Vaginismus final

Vaginismus is an involuntary contraction, or reflex muscle tightening, of the pelvic floor muscles that generally occurs when an attempt is made to insert an object, tampon, penis, speculum used for a Pap test, into the vagina. This muscle tightening causes pain. which can range from mild discomfort to severe burning and aching.
Vaginismus may be Primary, i.e. lifelong, or Secondary, occurring after a period of normal sexual function. It may also be Global, occurs in all situations and with any object, or Situational, may only occur in certain situations, such as with one partner but not others, or with sexual intercourse but not with tampons or pelvic exams or vice versa.

Women with vaginismus often think that they’re “Too Small” and that their vagina needs to be stretched. Just imagining this is painful! The truth is that women with vaginismus don’t need to “Stretch” anything; they need to learn to control the muscles around the vagina. This can be done with exercises.

  • How do I know if the pain I have with intercourse is vaginismus?

Your doctor should be able to answer that after he or she has asked you a few questions and examined you. The pain with vaginismus occurs only with penetration. It starts as soon as the partner attempts to insert his penis and usually, but not always, goes away after he withdraws. The pain is often burning or tearing.

Women may describe it as

  • It feels like he’s hitting a wall
  • It feels like he’s too big for me
  • I feel like I’m being torn

The pain may or may not improve as sexual intercourse progresses, and there may be times when the pain is not as bad. Women with vaginismus often, but not always, also have discomfort when inserting tampons or having an internal exam.

  • Is the pain all in my head?

Vaginismus is a learned reflex. A useful way to look at it is to compare it to getting a finger in our eye. We’ve all been poked in the eye at some time in our life and if we see a finger or other object approaching our eyes, we shut them automatically. In the same way, a woman with vaginismus has had an experience of painful intercourse, or other object in the vagina. Later on when she or someone else tries to insert an object in the vagina, the vagina “Shuts” to protect itself from pain without the woman even being conscious of it. The muscle spasm is what causes the pain and that is definitely real.

  • How common is vaginismus?

Vaginismus is a much more common problem than you may realize. Women with vaginismus tend to be very embarrassed about it and not mention it to anyone. That is too bad because it is a lot easier to treat vaginismus if it has only been going on for a few months than it is if it has been going on for several years.

Many women have mild degrees of it at some point in their lives. Vaginismus can vary from mild discomfort with intercourse to the man being unable to enter because of pain and spasm. There are many couples who have been together for years but have never had intercourse because of vaginismus. They may even have had children by means of a “Splash Pregnancy”, the man ejaculates near the vaginal opening and sperm make their way up the vagina. Many women with vaginismus have very active sex lives; they just don’t have intercourse. Sometimes a couple is happy with the way things are and would rather not try to change things; if you and your partner both agree - that is perfectly fine.

  • What can I do if I have vaginismus?

The good news is that there is a cure for vaginismus; it simply involves learning how to control and relax the muscles that are tightening involuntarily. The bad news is that this does not happen overnight and requires you to do “Exercises” for several weeks to several months. How long it takes for the exercises to work depends on how faithful you are in doing them and also on how long the vaginismus has been a problem.

During the time period that you are doing the exercises, you should avoid intercourse. It may be hard to explain to your partner that you won’t be having intercourse for several weeks and possibly several months. However, every time you have painful intercourse, you are reinforcing the reflex and it will take that much longer to get rid of it. You can still do all the other things that give you and your partner pleasure including touching each other, oral sex, etc., just not intercourse.

  • How exactly do I do these exercises?

Start by doing Kegel exercises. If you have had a baby, you probably learned to do Kegels in prenatal class. These involve tightening the muscles of the pelvic floor - the same muscles you would contract if you were on the toilet urinating and wanted to stop the flow of urine. You should contract your muscles, hold for a couple of seconds, then relax. Initially, you can do the exercises on the toilet to make sure that you are contracting your pelvic floor muscles and not your abdominal muscles instead; however, as soon as you are certain that you are doing them correctly, you should no longer do them on the toilet but whenever you think about it during the day. Each time you do them, do about 20 contractions. You can do these while talking on the phone, watching television, etc. Don’t forget to relax the muscles for a few seconds after each contraction.

