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Most men have experienced difficulties with erection at some time in their lives. Alcohol, tiredness, stress or simply not being in the right mood at the right time may all lead to failure to achieve or maintain an erection. The most frequent cause of temporary problems is anxiety.

It is quite common for a man to achieve erection but not be able to maintain a sufficiently hard penis for sexual intercourse to take place. Surveys have suggested that 50% of men will experience erectile dysfunction and around 7% of men will experience persistent difficulties with erection during the course of their lives. As men get older, the incidence of problems increases, but that should never deter anyone from seeking help.

It is estimated that as few as 10% of men with erection problems seek assistance, despite the fact that treatment and support can be highly effective. The first source of help is your GP. If necessary, a referral to another health professional can be organised.

The latest thinking among experts in this area is that in 70% of cases there is a physical cause for erection problems. Psychological causes are responsible for the other 30% of cases. If a man still has the occasional erection e.g. when he is asleep or first thing in the morning, there is a reasonable chance that the problem is psychological.

It can be difficult to break the cycle with sexual difficulties. Fear of failure and the pressure to succeed the next time is likely to worsen the problem. It is not unusual to become enveloped with feelings of self-doubt that are reinforced each time that sex does not work out and to feel that the cycle cannot be broken. Each failed act of intercourse becomes a powerful force that psychologically conditions the man to fail on each subsequent attempt.

If possible, you should discuss the situation with your partner. Failing to be open with your partner about your anxieties can exacerbate your problem and make your partner feel excluded or rejected. It is highly beneficial to have your partner's emotional support and understanding. It may help to have the partner accompany you to see the doctor.

Causes of erectile dysfunction
Circulation problems

To achieve an erection, it is necessary that blood flows to the penis and stays there. If there are circulation problems, there may be difficulties in maintaining an erection. Blockage of the blood supply to the penis is a common cause of erectile dysfunction. This is quite similar to blockage of the heart vessels in heart disease. Heavy smokers are particularly at risk from poor circulation and therefore problems with erection. Research has shown that men who smoke are more likely to encounter erectile problems than men who are non-smokers. New research also suggests that up to 11% of distance cyclists are prone to erectile dysfunction.

Diabetes
A large proportion of diabetics will experience ED at some stage, with the risk increasing as time goes by.
Diabetes can affect blood vessels and nerves in various parts of the body and is a major cause of erection problems. Diabetes has an impact on both blood supply to the penis and the nervous control needed to maintain an erection. It can affect the autonomic nerves which are responsible for controlling bodily functions. This can lead to a lowering of male sexual potency. It is a good idea for those with diabetes to have an open discussion with their GP about sexual problems associated with the condition.


Excessive drinking

Unfortunately 'brewers droop' is not a myth. It is estimated that excess alcohol consumption causes about one in six cases of erectile dysfunction. Contrary to popular belief alcohol is a depressant drug and although it may lessen sexual inhibitions it may also reduce sexual arousal. It is worth cutting back on your drinking to see if this has any impact on the problem.

Drugs
One of the side effects of certain groups of drugs is a problem with erection. Drugs for treating high blood pressure, depression, or some ulcer healing drugs and anticonvulsants can cause erectile dysfunction. Drugs that contain the female hormone oestrogen or medications to counteract testosterone may also cause problems. Illegal drugs like cocaine may also interfere with ability to maintain an erection.

Conditions of the penis
There are a number of conditions affecting the tissues in the penis that if left untreated, will have an impact on the ability to maintain an erection. These include Peyronie's Disease (bent penis) balanitis (inflamed glans or head of penis) and untreated priapism (where erection lasts for hours becoming very painful). Infections, including sexually transmitted diseases may also lead to problems.


Neurological conditions
With spinal injury, multiple sclerosis or tumours there is an impact on the nerve supply to the penis which can cause erection problems.

Surgery
Sometimes surgery to the prostate or pelvis where there has been nerve or tissue damage may cause erectile dysfunction.

Serious illness
A range of serious illnesses may cause erectile dysfunction. These include liver or kidney disease, heart attack, heart failure, chest problems, injury or major surgery. Some people may be so weakened by their condition that they simply lack the stamina for intercourse.

Psychological causes
There are a number of possible underlying psychological causes. These include:
• Depression
• Anxiety
• Fear of failure because of recent problems with erection
• Relationship problems or marital disharmony
• Loss of attraction to partner
• Bereavement
• Stress or tiredness
• Confusion about sexual orientation (e.g. unresolved gay feelings)
• Pressure to perform
• Premature ejaculation
• Guilt or 'hang-ups' about sex
• Child or adult sex abuse

Treatment
There is a range of treatments available and success rates are very high. Seeking help from your doctor is half the battle. Methods include prescription treatment, injections or devices.

 

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Welcome | How your doctor can help | What to say to your doctor | How the penis works | Sex drive
What causes erection problems? | Treatment of erectile problems | Medicines and your sex life
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