Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction can play itself out in many different ways. It can be the complete inability to get an erection or a tendency for the penis to soften too quickly to ‘complete’ sexual intercourse. Note that if a man has trouble with erections once in a while, it is usually not considered erectile dysfunction.

Almost 100% of men have, at one time or another, had trouble getting or keeping an erection during a sexual relationship. As well, some men have no trouble getting an erection during self-stimulation (masturbation), but may have difficulty during sexual activity with a partner.

Is erectile dysfunction the same as impotence?

Often the words “impotence” and “erectile dysfunction” are used interchangeably. Other people use the term “impotence” to refer to problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm.

Throughout history men have feared impotence and think of it as a weakness in their masculinity. The word, itself, reinforces this fear. We prefer to use the term “erectile dysfunction”.

Why is it a concern?

Sexual intercourse is usually an important part of a romantic relationship or partnership. As well, our culture gives men the message that sexual interest and ability are important parts of being male.

If a man is unable to have an erection long enough for intercourse and the couple is not able to talk about it openly, it may cause other problems in their relationship. The man may feel ashamed, unmanly or unworthy. This may cause him to distance himself from his partner - to strop trying to have sex. He may assume that it is his and only his problem, but may feel too embarassed to get help. 

Meanwhile, his partner may feel rejected and assume that he has lost interest in their relationship. Communication is important and couples often find that they need to work together and support each other in order to resolve this problem. 

How does a man get an erection?

If a man is thinking or fantasizing about sex, or is being touched in a sensual way, the brain will signal the body to send more blood to the penis. There are two arteries in the penis that expand as they become filled with blood, causing an erection, as well as is a physicall process that stops the blood from leaving the penis. When simulation ends, or after ejaculation, pressure in the penis decreases, blood is allowed to flow back into the body, and the penis resumes its normal, non-erect shape. 

An erection requires a precise set of events to happen and erectile dysfunction is said to occur when one or more of the functions gets interrupted or doesn't work properly. For example, the blood may be able to flow into a man's penis, but if the blood is not trapped in the penis, his erection won't last long enough for intercourse. 

Is erectile dysfunction just a part of aging?

Erections change with age. The decreasing testosterone levels and thinning of the blood vessels that occur with age will inevitably affect a man’s erections. Men may also notice that their sex drive (libido) decreases as they get older. Most older men find it takes more direct stimulation (touching) for an erection to happen and an erection may go “up and down” a few times during sex. Ejaculation often feels differently and the sensations of ejaculation (coming) may be felt more as a whole body sensation than as one specifically from the genitals. The time between ejaculation and the next erection usually takes longer as a man ages as well.

These changes don’t have to be a problem if a man and his partner understand that they are normal. It is helpful if an older couple can enjoy the slower pace and extra stimulation that it may take to reach full sexual arousal. It can also be an opportunity for them to try something new.

However, erectile dysfunction is something more than just changing erections and need not be seen as an inevitable part of the aging process. While many men with erectile dysfunction are older, not all older men will get erectile dysfunction and older men should not view it as just part of aging. There are often specific physiological and treatable causes (e.g. heart disease) and all men, young or old, have the right to get treatment.

(Sources: WebMDClinique médicale l’Actuel, MedlinePlus, National Kidney and Urologic Diseases Information Clearinghouse)