After a few days you should try doing the exercises with fingers in your vagina, starting with one finger and working your way up to three. It is a good idea to cut your fingernails and to use a lubricant. The fingers must be inserted to a depth of at least 5 to 6 cm or to the level of the first joint after your knuckle. We ask you to do this for several reasons: you can feel your pelvic floor muscles contract and relax around your fingers so that you can be sure you are contracting and relaxing the right muscle. It also helps you get used to having something in your vagina.

  • Why fingers?

They are the easiest object to remove if it starts to hurt and they don’t cost anything. Women will sometimes wonder if they can use their partner’s fingers instead; this is generally not a good idea since you have less control if you use your partner’s fingers than if you use your own.

You also want to avoid associating your partner with pain. Many women like to do the exercises in the bathtub where water acts as a natural lubricant. You should do the exercises daily if possible. Don’t get discouraged if some days you can’t insert as many fingers as others; this is normal. If you find that you can’t get your fingers in far enough, try doing the Kegels; as you relax the muscles you should be able to get the fingers in a little bit further.

  • How long do I have to do the exercises before I can try to have sexual intercourse again?

The time it takes to get to three fingers varies from weeks to months, depending on the duration of the problem and on how faithfully you do the exercises. When you can insert three fingers without pain a few times, then it is time to try intercourse. The first few times you try intercourse you should be on top so that you have total control and lubricants should be used. You can try pushing out as if you were having a bowel movement as you insert your partner’s penis. This is because you can’t push out and contract your muscles at the same time. If it hurts, you should stop, contract your pelvic floor muscles, then relax.

It is not a bad idea to just lie still with your partner’s penis in your vagina the first few times, with no movement. When that is successful, the next couple of times you only should move, so that you have total control over the situation. It’s a good idea to discuss this with your partner beforehand. If that doesn’t hurt, then the next time you can do whatever you wish. If you find you just can’t have intercourse the first time you try, don’t panic. Just go back to the fingers for a few days, then try again.

  • What are the chances that these exercises will work for me?

These exercises, though they may seem very simple, are successful more than 90% of the time, as long as there is no history of sexual trauma. Obviously, if you are suffering from flashbacks or nightmares as a result of sexual assault or abuse, these issues also have to be dealt with. The exercises also won’t work if you have physical problems causing pain such as an infection or inflammation of the vulvar glands. Usually, though, when the exercises “don’t work” the problem is that the woman hasn’t done them for some reason or other. If you just can’t seem to make yourself do these exercises, you should discuss it with your Sexologist. He or she may have some suggestions or may be able to refer you to someone who can help.

Sexual Desire Disorder final

Sexual desire disorder is a psychiatric condition marked by a lack of desire for sexual activity over a prolonged period.

Inhibited sexual desire (ISD) refers to a low level of sexual interest resulting in a failure to initiate or respond to sexual intimacy. ISD may be a primary condition (where an individual has never felt much sexual desire), or secondary (where lack of interest is something new).

ISD may also be specific to the partner, or it may be a general attitude toward any potential partner.

A diagnosis of hypoactive sexual desire disorder refers to a persistent or recurring lack of desire or an absence of sexual fantasies. However, sexual performance may be adequate once activity has been initiated. This disorder occurs in approximately 20 percent of the population and is more common in women, though it does affect both sexes.

Sexual aversion disorder refers to a condition in which the concept of genital sexual contact seems repulsive. This disorder probably occurs less frequently than hypoactive sexual desire.


  • Lack of sexual interest
  • Causes
  • Communication problems
  • Lack of affection
  • Power struggles
  • Lack of one-on-one time for partners to be alone together
  • A very restrictive upbringing concerning sex, or negative or traumatic sexual experiences
  • Physical illnesses and some medications
  • Psychological conditions such as depression or excessive stress may inhibit sexual interest
  • Fatigue
  • Individuals who were victims of childhood sexual abuse and persons whose marriages are lacking in emotional intimacy are particularly at risk.


In most cases, medical evaluation and lab tests will not reveal a physical cause. However, because testosterone is the hormone responsible for creating sexual desire in both men and women, it may be useful to check testosterone levels. For men taking this test, blood should be drawn before 10 a.m., when male hormone levels are at their highest. Interviews with a specialist in sex therapy are more likely to reveal possible causes.

Treatment must be individualized—some couples will need relationship or marital therapy prior to focusing directly on enhancing sexual activity.

Of course, many couples may need to focus on the sexual relationship itself, and through education and assignments they can expand the variety and time devoted to sexual activity.

