or behave in a way that sabotages the success of treatment or a sexual encounter. Timing and clear communication are one critical variable in the successful treatment of impotence.

Individuals who are unable to authentically communicate negative feelings to their partner frequently turn frustration inward and neglect their own appearance, physical or mental health. This suppression of feelings can create somatic problems including : headaches, backaches, anxiety, insomnia, panic attacks and a range of other health problems. Some people become physically unattractive in an effort to alienate their partner and discourage sexual advances.

ABUSING SUBSTANCES

Alcohol, drug abuse and other addictive/compulsive behaviors have negative sexual side-effects. Some individuals deal with sexual anxiety by becoming workaholics or exercising excessively.

STEP 2. CONSIDER YOUR PHYSICAL AND PSYCHOLOGICAL HEALTH

Women who contemplate resumption of intercourse after a long period of abstinence have physical, psychological and health needs to consider.

PHYSICAL HEALTH ISSUES

When a monogamous couple considers resumption of sexual activity after a long period of abstinence, both partners are faced with a physiological and psychological adjustment. Women contemplating the resumption of intercourse after a significant period of time should have a comprehensive gynecological examination. With appropriate medical consultation and treatment, most women, regardless of age, can resume normal sexual activity with no difficulty. Since the average age of an impotent man is 55-65 years and his partner is usually of similar age, medical issues due to aging are important.

AGE-RELATED PHYSICAL HEALTH ISSUES

Women from different generations have contrasting attitudes and values regarding sexuality. These attitudes and values have health care implications. In general terms, younger women may view the sudden loss of a sexual partner due to illness or traumatic injury as catastrophic. For an older woman, the gradual decline in sexual interest and activity may be considered a normal part of the aging process.

The medical considerations regarding resumption of intercourse vary depending on age. Particularly for the older woman, prolonged sexual abstinence can contribute to several physical problems, including vaginal dryness, loss of vaginal muscle tone, hormonal imbalances, cystitis, non-specific vaginitis, and painful intercourse. Regardless of age, most problems can be resolved in consultation with the physician.

It is important to be aware of the many sexual changes associated with aging for both men and women.

PRESCRIPTION AND RECREATIONAL DRUGS

Prescription drugs and alcohol often have side effects that impair sexual functioning. It is important to evaluate the effect of these drugs on each person's capacity and desire for sex.

Physiological Changes Associated with Aging
WOMEN MEN
Estrogen decreased Testosterone decreased
Size of Cervix, Uterus, and Ovaries Production of Sperm
Thickness and Elasticity of Vagina Size of Testes
Lubrication Viscosity and Volume of Ejaculate

The Effects of Aging on Sexual Responsiveness

WOMEN MEN
Slowed Response/Excitement Slowed Response/Excitement
More Stimulation Required More Stimulation Required
Clitoral Response Intact Erection Less Firm
Orgasms of Shorter Duration Orgasms of Shorter Duration
Multi-Orgasmic Capacity Retained Multi-Orgasmic Capacity Impaired

PSYCHOLOGICAL HEALTH ISSUES

FLUCTUATIONS IN SEXUAL DESIRE

Sex therapists document that low sexual desire is the number one complaint that brings couples into treatment. Many professionals believe that is you do not have sexual thoughts, fantasies or urges more than two times a month, there may be a problem. This yardstick is certainly arbitrary, but when either or both partners avoid sexual activity on a regular basis, something is amiss.

Women reach their orgasmic prime in their forties and fifties. It is not unusual for a mid-to-post menopausal woman to experience an increase in sexual interest as she ages. Simultaneously, men begin to experience cardiac and prostate disease, which can cause impotence. At a life period when many women are most interested in making love, their partners begin to lose their ability to perform.

When a woman experiences a lack of interest in sexual activity, there is usually a good medical or psychological reason. If you are not orgasmic, find out why. Discuss this problem with your physician and consider your treatment options.

DEPRESSION

Depression frequently accompanies sexual dysfunction in both women and men. In the general population, depression appears to more commonly affect females and older adults. It is important to have this problem evaluated if it is severe. If any individual experiences more than two of the following symptoms, he/she should consult a physician: suicidal feelings, impaired concentration, low energy, lack of interest in usual pleasurable activities(that includes sex), sleep disturbance, and significant weight loss or gain.

