Erection problems, or the clinical designation erectile dysfunction (ED), is still often referred to as impotence by many. The problem is the male has an inability to sustain an erection that is firm enough to enter the vagina during intercourse.  Erection dysfunction also focuses on the inability to remain firm enough for the completion of intercourse to his satisfaction and often to his partner's. It can be caused by medical problems such as diabetes, hypertension, or by surgery to prostate cancer.  Psychological factors can also get in the way of the sexy thoughts required to get and maintain an erection during sex.

As many as 10 or 20 million men, especially older individuals, suffer from erectile dysfunction. The recent release of Viagra in 1998 has made erectile dysfunction, or erection difficulties as the T.V. advertisements say, a household word and changed the way couples view ED.  Recently Levitra and Cialis have joined the market.

For males to get an erection during the first part sexual response cycle there must be sexual desire and sexy thoughts.  Unfortunately, sexual desire can be affected by factors ranging from brain tumors to depression or fear to medications.  It is also not uncommon for a male that is inexperienced or has infrequent sex to suffer from erection problems.

Desire and sexy thoughts are the key to getting and maintaining an erection, when there are no physical reasons present.  The mind must be immersed in sexy thoughts to engage in sex.  The second part of the sexual response cycle, for the male, is erection of the penis. It becomes firm because it is engorged or fills up with blood caused by an increase of blood flow to the penis which is also trapped there.   A similar process actually occurs in the female, and it's her vagina that becomes filled with blood, and that allows the wetness,  or lubrication, that occurs that allows her to be more prepared for intercourse. Blood vessels and tubes have to open up enough to carry the blood into the penis when nerves tell them to open. If either the vessels do not open or they do not get a signal to open the penis will not get firm. If there is a signal but the vessels do not open up enough or the blood does not stay trapped in the penis, the erection may not be firm enough to satisfy the male or his partner. 

The next part of the sexual response cycle is orgasm and ejaculation. Orgasm is marked by muscular contractions with ejaculate from the penis carrying the sperm.  Following orgasm is resolution which is the final part of the sexual response cycle.  The trapped blood is released and the vessels receive a signal to close up.  Resolution in the male is marked by the male not being able to get an erection until the sexual systems have recharged.  This can be a few minutes or hours for young male and up to several days for an older male.

Sex therapy focuses on getting the brain immersed in sexy thoughts and the pursuit of pleasure by decreasing interfering thoughts and finding ways to stay immersed in the sexy thoughts.  It addresses the sexuality of the couple. Strict adherence to sex therapy protocols do not necessarily address the communication and relationship issues.  In order to achieve and maintain an erection the male must be able to keep from focusing on his penis and how it is doing.

Medical treatment for ED focuses on the penis and how to get it to do what it is suppose to do.  In addition to Viagra (Levitra and Cialis), the penis can be isolated and treated by injection of alprostadil (or a pellet containing alprostadil can be inserted into the urethra), or use of a vacuum pump.  These treatments do not take into account the sexuality of either partner or the resulting changes the relationships. The combination of one of the medications mentioned above and the use of the vacuum pump have proved to be beneficial for many men trying this combination.  Ask your urologist about the options that may be best for you. 

I believe the most effective treatment is to combine sex therapy, medication therapy, and couples therapy to address ED.  It is clearly a couples issue in a committed relationship.  And with that view must be treated as a couples problem.  The barriers to treating to ED are being reduced today by the internet and open advertising on television.  I often get email from an individual talking about the unconcerned or joking manner their doctor used when the individual tried to get help in overcoming ED.  Viagra is readily available through on line consultations and prescriptions (for more information follow this AmeriMed link).  There are many online information resources, such as Just Ask Earl, on sex problems and sex therapy is available on line for those that do not have access to a sex therapist. Click on this e-sextherapy link to go there now. 

Among the self-help resources that I recommend are Dr. Bernie Zilbergeld's book, The New Male Sexuality, and the video, A Man's Guide to Stronger Erections,  are readily available for those wanting try to overcome ED without therapy or medication. 

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