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What is erectile dysfunction?**

All men have difficulties with erections from time to time. The occasional failure to get or maintain an erection, which lasts long enough to have sex, can occur for a variety of reasons, including drinking too much alcohol or being very tired. The inability to get or maintain an erection less than 20% of the time is not unusual.

Erectile dysfunction (ED) is the inability to get or maintain an erection 25% or more of the time. Some men with ED find they are completely unable to achieve an erection, others have an inconsistent ability to achieve an erection, and still others experience only brief erections. ED is a frustrating condition that can have physical or psychological causes. ED can be the first sign of an underlying health condition that needs treatment, so seeking medical evaluation is important.

ED is also different from a lack of sexual desire or problems with ejaculation and orgasm.

How common is it?**

Erectile dysfunction affects 30 million men in the United States. The problem can occur at any age, but the older a man gets, the greater the chance that he will have a health problem that results in ED. According to the National Institutes of Health, approximately 5% of 40-year-old men and between 15 and 25% of 65-year-old men experience ED on a long-term basis.

In young men, erectile dysfunction is less common and when it does occur is more likely to have a psychological cause such as stress or performance anxiety. Still, young men are seeking treatment for this and other sexual problems in increasing numbers. The use of Viagra increased 312% among men aged 18-45 between 1998 and 2002.

How does an erection occur?**

For an erection to occur, several parts of the body must work together. The brain sends messages to control the nerves, hormone levels, blood flow and muscles that cause an erection. If anything interferes with these messages, or if any part of the system doesn�t function correctly, an erection won�t occur.

The penis has two sponge-like cylindrical structures that run along its length, parallel to the urethra (the tube that carries semen and urine). During sexual arousal, these cylinders become engorged with blood, straightening and stiffening the penis. Continued sexual arousal maintains the higher rate of blood flow into the penis and limits the flow out of the penis, keeping the erection firm. After ejaculation or when the sexual excitement passes, the excess blood drains out of the spongy tissue and the penis returns to its non-erect size and shape.

What are the psychological causes of erectile dysfunction?**

While thoughts and emotions always play a role in getting an erection, erectile dysfunction is most often caused by something physical, such as a chronic health problem or the side effects of a medication. The physical and psychological causes of erectile dysfunction interact. For instance, a minor physical problem that slows sexual response may cause anxiety about maintaining an erection. The resulting anxiety can worsen erectile dysfunction.

A variety of physical risk factors can contribute to erectile dysfunction. Factors that may be present for younger men include:

Substance Abuse,Chronic use of alcohol, marijuana or other drugs can cause erectile dysfunction and decreased sexual drive.

Stress, anxiety or depression. Other psychological conditions also contribute to some cases of erectile dysfunction.

Smoking can cause erectile dysfunction because it restricts blood flow to veins and arteries. Men who smoke cigarettes are much more likely to develop erectile dysfunction.

Having a chronic health condition. Diseases of the lungs, liver, kidneys, heart, nerves, arteries or veins can lead to erectile dysfunction. So can endocrine system disorders, particularly diabetes. The accumulation of deposits (plaques) in your arteries (atherosclerosis) also can prevent adequate blood from entering your penis. And in some men, erectile dysfunction may be caused by low levels of testosterone.

Taking certain medications. A wide range of drugs � including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer � can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also can pose a problem.

Certain surgeries or injuries. Damage to the nerves that control erections can cause erectile dysfunction. This damage can occur if you injure your pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer can increase your risk of erectile dysfunction.

Prolonged bicycling. Over an extended period, pressure from a bicycle seat has been shown to compress nerves and blood flow to the penis, leading to temporary erectile dysfunction and penile numbness.

Metabolic syndrome. This syndrome is characterized by unhealthy cholesterol and triglyceride levels, high blood pressure, and insulin resistance.

What treatments are available?**

Although most men experience episodes of erectile dysfunction from time to time, you can take these steps to decrease the likelihood of occurrences:

• Exercise regularly.
• Reduce stress. Click to learn more about stress management.
• Get enough sleep. Click for healthy sleep tips.
• Get help for anxiety or depression.
• Limit or avoid the use of alcohol.
• Avoid recreational drugs, including marijuana.
• Stop or reduce smoking. Access smoking cessation strategies and support here.
• See your medical provider for regular checkups and medical screening tests.
• Work with your medical provider to manage conditions that can lead to erectile dysfunction, such as diabetes and heart disease.

What is premature ejaculation?**

Many men sometimes ejaculate sooner than they or their partner would like. If it just happens occasionally, it's probably not something to worry about. However, if you regularly ejaculate sooner than you and your partner would like, such as before intercourse begins or soon afterward, you may have a condition known as premature ejaculation. Although the issue is often phrased in terms of time (i.e., I�m ejaculating within thirty seconds after starting intercourse), the issue is really about voluntary control of the ejaculatory process.