STEP 3. EXPLORE THE RELATIONSHIP FACTORS THAT PREDICT SUCCESSFUL TREATMENT

Successful treatment of any sexual dysfunction is directly related to the quality of your relationship. You can determine whether you and your partner can benefit from medical treatment and opportunities for renewed intimacy by answering the following question :

* Are you committed to working with your partner on solving this problem? Is your partner motivated to work with you?

Research indicates that couples who are in love and share a strong commitment to their relationship benefit most from medical treatment and/or psychological counseling.

* Do you both share a successful history of problem-solving?

Good communication skills are essential in identifying and solving most problems.

* Are you and your partner interested in learning about impotence?

There is no substitute for accurate, up-to-date information upon which to base informed decisions. You and your partner will need to educate yourselves about sexual functioning, impotence and treatments available.

* Are you and your partner willing to jointly participate in the evaluation process?

Impotence is not just a "man's problem." Successful treatment depends on joint cooperation and involvement in the problem-solving process.

* Do you have a sense of humor?

While impotence is no laughing matter, couples who are able to share a smile in times of stress seem better able to survive life's trials. Some levity can make formidable tasks less arduous.

* Are you willing to have a frank discussion with your partner about his impotence and its effect on you?

Communication and motivation are the key to effective sex therapy. It takes a delicate balance of courage, tact and skill to discuss this sensitive subject honestly and openly.

* Did you and your partner have a good sexual relationship prior to the onset of impotence?

A normally active, fully functioning sex life is a good indication that you can, once again, recapture the sensuality you once enjoyed.

* In spite of impotence, are you and your mate sexually attracted to one another?

Sexual desire for your mate is a predictor of favorable outcome for sex therapy.

* How long has the erectile dysfunction existed?

Prompt treatment of an erectile problem ensures the most positive results. As with any problem, the longer it lasts, the more difficult it is to resolve. But, even long-standing impotence can be resolved when there is proper motivation and appropriate treatment methods are explored.

* Can you be realistic about the benefits of restored potency?

The ability to obtain an erection is not a quick-fix for on-going conflicts and disagreements between partners. However, medical intervention and counseling can be effective in ensuring long-term benefits.

Although there is no way to accurately predict your chances for successful treatment of impotence, the more positive your responses, the greater likelihood that treatment will be effective.

STEP 4. LEARN ABOUT THE CAUSES AND TREATMENTS FOR IMPOTENCE

Studies affirm the positive results women experience when their partners find a successful means to manage their impotence. This section of the guide will focus on the causes and diagnosis of impotence, present a brief description of all treatment options, and explain the many benefits associated with each option. Special concerns for women will be explored and important questions answered.

DIAGNOSIS OF IMPOTENCE

Impotence may be diagnosed by a comprehensive physical examination, blood work, laboratory analysis, and a variety of simple tests. These tests are conducted on an out-patient basis under the supervision of a physician who specializes in the diagnosis and treatment of sexual dysfunction.

Origins of Impotence

Physical Causes 85%
Psychological Causes 15%
Total 100%

PHYSICAL(ORGANIC) IMPOTENCE

Erectile disorders of any kind demand medical consultation, diagnosis and treatment. More than four out of five cases of impotence are the result of a medical problem. Physical impotence can be caused by many conditions, including diabetes, diseases of the blood vessels (arteriosclerosis, coronary artery disease, hypertension), prostate, bladder, colon, endocrine and hormonal disorders, as well as nerve damage, radiation therapy, prescription drugs, and substance abuse. There is often some psychological involvement, even when the cause is physical.

PSYCHOLOGICAL (NON-ORGANIC) IMPOTENCE

Emotional or psychological causes of impotence can include stress-related disorders secondary to depression, addiction, or problems caused by work or family.

PREMATURE EJACULATION

Premature ejaculation is a common male sexual disorder. Men who experience premature ejaculation cannot exert voluntary control over ejaculation, and once sexually aroused, ejaculate quickly and cannot resume intercourse for an undetermined period. Many times men ejaculate with very little direct penile stimulation and cannot accomplish intercourse.