When problems with sexual arousal or performance are factors, these sexual dysfunctions will need to be addressed.


One helpful way to prevent ISD is setting aside time for nonsexual intimacy. Couples who reserve time for one-on-one talking are more likely to experience sexual desire. Also, reserving time before exhaustion sets in will encourage closeness and sexual desire. Couples might mentally separate sex and affection, so that neither one is afraid to be affectionate daily.

Reading books or taking courses in couples communication or massage may also encourage feelings of closeness. For some couples, reading novels or viewing movies with romantic or sexual content may also serve to encourage sexual desire.

Low sexual desire may be a barometer of the emotional health of the relationship. In the case of a loving relationship, low sexual desire may cause a partner to repeatedly feel hurt and rejected, leading to eventual feelings of resentment and promoting eventual emotional distance.

Sex is something that, for most couples, either bonds their relationship or creates a wedge that gradually drives them apart. When one partner is significantly less interested in sex than their companion, professional help is recommended before the relationship becomes strained.

performance failure final

The truth ? -Everyone’s experienced performance anxiety at some point - including women. At the end of the day, sex - since it involves being naked, physical and very, very vulnerable in front of another person, especially a person you’re attracted to - can be a bit intimidating, and more people than not sometimes stress about how they stack up in bed.

Sex is supposed to be fun, but it’s hard to relax and enjoy it when you’re too busy worrying about how you look or what she thinks about you to just be in the moment. And unfortunately, worrying about your sexual performance can create a nasty cycle: Stress can block blood flow to the penis, marking it harder to get and stay hard, which in turn increases anxiety about performance…

If you find yourself freaking out when you’re about to get freaky, your best bet is to switch to a little foreplay. Go down on her or finger her for until you feel more relaxed, ands let her audible pleasure give you the confidence you need to get back in the saddle.

Ease your anxieties by arming yourself with the best information to improve your sex life.

Sexis supposed to be a pleasurable experience, but it's hard to feel sexy or intimate with your partner when you havesexual performance anxiety. When you're constantly wondering,

  • Am I doing this right?
  • Is my partner enjoying this?
  • Do I look fat?
  • you become too preoccupied to enjoy

Constant worry over your appearance or ability in bed can make sex stressful and nerve-wracking. It can even make you want to avoid having sex.

Sex is more than just a physical response. Arousal is tied into your emotions, too. When your mind is too stressed out to focus on sex, your body can't get excited either.

In this article, you'll learn what causes sexual performance anxiety and discover treatments that will help reignite your sex life.

Causes of Sexual Performance Anxiety

Many different kinds of worries can lead to sexual performance anxiety, including:

  • Fear that you won't perform well in bed and satisfy your partner sexually
  • Poorbody image, including concern over yourweight
  • Difficulties in your relationship
  • A man’s worry that hispeniswon't 'measure up'
  • A man’s concern about ejaculating prematurely or taking too long to reach orgasm
  • A woman’sanxietyabout not being able to have an orgasm or enjoy the sexual experience.

These anxieties cause your body to launch a response called “fight or flight.” Stress hormones likeepinephrineand norepinephrine are released in a series of reactions that were actually designed to prepare your body to run or confront a threat. Of course, your partner isn't a threat, which is why this response is so counterproductive to intimacy.

Symptoms of Sexual Performance Anxiety

Your state of mind can have a big impact on your ability to get aroused. Even if you're with someone who you find sexually appealing,worrying about whether you'll be able to please your partner can make it impossible for you to do just that.

In men, one of the effects of the stress hormones is to constrictblood vessels. Lessbloodflowing into thepenismakes it more difficult to have an erection. Even men who normally don't have any trouble getting excited can become unable to get an erection when they're overcome by sexual performance anxiety.

 Overcoming Sexual Performance Anxiety

If you've got sexual performance anxiety, see a doctor -- someone with whom you feel comfortable discussing your sex life. The doctor can examine you and do some tests to make sure a health condition or medication isn't causing your sexual performance issues. During the exam the doctor will ask about your sexual history to find out how long you've had sexual performance anxiety and what kinds of thoughts are interfering with your sex life.

