Register to join our community
|
|
Question:
GETTING AN ERECTION IS FOR THE MOST PART DIFFICULT TO OBTAIN, WHILE KEEPING IT WHEN IT HAPPENS IS EVEN MORE DIFFICULT. I AM CURRENTLY TAKING DILANTIN (29 years) & TEGRETOL (18 years) FOR EPILEPSY. I HAVE HAD THIS PROBLEM FOR ABOUT 15 YEARS, EXCEPT FOR THE 11 YEARS I WAS MARRIED. I FEEL IT TO BE PHYCOLOGICAL SINCE I ALWAYS HAVE THIS PROBLEM WITH SOMEONE NEW & IT USUALLY GOES AWAY IN TIME & AM ABLE TO EXPIERENCE A NORMAL SEXUAL RELATIONSHIP. ANY ADVICE WOULD BE APPRECIATED.
|
Answer:
by Hussein Ghanem: (06/06/2004)
Erectile dysfunction could be either physical or psychogenic. We may assume that your condition is mainly psychological since it is intermittent with periods where you function normally. However one needs to know if you develop occasional morning or night erections and the quality of these erections. Rigid night or morning erections are consistent with psychogenic erectile dysfunction.
You need to visit an Andrologist / sex therapist for evaluation to exclude physical risk factors for the dysfunction.
Most Important Causes Of Erectile Dysfunction Include:
PSYCHOGENIC FACTORS:
Most important factors are performance anxiety (fear of failure during intercourse) & depression.
ORGANIC FACTORS:
- Vascular: Example athersclerosis & related risk factors (Diabetes, Hypertension, high cholesterol and smoking.
- Neurogenic: Example multiple sclerosis, spinal cord injury, neuropathies, and radical pelvic surgery.
- Endocrine: Mainly Diabetes, decreased male hormone levels or elevated Prolactin, or disturbed thyroid hormone levels.
- Drugs: Medications: e.g. some antihypertensives,
antidepressants, antiandrogens & major tranquilizers
Cigarette smoking
Alcoholism
Recreational drugs: e.g. Marijuana & Heroin
- Other diseases: Erectile dysfunction might be associated with liver, renal & heart disease..
The performance-anxiety cycle can be broken by either the sensate focus exercises prescribed by a sex therapist or occasionally by medication. The goal of sex therapy is to retrain both sexual partners to relax and enjoy the pleasure of the sexual contact without focusing on the outcome.
The following are some strategies that the sex therapists commonly prescribe for psychogenic erectile dysfunction.
Strategies for sex therapy
1- Sensate focus (relaxed sensual massage, Developed by Masters & Johnson)): Taking turns at giving & receiving stimulation while forbidding genital touching, vaginal penetration & orgasm. The period prescribed for sensual massage could be days or weeks depending on the severity of the performance related anxiety.
2- Non-demand genital touching: The next step is to allow mutual genital & breast touching but still intercourse & orgasm are not allowed.
3- Vaginal containment (quite vagina): Vaginal penetration is allowed but both partners remain still (no pelvic thrusting).
4- Fantasy: Imagining sexually stimulating situations.
5- Squeeze technique & start stop technique (Semans maneuver) to treat premature ejaculation: In the squeeze technique, the female partner stimulates the penis then squeezes the glans firmly when the male partner signals he is about to ejaculate. In the start stop technique, stimulation is stopped before ejaculation is inevitable & then resumed once more. The cycle is repeated over & over again.
For general information purposes, I am enclosing this general classification of therapy for erectile dysfunction. Therapy is generally classified into first line, second line, and third line treatments options. Naturally, second line and third surgical options are mainly prescribed for patients with significant physical factors.
Treatment decision-making
. 1st line therapy (Oral erectogenic agents): e.g. Viagra and new medications in clinical trials Vardenafil & Cialis; Vacuum devices; Couples/sexual therapy
. 2nd line therapy (Local treatments): Intraurethral alprostadil; Intracavernous self injections
. 3rd line therapy (Surgery):
Please check my recent article on this subject - Modern Trends In The Management of Erectile Dysfunction - on sexualhealth.com (recent articles)
Best wishes, Hussein Ghanem, MD
Reviewed by Sexual Health Editorial Team
|
This question appears in the following topics:
|
|
|
|