The best news for the partners of premature ejaculators is that penile injections or a variation of an external vacuum device enables men to maintain an erection even after ejaculation. This improved performance may enable you to have intercourse and experience a higher level of vaginal stimulation and satisfaction. With practice, men may learn to gain better ejaculatory control by anticipating the body cues that trigger ejaculation.

STEP 5. DISCUSS THE PROBLEM WITH YOUR MATE AND SEEK MEDICAL CONSULTATION.

COMMUNICATION WITH YOUR PARTNER

Through the eyes of women, communication between the sexes is complex. Many excellent books detail strategies to improve the quality of sexual communication between partners. One reference that may be of interest is a book by Bernie Zilbergeld, The New Male Sexuality (1992). Under the best circumstances, sexuality and impotence are sensitive subjects. Your attitude and approach will make a critical difference in encouraging a reluctant partner to seek treatment or discuss feelings and options. As you take this final step, your relationship is on the way to becoming more gratifying than ever before.

The suggestions presented here are relatively simple. They involve diplomacy, honesty, and common sense. You know your partner better than anyone else. After carefully examining communication options, you will know which approach will be most effective in your individual situation. If the process suggested here proves ineffective or results in any escalated conflict, a profession counselor should be consulted.

CONSIDER HIS POINT OF VIEW

Although a woman can empathize with the feelings of an impotent partner, she can never really comprehend the problem from a man's unique perspective. A woman can fake an orgasm, but a man cannot fake an erection. The secret is out and cannot be hidden. So men use all sorts of stratagems to deal with the problem - making excuses, pretending it does not bother them, avoiding intimacy. Blaming himself, ashamed of himself, and fearful of the future, all his thoughts are focused on his inability to perform. He may sometimes forget the parts he can still do - kissing, fondling, caressing, speaking of his love. His mind focuses not on giving pleasure to his partner, but on trying to meet his own performance standards. For a man not to be able to participate in intercourse is a devastating loss. He feels he has failed not only himself but his lover.

Some men prefer to solve erectile problems with no help or assistance from their mate. Some even choose to seek medical advice and treatment without their partner's knowledge. They may have a strong sense of pride and resent any intrusion on their privacy. Communicating with your partner and seeking a solution together is vital to the success of any treatment. Lack of partner involvement in seeking treatment is the number one reason for non-use of an external vacuum device and also accounts for why more than 10% of the men treated with a penile implant never use the prosthesis for intercourse. Your support is essential. You can certainly offer gentleness, kindness and understanding. Ask him directly, "What can I do to be supportive of you?" He will probably give you a straight answer. Respect his position, but try to take good care of yourself, too.

CONSIDER YOUR POINT OF VIEW

Women are confronted with a dilemma. How do you tactfully broach the subject of impotence without inflicting more pain or embarrassment? What do you say to prevent an escalation of existing conflict? How can you recover a conversation that is deteriorating and re-focus it in a more positive direction? These are complex questions with few simple answers. However, the process we describe is a basic format for initiating effective communication about impotence.

The place to begin is with yourself. You now have an understanding of what your partner is thinking and feeling. Now you need to consider how this problem is affecting you and determine your personal and sexual needs. Once this information is available, you are ready to develop goals and formulate an effective plan.

There are two important variables affecting successful communication with your partner. One variable is a positive attitude that demonstrates caring and compassion. The other is your willingness to tackle the problem. Although everyone theoretically recognizes that impotence is a shared problem, for the purposes of an introductory conversation with your partner, you must be willing to take responsibility for your needs, desires and feelings. Whatever the nature of your feelings, they belong to you alone. In a spirit of friendly cooperation, you must solicit your partner's support in solving the problem. A simple statement, "I have a problem and I need your help in resolving it," obviously takes him off the defensive and promotes attentive listening.

DEFINE WHAT IT IS YOU WANT

Think about your personal feelings and sexual needs. Translate your feelings and needs into short sentences. Example: "I feel lonely and I want more affection." Statements that begin with "I feel..." encourage open sharing of feelings, are non-demanding and should be well accepted by your partner.

