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Erectile Dysfunction : A man is considered to have erectile dysfunction when he has regular difficulty in getting or maintaining a firm enough erection to be able to achieve sexual penetration, or which interferes with non-penetrative sexual activity. Communication difficulties and relationship stresses can lead to problems initiating or maintaining an erection.
Most men have occasionally experienced some difficulty with their penis becoming hard or staying firm, but this is not normally cause for a diagnosis of erectile dysfunction. This condition is only considered a concern if satisfactory sexual performance has been impossible on a persistent number of occasions for some time.
Broadly, two forms of erectile dysfunction can affect men's sex lives - the main cause is either medical or psychosocial.
Here, psychosocial refers to the psychological effects - including the effects of social relationships on sexual performance. Medical conditions can also affect psychological wellbeing, meaning that, while the primary cause of sexual impotence is typically either medical or psychological, there is often overlap between the two.
A healthy lifestyle can prevent erectile dysfunction since the problem can be caused by preventable conditions such as diabetes and vascular disease.
Causes of erectile dysfunction: To understand the causes of erectile dysfunction, it helps to understand how an erection happens physically. Relaxation of muscle (in parts of the penis and the walls of the arteries supplying it) allows blood to rush into the cylinder-shaped spongy tissue of the erection chambers, creating increased tissue pressure and an erection. Valves prevent the blood from flowing back out through the veins (which would cause a venous loss of pressure), and the resulting hardness persists until stimulation stops or ejaculation occurs. This blood flow process is led by nervous and hormonal triggers activated when the brain is stimulated by touch or other stimuli; such brain signals can be suppressed by anxiety.
Psychological causes of erectile dysfunction: In rare cases, erectile dysfunction has always been present, with a man never having achieved an erection. This is called primary ED, with the cause almost always psychological if there is no obvious anatomical deformity or physiological issue that could be causative; such psychological factors can include:
Guilt, Fear of intimacy, Depression, Severe anxiety
Most cases of erectile dysfunction are 'secondary', i.e. erectile function has been normal, but is now problematic. Causes of a new and persistent problem are usually physical; less commonly, psychological factors cause or contribute to erectile dysfunction, with such factors ranging from treatable mental health illnesses, to everyday emotional states that most people experience at some time or another.
Some psychological causes can also cause temporary erection problems that would not be classed as erectile dysfunction, while others may be related to a particular place, time, or partner.
The psychological causes include:
Depression: Which can cause a loss of interest in sex (lower libido) as well as erectile dysfunction and other mental health disorders as well.
Stress, fear, anxiety, or anger: Stress can include work, financial, and emotional problems.
Performance anxiety: Repeated feelings of doubt and failure in which worrying about getting an erection can cause a cycle of anxiety that prevents one from being possible.
Poor communication with a sex partner.
Other relationship problems such as pressure from a sex partner for example, because expectations make sex a task instead of a pleasure.
Erectile dysfunction can also be caused by atherosclerosis - the thickening of the walls of the arteries that causes them to narrow and lose elasticity, restricting blood flow. The smaller arteries in the penis are usually first affected by atherosclerosis - damage to the lining of the arteries (medically known as endothelial dysfunction) - as even a small amount of narrowing in these arteries can affect circulation. The early damage of atherosclerosis prevents the arteries to the penis from dilating (widening) properly, in turn preventing the penis from filling with blood and so becoming hard.
One of the main reasons for erectile dysfunctions is medications used for various problems like:
Drugs to control high blood pressure (antihypertensive)
Heart medications, Some diuretics.
Drugs that act on the central nervous system, including some sleeping pills.
Anxiety treatments, Antidepressants.
Some cancer drugs, including chemotherapeutic agents
Prostate treatments, including treatments for cancer, and for benign prostatic hypertrophy. Anti-androgen drugs used for prostate disease and other conditions, can also cause erectile dysfunction
Anticholinergics - drugs with a wide range of uses that block a neurotransmitter (nerve signal molecule) that affects muscle tone
Hormone drugs, including estrogens and drugs that act on luteinizing hormone-releasing hormone
The peptic ulcer medication
Organic (physical) causes account for some 90% of true (persistent) cases of erectile dysfunction, with psychological causes much less common
Premature Ejaculation: The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation. Premature ejaculation can be classified as:
Lifelong (primary): Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters.
Acquired (secondary): Acquired premature ejaculation develops after you've had previous sexual experiences without ejaculatory problems.
Many men feel that they have symptoms of premature ejaculation, but the symptoms don’t meet the diagnostic criteria for premature ejaculation. Instead these men might have natural variable premature ejaculation, which includes periods of rapid ejaculation as well as periods of normal ejaculation. Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It is common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem. Occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.
Causes: These are mainly psychological causes. Psychological factors that might play a role include:
- Early sexual experiences
- Sexual abuse
- Poor body image
- Worrying about premature ejaculation
- Guilty feelings that increase your tendency to rush through sexual encounters
- Erectile Dysfunction
Men who are anxious about obtaining or maintaining an erection during sexual intercourse might form a pattern of rushing to ejaculate, which can be difficult to change. You might be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection might cause you to consciously or unconsciously hurry through sexual encounters.
Stress: Emotional or mental strain in any area of your life can play a role in premature ejaculation, limiting your ability to relax and focus during sexual encounters.
Anxiety: Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.
Relationship problems If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problems.
Biological causes: A number of biological factors might contribute to premature ejaculation, including:
- Abnormal hormone levels
- Abnormal levels of brain chemicals called neurotransmitters
- Inflammation and infection of the prostate or urethra
- Inherited traits
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