Erectile dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.
While research suggests that Erectile dysfunction is common, it is a topic that many people are hesitant to discuss. Because treatment options are available, it is important to share your concerns with your partner and health care provider.
Emotional factors affecting sex include both interpersonal problems and psychological problems within the individual. Interpersonal problems include marital or relationship problems or lack of trust and open communication between partners. Personal psychological problems include depression, sexual fears or guilt, or past sexual trauma.
Erectile dysfunction are more common in the early adult years, with the majority of people seeking care for such conditions during their late 20s through 30s. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of male sexual dysfunction.
Erectile dysfunction generally is classified into four categories:
- Desire disorders —lack of sexual desire or interest in sex
- Arousal disorders —inability to become physically aroused or excited during sexual activity
- Orgasm disorders —delay or absence of orgasm (climax)
- Pain disorders — pain during intercourse
Who is affected by erectile dysfunction?
Erectile dysfunction can affect any age, although it is more common in those over 40 because it is often related to a decline in health associated with aging.
- Inability to achieve or maintain an erection suitable for intercourse (erectile dysfunction)
- Absent or delayed ejaculation despite adequate sexual stimulation (retarded ejaculation)
- Inability to control the timing of ejaculation (early or premature ejaculation)
- Inability to achieve orgasm
- Inadequate vaginal lubrication before and during intercourse
- Inability to relax the vaginal muscles enough to allow intercourse
In men and women:
- Lack of interest in or desire for sex
- Inability to become aroused
- Pain with intercourse
What causes erectile dysfunction?
Physical causes — Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual function.
Psychological causes — These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image, and the effects of a past sexual trauma.
How is erectile dysfunction diagnosed?
In most cases, the individual recognizes that there is a problem interfering with his or her enjoyment (or the partner’s enjoyment) of a sexual relationship. The clinician likely will begin with a complete history of symptoms and a physical. He or she may order diagnostic tests to rule out any medical problems that may be contributing to the dysfunction, if needed. Typically, lab testing plays a very limited role in the diagnosis of erectile dysfunction.
An evaluation of the person’s attitudes about sex, as well as other possible contributing factors (fear, anxiety, past sexual trauma/abuse, relationship concerns, medications, alcohol or drug abuse, etc.) will help the clinician understand the underlying cause of the problem, and will help him or her make recommendations for appropriate treatment.
How is erectile dysfunction treated?
Treatment for erectile dysfunction involves first determining the underlying cause. This includes dealing with obesity, smoking, cholesterol, and other risk factors for cardiovascular disease. In addition to modifying your lifestyle, there are several drugs available to treat erectile dysfunction, including Viagra, Levitra, and Cialis. Erectile dysfunction, also known as impotence, involves not being able to achieve or maintain enough of an erection to have sex. This is more than just a quality of life issue, though.
To sustain an erection, the penis needs good blood flow. Erectile dysfunction, therefore, “can be the first sign of significant cardiac or vascular disease. Studies have shown that the majority of men seen in the emergency room for a cardiac event such a heart attack or stroke suffered from erectile dysfunction three to five years earlier.
Top Most Common Health Issues
Physical Activity and Nutrition
Research indicates that staying physically active can help prevent or delay certain diseases, including some cancers, heart disease and diabetes, and also relieve depression and improve mood. Inactivity often accompanies advancing age, but it doesn’t have to.
Overweight and Obesity
Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, dyslipidemia and endometrial, breast, prostate, and colon cancers. In-depth guides and practical advice about obesity are available.
Tobacco is the single greatest preventable cause of illness and premature death in the U.S. Tobacco use is now called “Tobacco dependence disease.” The Centers for Disease Control and Prevention (CDC) says that smokers who try to quit are more successful when they have the support of their physician.
Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and alcohol, which can lead to serious health consequences. In addition, seniors may deliberately or unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens, many medical people fail to ask seniors about possible substance abuse.
Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between 1991 and 1996, AIDS in adults over 50 rose more than twice as fast as in younger adults. Seniors are unlikely to use condoms, have immune systems that naturally weaken with age, and HIV symptoms (fatigue, weight loss, dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can accompany old age. Again, stereotypes about aging in terms of sexual activity and drug use keep this problem largely unrecognized. That’s why seniors are not well represented in research, clinical drug trials, prevention programs and efforts at intervention.
Dementia is not part of aging. Dementia can be caused by disease, reactions to medications, vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There are many forms of dementia (including Alzheimer’s Disease) and some can be temporary. With accurate diagnosis comes management and help. The most common late-in-life mental health condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a surprising fact: The rate of suicide is higher for elderly white men than for any other age group, including adolescents.
Injury and Violence
Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to reduce injury include exercises to improve balance and strength and medication review. Home modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based fire prevention devices should be in place and easy to use. People aged 65 and older are twice as likely to die in a home fire as the general population.
Even though pollution affects all of us, government studies have indicated that low-income, racial and ethnic minorities are more likely to live in areas where they face environmental risks. Compared to the general population, a higher proportion of elderly are living just over the poverty threshold.
Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious infections, especially among women and the very old.
Access to Health Care
Seniors frequently don’t monitor their health as seriously as they should. While a shortage of geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and geriatric specialists of any medical community in the country. Your access to health care is as close as URMC, offering a menu of services at several hospital settings, including the VA Hospital in Canandaigua, in senior housing, and in your community.
Other treatment strategies include:
Medication — When a medication is the cause of the dysfunction, a change in the medication may help. Men and women with hormone deficiencies may benefit from hormone shots, pills, or creams. For men, drugs, including sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra) may help improve sexual function by increasing blood flow to the penis.
Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction (the inability to achieve or maintain an erection). A vacuum device (Eros) is also approved for use in women, but can be costly. Dilators may help women who experience narrowing of the vagina.
Sex therapy — Sex therapists can be very helpful to couples experiencing a sexual problem that cannot be addressed by their primary clinician. Therapists are often good marital counselors, as well. For the couple who wants to begin enjoying their sexual relationship, it is well worth the time and effort to work with a trained professional.
Behavioral treatments — These involve various techniques, including insights into harmful behaviors in the relationship, or techniques such as self-stimulation for treatment of problems with arousal and/or orgasm.
Psychotherapy — Therapy with a trained counselor can help a person address sexual trauma from the past, feelings of anxiety, fear, or guilt, and poor body image, all of which may have an impact on current sexual function.
Education and communication — Education about sex and sexual behaviors and responses may help an individual overcome his or her anxieties about sexual function. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.
The success of treatment for erectile dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a condition that can be treated or reversed. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.
Prevention for erectile dysfunction
Couples who are open and honest about their sexual preferences and feelings are more likely to avoid some erectile dysfunction. One partner should, ideally, be able to communicate desires and preferences to the other partner. People who are victims of sexual trauma, such as sexual abuse or rape at any age, are urged to seek psychiatric advice. Individual counseling with an expert in trauma may prove beneficial in allowing sexual abuse victims to overcome sexual difficulties and enjoy voluntary sexual experiences with a chosen partner.