TRANSLATE YOUR FEELINGS AND WANTS INTO A SPECIFIC BEHAVIORAL REQUEST

"I want you to hug and kiss me when you leave the housein the morning and when you come home in the evening." Sometimes, the message you intend to convey is not the one your partner receives-so make an effort to develop clear requests. Hinting or suggesting may not be sufficient. Some women expect their mates to magically understand what they want and need. This doesn't work well. Try to be sensitive, yet assertive, and avoid manipulation, subtleties, or double messages.

DECIDE HOW, WHEN AND WHERE TO COMMUNICATE WHAT YOU WANT TO YOUR PARTNER

Choose a place and time that are stress-free, perhaps out of the house in a neutral setting, when you are both well rested an in a fairly good mood. [Helpful hint: Never discuss sexual problems in the bedroom.] Be aware that your tone of voice as well as the words you speak will contribute to the spirit of cooperation you are trying to foster. Be positive. Talk about what you want, rather than what is wrong. Verbally acknowledge your share of responsibility for the problem.

PLAN AND REHEARSE WHAT YOU ARE GOING TO SAY, ANTICIPATE QUESTIONS AND HAVE WRITTEN MATERIALS AVAILABLE IF HE SEEMS RECEPTIVE

Focus on "the" problem and on "your" feelings about it. Keep your one goal clearly in mind...that you both seek a solution to impotence together. You care too much about him, and miss your previous intimacy too much to think about sacrificing it permanently. Plan what you are going to say, write it down in the form of a "script," and try to anticipate his responses.

PREVENT ESCALATION OF CONFLICT AND RE-FOCUS NEGATIVE DIALOGUE

Conversations about potentially volatile subjects tend to sour or escalate when the topic or question is changed, expanded, contradicted or diverted. Try to agree ahead of time to limit and contain discussion to one specific issue at a time. Example: "How can we get medical advice concerning impotence?" Stick with your planned agenda and redirect conversation back to the original subject as necessary.
ASK FOR FEEDBACK, PREPARE TO LISTEN TO HIS THOUGHTS AND FEELINGS
An accepting, non-critical attitude and reflective listening can encourage him to discuss painful feelings. You may not agree with what he thinks, but you can support his feelings, positive as well as negative.

VERBALLY AND PHYSICALLY REINFORCE POSITIVE BEHAVIOR

Always recognize and appreciate the energy he invests in trying to resolve this sensitive problem. Attempt to rekindle your relationship with touching and expressing words of love.

STEP 6. SEEK MEDICAL CONSULTATION

If you are experiencing erectile dysfunction, medical care is essential. Many primary care physicians are assuming a more active role in the diagnosis and treatment of impotence. This involvement by the non-surgeon is increasing because of the development, in recent years, of non-surgical treatment alternatives, and because most impotence is experienced by patients who are already under the care of a family physician for other disorders.

When the resolution of erectile dysfunction demands medical consultation, evaluation, diagnosis and treatment from a specialist, your physician may refer you to a urologist. Urologists are physicians who specialize in the treatment of the genito-urinary system, which includes the kidneys, ureters, bladder, prostate and the genitals. Urologists may prescribe any of the treatments discussed in this article.

Your physician should inspire trust and encourage you, as well as your partner, to be an important part of the treatment process. When your partner(and hopefully you) has made a decision to seek medical consultation, these suggestions may make your visit to the physician more informative and productive.

For the first medical consultation, the ideal situation is for the couple to see the physician together. However, as discussed, some men simply prefer to go alone and wish to have their preference respected. You are in the best position to determine whether or not to accompany your partner.

Prepare in advance for your first visit with the physician. Write down your questions and concerns ahead of time. Some of the information conveyed by the doctor may be technical and difficult to remember. This is no time to be shy. You need to fully understand all of your options. In order to make a sound, mutual decision about the appropriate medical approach to this problem, you need to have all of your question answered. Bring a notebook along if you would like to take notes as you are talking. A tape recorder can also be helpful if all participants in the discussion agree. You can also bring this article along and share it with your doctor.

