Erectile Dysfunction (Impotence)
What is erectile dysfunction?
Erectile dysfunction (ED) is the frequent inability to get or keep an erection that allows sexual activity with some form of penetration. More generally though, we can define it as frequently having difficulty in obtaining and maintaining an erection when in a sexual situation. It is not a disease, but is a symptom of another physical or psychological issue. ED is not the same as having a low libido (interest in sex) or not being able to achieve an orgasm. Occasional inability to maintain an erection is normal for men of all ages, though this does not constitute ED. How common is ED?
ED is quite common amongst men of al ages but the incidence increases with age. A recent study suggested
that one in five men over 40 experience ED.
What causes ED?
There are many factors which may contribute to ED. Even if there is a single specific cause, there are usually a number of factors which can make ED problematic. If ED is occurring frequently there is usually a physical cause. Most diseases which affect blood supply, testosterone levels or the nervous system can have an impact on erectile functioning, for example diabetes or blood vessel diseases. Furthermore, low testosterone is commonly seen in men with HIV. Various medications can have an impact on the functioning of the penis such as antidepressants, some blood pressure tablets and some protease inhibitors. Recreational drug use, cigarette smoking, alcohol intake and poor nutrition can also have an impact on erectile functioning. Regardless of whether there is a physical cause, psychological factors can have a significant impact on erectile functioning. Being anxious about sexual performance can often cause or contribute to ED. Other psychological factors can impact on erectile functioning such as depression, stress, lack of sleep, more general anxiety and worries about family, work etc. Issues within a relationship can also have a significant impact on sexual functioning in general, and erectile functioning specifically. If there is still an involuntary erection during the night or in the morning (nocturnal penile tumescence or “morning glory”) the ED is more likely to be related to psychological issues.
ED should be medically investigated by a doctor. Even if the person doesn’t want to have sex, ED can be a symptom of an underlying condition, such as heart disease, and should be investigated. The doctor wil take a medical and sexual health history and conduct a physical examination. You may be required to give a urine sample and have blood col ected for testing. As mentioned above, regardless of whether ED has a physical cause, psychological factors almost inevitably play a role. A discussion with a psychologist can help address any issues which may be causing or contributing to the ED. Advice from a nutritionist on maintaining a healthy diet may also be of benefit. How can it be treated?
There are a number of physical and psychological treatments available for ED. Oral medications, such as Viagra, Cialis or Levitra are effective in around 70% of men and can help regardless of whether the cause is physical or psychological. There are also injections which can help with an erection. Furthermore, changing medications you may already be on (such as an antidepressant) may improve erectile functioning. A certain percentage of people wishing to have an erection, particularly as they age, have lower levels of testosterone. Hormone therapy can have a significant impact on ED if this is the issue. There are also various devices, such as vacuum pumps and implants, which may improve erectile functioning. Psychological treatments for ED include assistance in changing lifestyle factors, such as reducing drug or alcohol intake. Specially trained clinicians, such as psychologists and counsellors, can help with strategies to control stress and are able to treat depression, anxiety and sleep problems as well as other similar issues. They can also help by suggesting specific sexual techniques which can aid in reducing anxiety and improving sexual functioning, including erectile functioning. Work can be done with couples to improve communication and relationship satisfaction. Who to contact?
The Albion Centre can provide free medical, psychological and nutritional assistance around ED to people
living with, or at risk of, HIV. In other cases we are also able to provide referral to other services. Please
contact reception and ask to speak to “Intake” on: 9332 9600
. For more information or support please contact The Albion Centre’s Psychology Unit on 93329600
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