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Erectile dysfunction

What is erectile dysfunction?

All men have difficulties with erections from time to time. The occasional failure to get or maintain an erection, which lasts long enough to have sex, can occur for a variety of reasons, including drinking too much alcohol or being very tired. The inability to get or maintain an erection less than 20% of the time is not unusual.

Erectile dysfunction (ED) is the inability to get or maintain an erection 25% or more of the time. Some men with ED find they are completely unable to achieve an erection, others have an inconsistent ability to achieve an erection, and still others experience only brief erections. ED is a frustrating condition that can have physical or psychological causes. ED can be the first sign of an underlying health condition that needs treatment, so seeking medical evaluation is important.

ED is also different from a lack of sexual desire or problems with ejaculation and orgasm. (If you are able to get an erection but then it goes away because you ejaculate more quickly than you would like

How common is it?

The problem can occur at any age, but the older a man gets, the greater the chance that he will have a health problem that results in ED.

In young men, erectile dysfunction is less common and when it does occur is more likely to have a psychological cause such as stress or performance anxiety.

How does an erection occur?

For an erection to occur, several parts of the body must work together. The brain sends messages to control the nerves, hormone levels, blood flow and muscles that cause an erection. If anything interferes with these messages, or if any part of the system doesn’t function correctly, an erection won’t occur.

The penis has two sponge-like cylindrical structures that run along its length, parallel to the urethra (the tube that carries semen and urine). During sexual arousal, these cylinders become engorged with blood, straightening and stiffening the penis. Continued sexual arousal maintains the higher rate of blood flow into the penis and limits the flow out of the penis, keeping the erection firm. After ejaculation or when the sexual excitement passes, the excess blood drains out of the spongy tissue and the penis returns to its non-erect size and shape.

What are the psychological causes of erectile dysfunction?

A number of things can interfere with sexual feelings and lead to or exacerbate erectile dysfunction. These can include:

  • depression
  • anxiety
  • history of physical, emotional, or sexual abuse
  • stress
  • fatigue
  • poor communication or conflict with your partner

Erectile dysfunction as a result of a psychological cause tends to develop rapidly and be related to a recent situation or event. You may find you are able to have an erection in some circumstances but not in others. If you are generally able to experience or maintain an erection when you first wake up in the morning this can suggest that the problem is psychological rather than physical.

What are the physical causes of erectile dysfunction?

While thoughts and emotions always play a role in getting an erection, erectile dysfunction is most often caused by something physical, such as a chronic health problem or the side effects of a medication. The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.

A variety of physical risk factors can contribute to erectile dysfunction. Factors that may be present for younger men include:

  • Substance abuse.
  • Chronic use of alcohol, marijuana or other drugs can cause erectile dysfunction and decreased sexual drive.
  • Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.
  • Smoking: It can cause erectile dysfunction because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop erectile dysfunction.

Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone.

Taking certain medications. A wide range of drugs — including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer — can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.

Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.

Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.

Metabolic syndrome. This syndrome is characterized by unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.

When should I seek treatment?

Whether the cause is physical factors or psychological factors or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you — and your partner(s). If erectile dysfunction is more than a temporary, short-term problem, see your medical provider.


Premature Ejaculation

What is premature ejaculation?

Many men sometimes ejaculate sooner than they or their partner would like. If it just happens occasionally, it's probably not something to worry about. However, if you regularly ejaculate sooner than you and your partner would like, such as before intercourse begins or soon afterward, you may have a condition known as premature ejaculation. Although the issue is often phrased in terms of time (i.e., I’m ejaculating within thirty seconds after starting intercourse), the issue is really about voluntary control of the ejaculatory process.

What is the average time until ejaculation?

In assessing whether you have premature ejaculation, it can be important to ask whether your own or your partner’s stamina expectation is realistic. Keep in mind that the average time from insertion to ejaculation is less than three minutes.

If your partner is a woman, remember that female orgasm doesn’t occur automatically as a result of prolonged intercourse. Surveys tell us that only about one fourth to one half of women regularly orgasm during intercourse. Most women find it is easier to be orgasmic with manual or oral stimulation than through intercourse.

How common is it?

Premature ejaculation affects about one out of three men. It is the most common male sexual problem, particularly among younger men.

What are the causes?

Premature ejaculation can have both psychological and biological causes.

Psychological causes

Early sexual experiences may establish a pattern which is difficult to change. First experiences of sexual intercourse often involve excitement mixed with anxiety and a demand to perform quickly in order to avoid being discovered. Your focus might be on your performance rather than on the pleasurable and erotic aspects of the experience. Most males reach orgasm very quickly the first time they have intercourse. Although most men also learn to slow down, to enjoy their own and their partner’s pleasure, and become comfortable and confident with sexual intercourse, early ejaculation continues to be a problem for about 30 percent of men.

Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance, or anxiety caused by other issues. In general, linking sex and performance, rather than sex and pleasure, can be problematic. In developing ejaculatory control, you might find that it is best to focus on what would bring pleasure to you and to your partner. It can also help to think of ejaculatory control as a skill that you and your partner develop together to enhance mutual satisfaction.

Premature ejaculation can also be related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate and have difficulty changing that pattern.

Biological causes:

A number of biological factors may contribute to premature ejaculation, including:

  • Abnormal hormone levels
  • Insufficient concentration of the neurotransmitter serotonin
  • Abnormal reflex activity of the ejaculatory system
  • Certain thyroid problems
  • Inflammation and infection of the prostate or urethra
  • Inherited traits

Rarely, premature ejaculation is caused by:

  • Nervous system damage resulting from surgery or trauma
  • Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Whether the cause is psychological or biological, treatments including medications, counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner(s).


Prostate Cancer

What is cancer?

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong -- cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous.

What is prostate cancer?

The prostate is a male sex gland, about the size of a large walnut. It is located below the bladder and in front of the rectum. The prostate's main function is to make fluid for semen, a white substance that carries sperm.

Prostate cancer occurs when a tumor forms in the tissue of the prostate. In its early stage, prostate cancer needs the male hormone testosterone to grow and survive.

What causes prostate cancer?

Scientists don't know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases your chances of getting a disease.

What are the symptoms of prostate cancer?

  • a need to urinate frequently, especially at night
  • difficulty starting urination or holding back urine
  • inability to urinate
  • weak or interrupted flow of urine

If prostate cancer develops and is not treated, it can cause these symptoms:

  • painful or burning urination
  • difficulty in having an erection
  • painful ejaculation
  • blood in urine or semen
  • pain or stiffness in the lower back, hips, or upper thighs

What Can You Do About It?

  • Regular physical exams and a simple blood test (called a PSA test) are the keys to early diagnosis you can start having regular physical exams and PSA tests in your mid-40s.
  • If you have a family history of prostate cancer, you should start having regular tests earlier.
  • Early diagnosis will allow you to have early treatment, if this is necessary. If prostate cancer is diagnosed and treated early, then your risk of dying from this illness is small. If prostate cancer is diagnosed late (when it has spread to other parts of the body), then prostate cancer cannot be cured.