A NEW BEGINNING FOR HELEN AND JOHN

Helen became increasingly concerned about John's withdrawn and uncharacteristic behavior. She strongly suspected that their sexual problems accounted for his depression and her own unhappiness. Helen decided to confide in her personal physician. She received reassuring advice and accurate information about impotence. As her knowledge increased, so did her confidence and determination to solve their shared problem. She then thoughtfully planned a positive, tactful intervention with John, using simple, effective communication techniques such as those outlined in this guide.

Helen and John were fortunate. They had a solid relationship based on trust, caring and friendship. As a couple, their communication and problem-solving skills were good. They sought medical consultation together, recognizing the importance of mutual decision-making. Their choice of treatment was a well-informed and successful one.

After six months, Helen and John were engaging in intercourse 4-6 times per month. Each reported improvements in mood, self-esteem and marital satisfaction. Anxious and futile attempts at love-making were replaced by renewed confidence and pleasure. This couple considered the treatment they had chosen an investment in their future relationship. A new beginning for the years ahead.

A NOTE TO MEN

On a personal level, men and women both wish the problems associated with impotence would just go away. A man does not want to live with feelings of inadequacy and failure. A woman does not want her partner to need an implant, injection or external vacuum device to achieve an erection. Everyone would like the resolution to be a pill or some simple treatment not visible in the bedroom. Unfortunately, this is not always possible. Yet couples want the difficulty to be resolved. This article describes the realities of impotence for both sexes and the current treatment options available

Your partner is greatly affected by your erectile difficulty. This problem is not your fault. You are not to blame. The fact that you are reading this article is evidence of your positive motivation to understand how your partner feels. She may feel that you are no longer attracted to her and worry that she has lost her power to "turn you on." You can do a great deal to offer her reassurance. Tell her that she is loved and desired, that you want to have sexual intercourse and are even willing to use one of the medical treatments available just to be close and prove your love for her. Ask for her cooperation in renewing your bond of intimacy.

( Adapted from a booklet published by the Osbon Medical Foundation, Georgia, U.S.A. )

The Male Species

From 20 to 30
If a man lives right
It’s once in the morning and twice at night

From 30 to 40
If he still lives right
He misses a morning and sometimes a night

From 40 to 50
It’s just now and then

From 50 to 60
It’s heaven knows when

From 60 to 70
He is slightly declined.
But don’t let him kidyou.
It's still on his mind.

FACTS ABOUT ERECTILE DYSFUNCTION

FACT-1 ERECTILE DYSFUNCTION IS A COMMON DISORDER

Erectile dysfunction, commonly known as impotence is a common symptom among men. Usually ED is caused by an underlying health problem that can prevent men from getting the erections they want. Most of the medical disorders associated with ED affect the blood vessels, reducing the blood supply to the penis. Two out of three men with hypertension have ED to some degree, while more than half of men with diabetes also have ED to some degree by the age of 60.

FACT-2 ERECTILE DYSFUNCTION CAN BE TREATED

There are many different ways that ED can be treated. Simple and effective medications that can be taken orally are available today. Taking the right drug can help in the treatment of ED. Other ways of treating ED include injection of medications that dilate blood vessels, into the urethra or penile tissue, vacuum devices that use a vacuum pump to draw blood into the penis until it is rigid, and penile prosthetic implants.

FACT-3 ERECTILE DYSFUNCTION IS NOT ONLY A NORMAL PART OF AGING

ED is not just the result of getting older. ED prevalence is thought to increase with age because the disorders associated with ED increase with age, and because older men more commonly take medications associated with ED (e.g., certain antihypertensives). A wide variety of diseases and risk factors are associated with ED, including heart disease, hypertension, diabetes, abnormal lipid levels, renal disease, neurological disease, depression, cigarette smoking, and excessive alcohol consumption. Surgery, trauma to the genitals, hormonal disturbances, and psychological factors can also be associated with ED. In fact, ED may be among the first signs of
With age, physical changes can occur in the genital organcardiovascular disease in individuals who otherwise do not have complaints suggestive of cardiovascular disease.

FACT-4 A MAN CANNOT GET AN ERECTION WHENEVER HE WANTS

With age, physical changes can occur in the genital organs, requiring greater stimulation to produce an erection. The intensity, duration, and frequency of ejaculation also tend to decrease, and erections may be less firm.