Medications and other therapies can help treat erectile dysfunction and other sexual problems that are due to physical causes. If a medical issue isn't to blame, your doctor might suggest trying one of these approaches:

Talk to a therapist. Make an appointment with a counselor or therapist who is experienced in treating sexual problems. Therapy can teach you to become more comfortable with your own sexuality, and it can help you understand -- and then reduce or eliminate -- the issues that are causing your sexual performance anxiety. Men who are worried about premature ejaculation, for example, can try some techniques that help them gain more control over ejaculation.

Be open with your partner. Talking with your partner about your anxiety can help ease some of your worries. Trying to reach a solution together might actually bring you closer as a couple and improve your sexual relationship.

Get intimate in other ways.There are many ways to be intimate without actually having sex. Give your partner a sensualmassageor take a warm bath together. Take turns pleasing each other with masturbationso you don't always have to feel pressured to perform sexually.

Exercise.Not only willworking outmake you feel better about your body, but it will also improve your stamina in bed.

Distract yourself.Try putting on some romantic music or a sexy movie while you make love. Think about something that turns you on. Taking your mind off of your sexual performance can remove the worries that are stopping you from getting excited.

Finally, take it easy on yourself. Don't beat yourself up about your appearance or ability in bed. Get help for sexual performance anxiety so you can get back to having a healthy and enjoyable sex life.

premature ejaculation final

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.

However, you may meet the diagnostic criteria for premature ejaculation if you:

Always or nearly always ejaculate within one minute of penetration

Are unable to delay ejaculation during intercourse all or nearly all of the time

Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation - or a combination of these - can help improve sex for you and your partner.

The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as lifelong – primary - or acquired – secondary-.

Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.

When to see a doctor

Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.

For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.


The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

Situations in which you may have hurried to reach climax in order to avoid being discovered. Guilty feelings that increase your tendency to rush through sexual encounters. Other factors that can play a role in causing premature ejaculation include:

Erectile dysfunction.Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.

Anxiety.Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.

Relationship problems.If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

     Abnormal hormone levels

     Abnormal levels of brain chemicals called neurotransmitters

     Abnormal reflex activity of the ejaculatory system

     Certain thyroid problems

     Inflammation and infection of the prostate or urethra

     Inherited traits

     Nerve damage from surgery or trauma (rare)

Risk factors

Various factors can increase your risk of premature ejaculation, including:

Erectile dysfunction.You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to consciously or unconsciously hurry through sexual encounters.

Health problems.If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate.

Stress.Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.


While premature ejaculation alone doesn't increase your risk of health problems, it can cause significant problems in your personal life, including:

Stress and relationship problems.A common complication of premature ejaculation is relationship stress.

Fertility problems.Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.

erectile dysfunction final

Erectile Dysfunction


Treatment for men unable to have an erection took a great leap forward when the first oral erectile dysfunction  medication, Viagra, sildenafil, was introduced in 1998. But there have been strides recently in a host of other erectile dysfunction treatments, ranging from over-the-counter pumps to surgical implants and suppositories.

Diagnosing your own erectile dysfunction is not a good idea, however. If you have troublegetting an erection, it's important to see a doctor before pursuing any sort of treatment. There could be amedical explanationfor your condition, and your health and sexual history may come into play. 

Erectile dysfunctionorimpotenceissexual dysfunctioncharacterized by the inability to develop or maintain anerectionof thepenisduringsexual activity.A penile erection is thehydrauliceffect of blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result ofsexual arousal, when signals are transmitted from thebraintonervesin the penis. The most important organic causes arecardiovascular diseaseanddiabetes, neurological problems (for example, trauma fromprostatectomysurgery),hormonalinsufficiencies (hypogonadism) anddrug side effects.

Psychologicalimpotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. Notably in psychological impotence, there is a strongresponse to placebo treatment. Erectile dysfunction can have severe psychological consequences as it can be tied to relationship difficulties and masculine self-image generally.

Besides treating the underlying causes such as potassium deficiency or arsenic contamination of drinking water, the first line treatment of erectile dysfunction consists of a trial of PDE5 inhibitordrugs (the first of which wassildenafilor Viagra). In some cases, treatment can involveprostaglandintablets in theurethra, injections into the penis, apenile prosthesis, apenis pumporvascular reconstructive surgery.

