Impotence is the inability to get and keep an erection hard enough to have sex. Many men experience difficulties getting an erection when they are tired or stressed. This is normal and it doesn’t require treatment. However, if you encounter problems that persist, you may be suffering with a degree of impotence. Impotence is a very treatable condition and help is available either when you visit your local GP or an online doctor.
Psychological Causes of ED – Between 10% and 20% of ED cases have a psychological cause. Because arousal starts in the brain, psychological issues can be a significant contributing factor to erectile dysfunction. Mental health conditions like depression or anxiety can negatively impact your libido, making it more difficult for you to become aroused.
Some men should not take PDE5 inhibitors. They can cause hypotension (abnormally low blood pressure that can lead to fainting and even shock) when given to patients who are taking nitrates (medications taken for heart disease). Therefore, patients taking nitrates daily should not take any of the PDE5 inhibitors. Nitrates relieve angina (chest pain due to insufficient blood supply to the heart muscle because of narrowing of the coronary arteries); these include nitroglycerine tablets, patches, ointments, sprays, and pastes, as well as isosorbide dinitrate and isosorbide mononitrate. Other nitrates such as amyl nitrate and butyl nitrate also are in some recreational drugs called "poppers."
I’m going to share a secret with you. I understand that for men it’s a big (well, perhaps flaccid and at least momentarily small) deal when you can’t get hard. However, in most instances, women don’t give a fuck. We’re understanding creatures who (ahem) know a thing or two about not being able to get off every time. To ease the awkwardness, here are a few go-to phrases to drop when you just can’t get it up.
The history can be useful in distinguishing organic from psychogenic impotence (Table 187.1). The patient with organic impotence describes problems with erection that progress over months to years. At first, the patient will have partial erections or seemingly firm erections that become flaccid during intercourse. With time, total erectile failure ensues. Organic impotence is constant and nonselective, meaning it is not better or worse with any specific partner or any type of stimulation.
#2 Physically exhausted. If you’ve been cranking it at the gym, haven’t been sleeping well, or you’ve been working your ass off at your job, getting tangled up with your lover for even more physically demanding activities may not sound ideal. Physical exhaustion has a direct effect on your ability to get aroused. The only fix for this one is to get some rest.
Frankly, I sympathize with you: He’s got a bad credit history (and likely a history of making similarly poor financial decisions) and you are anxious to pay this debt back before anything else, to the extent that you’re “basically” spending your whole paycheck on debt. Should he be paying more right now? Maybe he should pay more — but, then again, maybe it’s not all or nothing: Maybe you could compromise.
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So here’s something that’s really fascinating. Healthy eating is a way to reduce anxiety and stress. Now how, you may be asking, right? Well, think about it. We live in a world where there are so many variables and where we don’t have control over our lives. But now, with healthy eating, we have control over what goes into our body. And now having that control empowers us to be even healthier, to be more directive in what we do. And certainly, that begins then to reduce the anxiety and the stress. So all in one, you have a healthier body, but certainly a healthier mind.
Patient can inject medications directly into the corpora cavernosa to help attain and maintain erections. Medications such as papaverine hydrochloride, phentolamine, and prostaglandin E1 (alprostadil) can be used alone or in combinations to attain erections. All of these medications are vasodilators and work by increasing blood flow into the penis. Prostaglandin E1 (Caverject, Edex) is easier to obtain; however, it is associated with penile pain in some individuals. The use of combinations of two or three of these medications can decrease the risk of having penile pain.
Because adequate arterial supply is critical for erection, any disorder that impairs blood flow may be implicated in the etiology of erectile failure. Most of the medical disorders associated with erectile dysfunction appear to affect the arterial system. Some disorders may interfere with the corporal veno-occlusive mechanism and result in failure to trap blood within the penis, or produce leakage such that an erection cannot be maintained or is easily lost.
Although not proven, it is likely that erectile dysfunction can be prevented by good general health, paying particular attention to body weight, exercise, and cigarette smoking. For example, heart disease and diabetes are problems that can cause erectile dysfunction, and both are preventable through lifestyle changes such as sensible eating and regular exercise. Furthermore, early diagnosis and treatment of associated conditions like diabetes, hypertension and high cholesterol may prevent or delay erectile dysfunction, or stop the erectile dysfunction from getting more serious.
Kimberly Hildebrant, ARNP is a board certified Family Nurse practitioner. She graduated with a Bachelor of Science in Nursing from the University of Pittsburgh and a Masters in Nursing from Duquesne University. She has practiced as a nurse practitioner in the field of Infectious Disease as well as HIV for 4 years. She has over 13 years of experience as a critical care nurse. Kimberly is passionate about providing affordable healthcare to all individuals to ensure that all can live their best life. She is an advocate for preventative care and early treatment to avoid lasting illness.