FACT-5 ERECTILE DYSFUNCTION IS NOT ONLY PSYCHOLOGICAL

As little as 10% of ED is based purely on psychogenic factors, with the remainder of the cases based on factors such as medical conditions (diabetes, hypertension, etc) or surgical problems (following surgery for prostate cancer). The younger the patient, the more likely it is that the basis for ED is psychogenic. In older men, ED related to diabetes, hypertension, and medication use account for most of the cases.

FACT-6 MOST MEN EXPERIENCE ERECTILE DYSFUNCTION

Studies suggest that as many as 52% of men between the ages of 40 and 70 may experience ED.

FACT-7 ERECTILE DYSFUNCTION IS NOT A PERSONAL PROBLEM

ED often leads to anxiety, depression, loss of self-esteem, and diminished quality of life. It can cause mental stress that can affect a man's interactions with family and associates, and can lead to depression, loss of self-esteem, and increased anxiety or tension with one's partner. ED should be viewed as a problem that affects both the man and his partner, not simply as an individual man's personal problem in attaining an erection.

HOW TO GET CLOSE AGAIN

If you haven’t had sex in a little while, keep in mind that your partner may be nervous. It may take a few tries before you see results. That’s why it’s important not to give up if ED medication doesn’t work the first time.

One study looked at a group of men with ED who were not successful with ED medication the first time. These men talked to their doctors, who adjusted their dose and explained the right way to take ED medication. When most of these men tried ED medication again, they had success.

GET HIM IN THE MOOD

Help your partner get results.

Make him feel comfortable about having sex again. Try talking about the issue and be supportive of his desire to improve his sex life.

Also, take your time when it comes to sex. Your partner may have better success if he is relaxed. Spend some time just being close together.

Enjoy the connection you have when you are physical. Who knows where this may lead

HOW WOMEN CAN HELP THEIR PARTNER TO FIGHT ERECTILE DYSFUNCTION

Your partner will probably benefit more from treatment than you think. That’s because erectile dysfunction (ED) can have a serious effect on your partner’s self-image. It can even make him think that he is less of a man.

Studies show that ED is associated with a loss of self-esteem and even depression. Your partner may be avoiding intimacy so he can escape these negative emotions.

All these factors can put a strain on your sexual relationship

BE SUPPORTIVE

Let your partner know that information and treatment options are available to him. Be clear when you talk to your partner. He may misread subtle cues urging him to find treatment. If you’re looking for a way to bring up the subject

Try one of these

“It seems everyone is talking about ED medication these days. Would you want to try it? Just to see how it works.”

“Let’s work to improve our sex life. I know we can find ways to make it even better. What do you think about ED medication?”

“I read that women are very satisfied with how ED medication works for their partner. Would you be willing to try it for me? And for us?”

WHAT WOMEN SHOULD KNOW ABOUT THEIR PARTNER’S MEDICATION FOR ERECTILE DYSFUNCTION

When using ED medication, your partner must be sexually excited to get an erection. If he takes ED medication and is not sexually stimulated, nothing will happen. ED medication is not an aphrodisiac or a hormone. It’s a medicine that treats the physical problem of erectile dysfunction (ED), also known as impotence.

SAFETY AND ERECTILE DYSFUNCTION

ED medication has been shown to successfully treat erectile dysfunction (ED) in millions of men. But remember, no medicine is for everyone.

If your partner uses nitrate drugs, often used to control chest pain (also known as angina), he should not take ED medication. Since ED medication also reduces blood pressure, his blood pressure could suddenly drop to an unsafe level

Your partner should discuss his general health status with his doctor to ensure that he is healthy enough to engage in sexual activity. If he experiences chest pain, nausea, or other discomforts during sex, he should seek immediate medical help.

Although erections lasting for more than four hours may occur rarely with all ED treatments in this drug class, it is important to seek immediate medical attention. Erections lasting longer than six hours can result in long-term loss of potency

Be safe. Make sure to protect you and your partner from sexually transmitted diseases

The most common side effects of ED medication are headache, facial flushing, and upset stomach. Less common are bluish or blurred vision, or being sensitive to light. These may occur for a short time

WHAT WOMEN SHOULD KNOW ABOUT THEIR PARTNER’S ERECTILE DYSFUNCTION

Is your sex life with your partner not what it used to be? Has he had any problems performing sexually? Maybe it’s been only once in a while. Maybe more often. Either way, it can hurt his confidence. It can also take a toll on your relationship.

