Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection. This is also know as erectile dysfunction.
The disorder may cause marked distress or interpersonal difficulty. There are different patterns. Some individuals report inability to obtain erection from the beginning of sexual experience; while others report being able to experience erection only during masturbation or on awakening, but not during the coitus. Some experience adequate erection, lose it when attempting penetration. Still other report that they have an erection that is sufficiently firm for penetration, but they lose erection before or during thrusting.
Male erectile disorder is frequently associated with anxiety, fear of failure, pressure of sexual performance, and decreased sexual excitement and pleasure. This can disrupt marital relationship and may be the cause of unconsummated marriage and infertility.
Causes:
Ageing: With advancing age,
- The orgasm is less intensive,
- The ejaculate is reduced
- The interval between the two successive acts is increased.
Psychological factors:
- Fatigue,
- Depression,
- Stress,
- Mental disorders,
- Guilt,
- Fear of failure,
- Low self esteem
- Religious restrictions
- Homosexuality
- Long/serious illness
- Traumatic initial experience
- Negative feelings towards the partner
- Vascular causes
- Use of tobacco/Alcohol
- Atherosclerosis
- Peyronie’s disease
- Diabetes
- Hypertension
- Venous leak or occlusion
- Trauma
- Surgery
- Radiation
Hormonal causes:
- Hypogonadism
- Hyperprolactinemia
- Diabetes
- Thyroid disease
- Androgen deficiency
- Estrogen excess
- Adrenal pituitary of Hypothalamic disease
Neurogenic causes:
- Peripheral Neuritis
- Autonomic neuropathy (in Diabetes)
- Multiple sclerosis
- Spinal cord disease
Drug related causes:
- Antiandrogens
- H2receptor antagonists
- Diuretics
- Antihypertensive
- Anticholinergics
- Antidepressants
- Antipsychotics
- CNS Depressants
- Substance abuse
Miscellaneous:
- Renal failure
- Prostatectomy
Diagnostic tests
Sexual dysfunction is a marital unit problem and therefore both, husband and wife, should attend. Counselling is towards strengthening marital relationship. Wife is requested to co-operate. Client is requested to quit smoking and alcohol. He is advised relaxation exercise, yoga. The couple is educated about anatomy, physiology of sexual organs sexuality are countered. Their myths and misconceptions about sexuality are countered. They are also explained that he does not have to do anything to have an erection. Erection is a physiological response to effective stimuli.