Erectile dysfunction (ED), formerly known as impotence, is the chronic inability to achieve and maintain an erection for the performance of a sexual act.
ED is a very common condition, believed to affect one in ten men worldwide, and the causes can be physical or psychological.
Physical causes include underlying health issues, such as diabetes, heart disease, hypertension and obesity, which account for 70% of cases of the condition.
Alcohol, tobacco and drugs – narcotics and prescription medications – are also contributory factors to erectile dysfunction problems.
ED is associated with ageing and most common in men over the age of 75 but, for younger men, the condition may have psychological causes, including anxiety, depression and stress. In fact, psychological causes are believed to account for up 20% of erectile dysfunction cases.
One of the most common psychological causes is known as performance anxiety, which can lock the sufferer into a spiral of negative reinforcement from which it is difficult to escape.
It is not uncommon for a man to be anxious about sexual intercourse with a new partner but, if his anxiety causes erectile dysfunction, the more anxious he becomes, the less able to he is to perform and so on.
Frank, honest conversation with a new sexual partner is often the key to tackling performance anxiety, which may lessen or disappear altogether as partners become more familiar with each other.
Of course, anxiety may be caused by factors other than sexual performance or a distressing sexual experience in the past.
Anxiety about work, money, relationships or anything else not only diverts and distracts the brain from less essential tasks, such as managing arousal but triggers the release of cortisol, a steroid hormone produced by the adrenal gland.
The level of cortisol in the bloodstream is inversely proportional to the level of testosterone, the primary male sex hormone, so a loss of libido and erectile dysfunction may occur.
Treatment for the psychological causes of erectile dysfunction includes sex therapy and prescription medications, such as Sildenafil, better known by its brand name, Viagra.
Sex therapy, in the form for regular, but brief, counselling sessions with a qualified therapist, followed by ‘homework’, can be effective in cases where no physical reason exists for erectile dysfunction and, indeed, may be the best treatment option available.
Sex therapists can be doctors, including psychiatrists and psychologists, or other healthcare professionals, but all are trained in psychological methods of treatment for erectile dysfunction.
Prescription treatments, such as Sildenafil and other similar drugs, are technically known as vasodilators or phosphodiesterase (PDE5) inhibitors.
They work by suppressing the action of a chemical called phosphodiesterase type-5, with the effect of relaxing the blood vessels and increasing blood flow to the penis during sexual arousal.
Two-thirds of men, or more, taking PDE5 inhibitors have reported an improvement in their condition. However, sexual arousal is a prerequisite for PDE5 inhibitors to work and they can have some very dangerous side effects for men with certain underlying health conditions, so they should not be taken without medical supervision.