What you should know about Erectile Dysfunction (ED)

The first thing you should know is that you and your partner are not alone. Millions of men have some form of ED. It happens when a man doesn’t get enough blood to his penis.

This means he cannot get or keep an erection for successful sex. ED is a common, and often misunderstood, condition.

In fact, over half of all men over 40 have ED to some degree. And many men don’t realize they have it.

Your partner may feel less embarrassed about getting help if he knows that ED is a real medical condition. It may be caused by another health issue such as:

High blood pressure
High cholesterol
Diabetes
Heart disease
Enlarged prostate
Depression

For most men, ED is treatable. ED medications treat ED by increasing the blood flow where your partner needs it. If you think your partner may have ED, encourage him to talk to his doctor today

HOW TO START THE CONVERSATION ABOUT ERECTILE DYSFUNCTION TO YOUR DOCTOR

TAKING HELP OF A DOCTOR

Want to improve your sex life? Talk to your doctor about ED medication.

Bringing up your sexual health doesn’t need to be stressful. Today, doctors have a lot of experience helping men improve their erections. To them, it’s no different from helping patients with any other health issue—like a bad headache or a sprained ankle

There are a number of ways to start talking with your doctor about sexual health. Go with what makes you most comfortable.
Your doctor will know right away that you are looking to improve your sexual performance.

Try on of the following

“Can you tell me how ED medication works?”

“Should my sex life be slowing down?”

“Every so often I have a problem getting an erection. What does this mean?”

“I don’t know what’s wrong, but I haven’t been able to perform in bed lately”

“I have high blood pressure. I heard it can cause erection problems. Is this true?”
(You can also replace “blood pressure” with other medical conditions like “diabetes”)

“Could the medicine I take cause me to have erection problems?”

Be open and honest with your doctor about what’s bothering you. This will help your doctor provide the best treatment. Also be sure to:

Review any medicines that you are currently taking
Tell your doctor about over-the-counter medicines that you use
Tell him or her about any vitamins and supplements you take

HOW TO DEAL WITH ERECTILE DYSFUNCTION?

The good news is that for most men, ED is treatable. Treatment options for ED include injection of medications that dilate blood vessels into the urethra or penile tissue, vacuum constriction devices (that use a vacuum pump to draw blood into the penis until it is rigid), penile prosthetic implants, vascular surgery, hormonal therapy, some topical (e.g., nitroglycerine) or oral (e.g., yohimbine) agents. Now, oral phosphodiesterase inhibitors are available for the treatment of ED.

It is also important to note that the underlying cause of ED has to be treated. Besides, some patients may require a change in their medication, if the medication is suspected to be the cause of ED.

Be sure to get the right treatment. When you talk to your doctor about improving your erections, ask for a treatment that:

Can help you achieve harder erections

Can help you maintain your erection during sex

Works when you need it most

Can increase your partner’s satisfaction with your erections

Has a strong safety record

Works for most men with ED who also have a wide range of health issues

REALITY OF ERECTILE DYSFUNCTION

When men have erection difficulty, they usually don’t know the real issue. Men often make excuses. Do any of these look familiar?

“Well, it just happened a few times. It’s no big deal”

“It’s because I’ve been so stressed lately”

“I’m too tired for sex anyway”

“I’m way too young to have a problem. It must be something else”

“It’s all in my head”

“Maybe if I didn’t have so many drinks...”

If you have a problem getting or keeping an erection, your sex life can suffer. You should know that you’re not alone. In fact, more than half of all men over 40 have difficulties getting or maintaining an erection

ALL THAT YOU EVER WANTED TO KNOW ABOUT ERECTILE DYSFUNCTION

What is Erectile Dysfunction?
ED occurs when there is a lack of blood flow to the penis. This means that a man can have trouble getting and keeping an erection long enough to have sex. It may happen only once in a while, or more often.