The Latin termimpotentia coeundidescribes simple inability to insert the penis into thevagina; it is now mostly replaced by more precise terms, such aserectile dysfunction. The study of erectile dysfunction within medicine is covered byandrology, a sub-field withinurology. Researchthat erectile dysfunction is common, and it is suggested that approximately 40% of males suffer from erectile dysfunction or impotence, at least occasionally.Erectile dysfunction (ED) represents a common and debilitating condition with a wide range of organic and non-organic causes. Physical aetiologies can be divided into disorders affecting arterial inflow, the venous occlusion mechanism or the penile structure itself. Various imaging modalities can be utilised to investigate the physical causes of ED, but penile Doppler sonography (PDS) is the most informative technique,INDICATEDin those patients with ED who do not respond to oral pharmacological agents (e.g.phosphodiesterase type 5 inhibitors). This review will examine the anatomical and physiological basis of penile erection, the method for performing PDS and features of specific causes of ED, and will also consider the alternative imaging modalities available.

Erectile dysfunction represents a substantial burden upon public health. Studies have estimated that approximately 50% of the male population aged between 40 and 70 years will suffer from Erectile dysfunction at some stage, with 10% of these affected severely. On average, a general practitioner is estimated to see between one and five new cases of Erectile dysfunction per month, and the impact upon the psychosocial health of the sufferer and his relationships may be considerable. Erectile dysfunction is defined as the persistent inability to achieve or maintain penile erections of sufficient value to engage in satisfactory sexual activity. Impotence tends not to be used as a descriptive terminology currently as it is felt to imply failure.

Many physical causes of Erectile dysfunction exist, with only 10–20% of sufferers believed to have a solely psychological cause. There are many organic causes for Erectile dysfunction, with the majority of these based upon vascular insufficiency.

Erectile dysfunction, sometimes called impotence, is the inability to get or keep an erection firm enough for sexual intercourse. The condition has become highly visible in recent years, but that doesn’t make it any more welcome for the 5 to 15 percent of men whose sex lives are affected.

The disorder can occur at any age, but is more common in men over age 75. In middle aged men, Erectile dysfunction can signal risk of a heart attack.

The same cholesterol plaques that can build up in the arteries surrounding the heart can also affect arteries that go through penile tissue. Once doctors rule psychological causes, "they need to do a cardiac workup to make sure that this guy is not on the verge of getting a heart attack.

Understanding all about Erectile Disorder

To understand what causes erectile dysfunction, it is important to first review how an erection occurs. For a man to have an erection, a complex process takes place within the body.

An erection involves the central nervous system, the peripheral nervous system, psychological and stress-related factors, local factors with the erection bodies or the penis itself, as well as hormonal and vascular (blood flow or circulation) components. The penile portion of the process leading to an erection represents only a single component of a very complicated and complex process.

Erections occur in response to touch, smell, and auditory and visual stimuli that trigger pathways in the brain. Information travels from the brain to the nerve centers at the base of the spine, where primary nerve fibers connect to the penis and regulate blood flow during erections and afterward.

Sexual stimulation causes the release of chemicals from the nerve endings in the penis that trigger a series of events that ultimately cause muscle relaxation in the erection bodies of the penis. The smooth muscle in the erection bodies controls the flow of blood into the penis. When the smooth muscle relaxes, the blood flow dramatically increases, and the erection bodies become full and rigid, resulting in an erection. Venous drainage channels are compressed and close off as the erection bodies enlarge.

Detumescence (the process by which the penis becomes flaccid) results when muscle-relaxing chemicals are no longer released.

If one or more of the above physical and/or psychological processes is disrupted, erectile dysfunction can result. Erectile dysfunction describes a man's inability to achieve and maintain an erection of his penis sufficient for mutually satisfactory intercourse with his partner.

In general, the cause of erectile dysfunction is divided into 2 types. Many men will have both:

Psychological Causes

Erection problems usually produce a significant psychological and emotional reaction in most men. This is often described as a pattern ofanxietyand stress that can further interfere with normal sexual function. This "performance anxiety" needs to be recognized and addressed by your doctor.

For some men, erectile dysfunction develops with age or may be related to depression or another psychological cause, such as widower syndrome.

Certain feelings can interfere with normal sexual function, including feeling nervous about or self-conscious about sex; feeling stressed either at home or at work; or feeling troubled in your current relationship. In these cases, psychological counseling with you and your sexual partner may be successful. One episode of failure, regardless of cause, may propagate further psychological distress leading to further erectile.