Studies to further define vasculogenic disorders include pharmacologic duplex grey scale/color ultrasonography, pharmacologic dynamic infusion cavernosometry/ cavernosography, and pharmacologic pelvic/penile angiography. Cavernosometry, duplex ultrasonography, and angiography performed either alone or in conjunction with intracavernous pharmacologic injection of vasodilator agents rely on complete arterial and cavernosal smooth muscle relaxation to evaluate arterial and veno-occlusive function. The clinical effectiveness of these invasive studies is severely limited by several factors, including the lack of normative data, operator dependence, variable interpretation of results, and poor predictability of therapeutic outcomes of arterial and venous surgery. At the present time these studies might best be done in referral centers with specific expertise and interest in investigation of the vascular aspects of erectile dysfunction. Further clinical research is necessary to standardize methodology and interpretation, to obtain control data on normals (as stratified according to age), and to define what constitutes normality in order to assess the value of these tests in their diagnostic accuracy and in their ability to predict treatment outcome in men with erectile dysfunction.
My boyfriend, 25, can't get hard anymore!! He WANTS to have sex, but he just won't get hard, when just about a month ago he would get hard just by looking at me. We have been together for six months, and I'm starting to think he might be bored of me or that I'm the problem. He says it's not me at all. Our relationship is great, but I don't know what to do. Please help!!
In diabetics, impotence that develops acutely in the setting of hyperglycemia and poor metabolic control is usually reversible. This is not true of the slowly progressive impotence of long-standing diabetes that is a manifestation of autonomic neuropathy. Intracavernosal self-injection of vasoactive drugs such as papaverine, which relaxes arteriolar smooth muscle is a promising new approach to treatment that is particularly suited for diabetic patients whose erectile dysfunction is on a neuropathic basis. It also has been used with success in spinal cord patients.
All studies demonstrate a strong association with age, even when data are adjusted for the confounding effects of other risk factors. The independent association with aging suggests that vascular changes in the arteries and sinusoids of the corpora cavernosa, similar to those found elsewhere in the body, are contributing factors. Other risk factors associated with aging include depression, sleep apnea, and low HDL levels.
Men with physical causes of ED have options, including such medicines as sildenafil (Viagra®), vardenafil (Levitra®), or tadalafil (Cialis®). Men who use nitroglycerin products and those who should avoid sexual activity because of cardiovascular disease shouldn’t take these drugs. Other treatment modalities include use of a vacuum pump or injection of a substance (papaverine) into the penis to increase blood flow to the penis. Men can also have surgery to put a prosthesis into the penis.
Me and my boyfriend have been together almost two years, and he has only said "I love you" about a dozen times. I know he loves me by his actions but I would still like to hear the words. I have tried talking to him about it but he also isn't one for talking about anything that could possibly be uncomfortable. Sometimes this really makes me insecure, especially since I tell him daily I love him. Other times I feel like I am just being silly and that actions speak louder than words. What should I do?
Erectile dysfunction can have so many long-lasting effects that the inability to achieve an erection is almost the least of them. Men who suffer from erectile dysfunction often suffer from self-esteem concerns, and these can then translate into issues regarding sexual relationships, friendships, and even work-related relationships. As things begin to spiral out of control, men dealing with erectile dysfunction may go on to suffer from depression, anxiety, and other psychological problems that further inhibit relationship and sexual intimacy. So what is it that’s causing this mess?
Dr. Matthew Walvick, D.O. is a board certified Internal Medicine physician. He completed his undergraduate education at UCLA. He received his medical degree from Touro University College of Osteopathic Medicine in Vallejo, California. He completed his Internal Medicine residency at UCSF's Fresno Medical Education Program. Prior to joining Lemonaid Health, Dr. Walvick was a practicing primary care physician at John Muir Health and then doing house calls with the start-up Heal. Dr. Walvick is excited to be a part of the Lemonaid Health team making healthcare refreshingly simple.
Vijay Bhat, MD is a board certified internal medicine physician who is passionate about providing quality medical care that’s affordable for patients. He believes that integrating technology and medicine can make healthcare efficient and more accessible. Throughout his training Dr. Bhat was involved with global health initiatives, providing care to underprivileged communities locally and overseas. He’s also been a strong proponent of quality improvement in the medical field. Dr. Bhat graduated with a BS from the University of California Berkeley, and received his medical degree from Stony Brook University in New York. He completed his residency in Internal Medicine at Rutgers Robert Wood Johnson.
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The risk of impotence increases with age. It is four-fold higher in men in their 60s compared with those in their 40s according to a study published in the Journal of Urology (2000;163:460-463). Men with less education are also more likely to experience impotence, perhaps because they tend to have less healthy lifestyles, eat a less healthy diet, drink more and exercise less. Physical exercise tends to lessen the risk of impotence.
This consensus development conference on male erectile dysfunction has provided an overview of current knowledge on the prevalence, etiology, pathophysiology, diagnosis, and management of this condition. The growing individual and societal awareness and open acknowledgment of the problem have led to increased interest and resultant explosion of knowledge in each of these areas. Research on this condition has produced many controversies, which also were expressed at this conference. Numerous questions were identified that may serve as foci for future research directions. These will depend on the development of precise agreement among investigators and clinicians in this field on the definition of what constitutes erectile dysfunction, and what factors in its multifaceted nature contribute to its expression. In addition, further investigation of these issues will require collaborative efforts of basic science investigators and clinicians from the spectrum of relevant disciplines and the rigorous application of appropriate research principles in designing studies to obtain further knowledge and to promote understanding of the various aspects of this condition.
Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.