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Issues with Erectile Dysfunction

Erectile Issues

Michael had been experiencing problems with his erection for the last 8 years. He and his wife had also not had sex in 2 years, their conflict was high, and he expressed that he rarely even thought about sex. Russ and his wife engaged in sex therapy and had some amazing results in their marriage and their intimacy, yet he still continued to be unable to reach orgasm, though he remained erect throughout sexual stimulation. Philip expressed that he always ejaculated with 15-30 seconds after entering his wife.

Men may experience a number of different challenges with erection and ejaculation. They may feel they have a problem gaining or maintaining an erection. They may feel they ejaculate too soon, thereby loosing their erection. They may also have been unable to orgasm or ejaculate even though they maintain their erection throughout sensual and sexual time together. There are a lot of books, a lot of research studies, and a number of different treatments available through the centuries for issues with erection and ejaculation. One thing that is important medically to note is that erectile difficulties specifically may be one of the earliest signs of heart trouble or other medical problems, hence the importance of making a medical appointment to check that out. This particular entry is focused on gaining or maintaining an erection. Further entries will address delayed or premature ejaculation.

For some men, when their penis does not stay erect, they have few concerns and know that things will work better another time. However, for others, they regularly cannot reach orgasm due to loosing their erection or loosing the strength of their erection. This can cause a number of feelings including embarrassment, discouragement, frustration, anxiety, and feelings of loss. It can be particularly difficult if their spouse responds in any manner that is negative, either by expressing disappointment, making negative, derogatory remarks, making comparisons with other partners, or with wondering if their spouse is getting their needs met somewhere else.

It is important to understand a few things about erection. Most men's penises become erect several times during the night, thereby bringing in oxygen and maintaining health in the penile tissues. Testing this, for instance, by using a plethometer at night around the penis, is actually one of the ways in which a doctor can discern if there are any complicating physiological factors that need to be addressed. During sexual stimulation, the penis also regularly fluctuates between differing levels of erection.

Initially, erection may be elicited by direct touch to the genitals that leads to an automatic, reflexive response controlled by the lower spine (much like the knee jerk reaction you get when the doctor taps your knee with a reflex hammer during an physical examination). Erection can also be induced by nerve stimuli from the brain caused by thoughts, images, touch, sounds, and emotions. These various forms of nerve impulses (genital and brain) combine synergistically to increase blood flow to the penis and restrict blood from the penis, causing erection.

Men are sometimes not aware of how normal it is to experience fluctuations in erection even during sexual stimulation. Any sign of a loss of erection can then create high anxiety or frustration, which in turn may, in a complicated loop with the brain, cause further loss of erection. The term generally used for this in popular literature and in the field of sexual treatment is performance anxiety. There are however many different factors that affect the levels of anxiety and the level of erectile functioning overall. As some authors explain, "The causes of ED are frequently multifactorial, with psychological, neurological, endocrinological, vascular, traumatic, and iatrogenic components described" (Kirby, Carson, & Goldstein, 1999). What the heck does that mean? That means that erection can been effected by what you think and feel, by blood flow, by damage or accidents that affect sexuality, by illness, and by things going on in your brain and how your brain, overseeing the control of nerves and hormones, interacts and communicates with the rest of your body.

In particular, erectile problems can be effected by physiological, psychological, and relational issues. Physiological factors may be poor eating habits, lack of exercise, higher levels of fat in the blood and circulatory system, poor sleeping patterns, smoking, alcohol, illegal drugs, prescribed medications (such as antidepressants or blood pressure medications), diabetes, high blood pressure, illnesses, cancer, or surgeries. Psychological factors may be anxiety, depression, distractions, perfectionism, and fear. Relationship factors may include unresolved resentments, relational injuries, demands, high conflict, avoidance, lack of relational intimacy, broken trust, or lack of safety in the relationship.

The bottom line question my clients often ask about erection is how can they overcome these difficulties. For some couples, the level of anxiety connected to erectile difficulties lowers just by learning how normal it is for the penis to fluctuate in the level of erection during sexual interactions. So what happened for Michael? He and his wife came to see me for sex therapy. They were experiencing high conflict and high disconnection. That was the primary focus of the first part of therapy. As they became more connected and learned to work through their disagreements in a way that brought them closer, the work on touch and affection and sensual and sexual touch progressed. Michael chose to pursue a prescription for Viagra. By the end of therapy, he and his wife felt closer than they ever had in their marriage and he had been successful maintaining erection and achieving orgasm both with and without Viagra.

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