Physical (Organic) Causes

Physical causes for erectile dysfunction are much more common than psychological causes. In determining a physical (or organic) cause, your doctor will first rule out certain conditions, such ashigh blood pressure,high cholesterol, heart and vascular disease, low male hormone level,prostate cancer, and diabetes, which are associated with erectile dysfunction. In addition to these conditions, certain systemic and respiratory diseases are known to result in erectile dysfunction:

Scleroderma (stiffening or hardening of the skin)

Kidney failure


Hemachromatosis (too much iron in the blood)

Chronic obstructive pulmonary disease.

Often, one can restore sexual health by treating a condition such as high blood pressure with diet and/orexerciseor by controlling diabetes or other chronic diseases. Nutritional states, including malnutrition and zinc deficiency, may be associated with erectile dysfunction and can also be treated with diet.

Almost any disease can affect erectile function by altering the nervous, vascular, or hormonal systems. Various diseases may produce changes in the smooth muscle tissue of the penis or influence mood and behavior.

Diseases that affect the nervous system and are commonly associated with erectile dysfunction include:



Multiple sclerosis

Guillain-Barré syndrome

Alzheimer disease

Parkinson disease

Vascular diseases account for nearly half of all cases of erectile dysfunction in men older than 50 years.

Vascular disease includesatherosclerosis(fatty deposits on the walls of the arteries, also called hardening of the arteries), a history of heart attacks,peripheral vascular disease(problems with blood circulation), and high blood pressure.

Prolonged tobacco use (smoking) is considered an important risk factor for erectile dysfunction because it is associated with poor circulation and its impact on cavernosal function.

Blood diseases, such as sickle cellanemiaand leukemias, are also associated with erectile dysfunction.

An imbalance in your hormones, such as testosterone, prolactin, orthyroid, can cause erectile dysfunction. The following hormonal (or endocrine) conditions are commonly associated with erectile dysfunction:

Hyperthyroidism(overactive thyroid gland)

Hypothyroidism(underactive thyroid gland)

Hypogonadism (leads to lower testosterone levels)


Medications used to treat other medical disorders may cause erectile dysfunction. If you think erectile dysfunction is caused by a medication, talk with your doctor about drugs that might not cause this side effect. Do not just stop taking a prescribed medication before talking with your doctor. Common medications associated with erectile dysfunction are:

Antidepressants(for depression)

Antipsychotics (for psychological illness)

Antihypertensives (for high blood pressure)

Antiulcer drugs, such ascimetidine(Tagamet)

Medications to treat prostate cancer, such asgoserelin(Zoladex) andleuprolide(Lupron), and medications to treat benign enlargement of the prostate, such asfinasteride(Proscar) anddutasteride(Avodart)

Drugs that lower cholesterol (More studies are needed to determine if erectile dysfunction is actually due to the high cholesterol in the blood vessels or the drugs to lower the high cholesterol.)

Alcohol abuse

Mind-altering agents, such as marijuana and cocaine

Surgical Causes

Surgery in the pelvic area may injure the nerves and the arteries near the penis, resulting in erectile dysfunction. Also, surgical procedures on the brain and the spinal cord may cause erectile dysfunction. Those procedures often associated with erectile dysfunction include:

Aortoiliac or aortofemoral bypass

Abdominal perineal resection


Radical prostatectomy

Radiation therapy for prostate cancer as well as for other cancers, such asbladder cancer,colon cancer, orrectal cancer

Brachytherapy (seed implants) for prostate cancer

Cryosurgery of the prostate

Cystectomy (removal of the urinary bladder)

Traumatic Causes

Trauma or injury to the penis and/or the pelvic blood vessels and nerves is another potential factor in the development of erectile dysfunction.

Peyronie's disease is a condition associated with erectile dysfunction. With this disease, scar tissue forms inside the penis, and the penis is usually bent or curved during an erection. Injuries to the penis may also result in scar tissue formation as well as penis curvature during an erection.

Bicycle riding for long periods has also been implicated as a cause of erectile dysfunction. Some of the newer bicycle seats have been designed to soften pressure on the perineum (the soft area between the anus and the scrotum).

Next Steps

Currently, virtually any man who wishes to have an erection can obtain it, regardless of the underlying cause of his problem. Many reasonable treatment options exist. Your first step is to find a well-trained, experienced, and compassionate doctor who is willing to take the time to understand you as well as to fully examine you to discover the cause of erectile dysfunction. Together, you and your doctor can then discuss possible treatments.



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