What are types of Erection?
Erection can be classified in the following 4 grades:
GRADE 1 - Penis is larger, but not hard
GRADE 2 - Penis is hard, but not hard enough for penetration
GRADE 3 - Penis is hard enough for penetration, but not completely hard.
GRADE 4 - Penis is completely hard and fully rigid.

What causes an Erection?
Usually when a man is sexually excited:
1. The brain sends an impulse to the penis telling the penis to relax. This is caused by physical or mental stimulation.
2. The arteries in the penis respond and widen. This allows more blood to flow into the penis.
3. The arteries expand and then harden.
4. The veins that carry blood away from the penis get compressed. This restricts the blood flow out of the penis.
5. More blood flows in. And less flows out. This makes the penis larger and causes an erection.

What is the physiology of Erection?
The physiological process of erection begins in the brain and involves the nervous and vascular systems. Physical or psychological stimulation (arousal) causes nerves to send messages to the vascular system, which results in significant blood flow to the penis. Because blood must stay in the penis to maintain rigidity, erectile tissue is enclosed by fibrous elastic sheaths (tunicae) that cinch to prevent blood from leaving the penis during erection. When stimulation ends, or following ejaculation, pressure in the penis decreases, blood is released, and the penis resumes its normal shape.

What causes Erectile Dysfunction (ED)?
ED can happen at any age. There are many other factors which may lead to ED.

Diabetes
Diabetes is a condition where there is too much glucose (sugar) in the blood. Over time, high blood sugar levels can damage nerves and blood vessels, like those that produce erections. When this occurs, diabetes often leads to erection difficulties.

Prostate Problem
The prostate is a small gland near your bladder. It is in proximity to the nerves that are involved for erections. That's why certain surgeries for prostate problems can lead to ED.

Depression
For men with depression, the cause of ED may be psychological, physical, or both. ED can lower self-esteem and put a strain on your relationship with your partner. What's more, certain medicines that treat depression can also cause ED.

Spinal Injury
An injury to the spine can affect almost every function in the body. For men with spinal injuries, ED is the most common sexual problem.

Does certain medication cause ED?
There are many medicines that can cause ED. Some of the most common are: Certain blood pressure-lowering medicines, some heart condition medicines, some cancer medicines and certain medicines for depression.

StressStress and anxiety can affect your ability to get an erection. However, these factors are often not the primary cause of ED. It's more likely to be a physical problem. When a physical problem causes erection difficulty, men become more anxious about sex. This can increase the severity of ED.

Smoking and Alcohol
Smoking and drinking too much alcohol can lead to ED. The good thing is, these are factors you can control. If you smoke, you should consider stopping. Smoking can cause cancer, emphysema, chronic obstructive pulmonary disease (COPD), and other illnesses. It can also cause damage to blood vessels. This may prevent blood flow to the penis. For men with other ED risk factors, smoking doubles their chances of having ED.

Diagnosis
A medical examination may indicate neurological, vascular, hormonal disease, or Peyronie's disease. History of illness, smoking, drug use and hypertension can be ascertained with a thorough examination of health history. Laboratory tests are performed to identify the underlying cause.

Heart Disease
Heart disease is also called coronary artery disease. For a person with heart disease, blood does not flow as easily as it should throughout the body. That's because the arteries are clogged or narrowed. This may prevent blood from getting to the penis. The result can be less rigid erections.

High Cholesterol
High cholesterol can clog your arteries. As a result, it can affect your sexual health.

High Blood Pressure
High blood pressure makes the heart work harder. This puts strain on the blood vessels. The blood vessels may harden and narrow. This can prevent blood from getting to the penis. It can also make it more difficult to get an erection.

Erectile Function Tests
Tests that assess erectile function examine the blood vessels, nerves, muscles and other tissues of the penis and pelvic region. Ultrasound: Ultrasound is used to evaluate blood flow, venous leak, signs of artherosclerosis and scarring or calcification of erectile tissue. Ultrasound is then used to see vascular dilation and measure penile blood pressure (which may also be measured with a special cuff). Measurements are compared to those taken when the penis is flaccid.

Prostate Examination
An enlarged prostate can interfere with blood flow and nerve impulses in the penis. Penile nerve function tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis.
A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus

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