By: Robert W. Griffith, MD
Sex Problems: Once it was "inability to perform". Then came "impotence", and now it's called "erectile dysfunction" (ED). Since effective medicines have become available, the numbers of men complaining of difficulty in getting and maintaining an erection have skyrocketed; 30 million men in the USA alone, according to recent estimates. Sexual problems in men are fairly common and in most cases these can be treated.
Along with many things, sex changes as we age. In healthy men the time it takes to get an erection and the time needed before the next erection get longer with the passing years. More direct stimulation of the penis is needed than in youth. By the time they are 40, as many as half all US men have difficulty getting an erection from time to time. While men have the advantage over women of being able to father children at any age, they may have difficulties with the sex act that become more frequent with age.What are the main causes of men's sex problems?
Causes of sex problems in men
What are the causes of ED? Too often, increasing age is automatically - and incorrectly - blamed. Aging is accompanied by a gradual fall in testosterone (the male hormone) levels, but they remain in the normal range in 70% of older men. On the other hand, aging is associated with a number of conditions that impact significantly on sex - heart disease (heart attack, angina), stroke, diabetes, enlarged prostate, arthritis, Parkinson's disease, and chronic obstructive pulmonary disease (COPD) are examples. A future article on this site will discuss the sexual problems related to chronic diseases in both men and women.
Medications are quite a common cause of ED. For instance, at one time almost any blood pressure-lowering drug was likely to cause it. However, newer drugs don't have this distressing side effect - your physician can easily find one that doesn't cause this problem. Surgery (e.g. prostatectomy, rectal cancer surgery) is another reason for lessened sex in age, but it is a more common problem for women than for men.
About 90% of cases of ED that aren't caused by medications or surgery are due to medical conditions, such as blood vessel disorders (atherosclerosis, or narrowing of the arteries) involving the pelvis and penis, a complication of diabetes that affects the pelvic nerves, and hormone disturbances (thyroid disorders, diabetes, and low testosterone levels). Unfortunately, medical disorders can themselves produce mental "inhibition" that affects sexual ability. In this way, men with heart disease may worry that sex will cause a heart attack, and they become impotent.
A psychological or emotional cause is directly responsible for about 10% of cases of ED. This is diagnosed largely by making sure that there aren't any other causes. If someone has occasional erections at night, or on waking in the morning, the chances are fairly good that he doesn't have ED due to a medical condition. There are ways to test for erections during sleep, if necessary.
If a man has ED, it's important for him to visit his physician, not only to get appropriate treatment, but also because ED may itself be a symptom of a serious underlying disorder - e.g. advanced atherosclerosis, or diabetes.