What is the average time until ejaculation?**

In assessing whether you have premature ejaculation, it can be important to ask whether your own or your partner�s stamina expectation is realistic. Keep in mind that the average time from insertion to ejaculation is less than three minutes.

If your partner is a woman, remember that female orgasm doesn�t occur automatically as a result of prolonged intercourse. Surveys tell us that only about one fourth to one half of women regularly orgasm during intercourse. Most women find it is easier to be orgasmic with manual or oral stimulation than through intercourse.

How common is it?**

Premature ejaculation affects about one out of three men. It is the most common male sexual problem, particularly among younger men.

What are the causes?**

Premature ejaculation can have both psychological and biological causes.

Psychological causes

• Early sexual experiences may establish a pattern which is difficult to change. First experiences of sexual intercourse often involve excitement mixed with anxiety and a demand to perform quickly in order to avoid being discovered. Your focus might be on your performance rather than on the pleasurable and erotic aspects of the experience. Most males reach orgasm very quickly the first time they have intercourse. Although most men also learn to slow down, to enjoy their own and their partner�s pleasure, and become comfortable and confident with sexual intercourse, early ejaculation continues to be a problem for about 30 percent of men.
• Many men with premature ejaculation also have problems with anxiety � either specifically about sexual performance, or anxiety caused by other issues. In general, linking sex and performance, rather than sex and pleasure, can be problematic. In developing ejaculatory control, you might find that it is best to focus on what would bring pleasure to you and to your partner. It can also help to think of ejaculatory control as a skill that you and your partner develop together to enhance mutual satisfaction.
• Premature ejaculation can also be related to erectile dysfunction. Men who are anxious about obtaining or maintaining their erection during sexual intercourse may form a pattern of rushing to ejaculate and have difficulty changing that pattern.

Biological causes

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

• Abnormal hormone levels
• Insufficient concentration of the neurotransmitter serotonin
• Abnormal reflex activity of the ejaculatory system
• Certain thyroid problems
• Inflammation and infection of the prostate or urethra
• Inherited traits

Rarely, premature ejaculation is caused by:

• Nervous system damage resulting from surgery or trauma
• Withdrawal from narcotics or a drug called trifluoperazine (Stelazine), used to treat anxiety and other mental health problems

Whether the cause is psychological or biological, treatments including medications, counseling and learning sexual techniques to delay ejaculation can improve sex for you and your partner(s).

What are the treatment options?**

Treatment for premature ejaculation can include behavioral therapy (including learning specific sexual techniques), certain medications and counseling or psychotherapy. Often, a combination approach works best. 80-90% of men are able to learn better control through treatment.

In some cases, behavioral therapy may involve simple steps such as masturbating an hour or two before intercourse to help you delay ejaculation during sex or stimulating your partner to a state of high arousal before you have your genitals touched, so that your orgasms can be achieved closer to the same time.

Another approach that may help is to avoid intercourse for a period of time and instead focus on other types of sexual play so that pressure is removed from your sexual encounters. Connecting in this way can help you re-establish a satisfying physical bond with your partner(s).

In addition to the approaches above, there are two specific behavioral methods which can help you develop ejaculatory control:

The stop and start method helps you learn to recognize when climax is imminent and to slow down or reduce stimulation in order to extend the time until ejaculation. If you find yourself nearing climax, withdraw your penis from your partner or otherwise reduce stimulation and allow yourself to relax enough to prevent ejaculation. By starting and stopping sexual stimulation and learning to notice when climax is imminent, you can learn to prolong the sex act.

A second method known as the squeeze technique also helps you gain control over the timing of your ejaculation. To use the squeeze technique, you begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate. Have your partner squeeze the end of your penis, at the point where the head joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes. After the squeeze is released, wait for about 30 seconds, then go back to sex play. (You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, the full erection returns.) If you again feel you're about to ejaculate, have your partner repeat the squeeze process. By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. You can also use this technique without a partner by masturbating and then applying the squeeze yourself as described above. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the squeeze technique.

Medication is another option for treatment and generally most effective when used in combination with behavioral methods. Certain antidepressants and topical anesthetics can be used to treat premature ejaculation. You may need to try different medications or doses before you and your doctor find a treatment that works for you.

A side effect of certain antidepressants is delayed orgasm. Doctors sometimes suggest men who have premature ejaculation can take antidepressants to benefit from this specific side effect. You may not need to take these medications every day to prevent premature ejaculation. Taking a low dose several hours before you plan to have sexual intercourse may be enough to improve your symptoms. Other side effects of these antidepressants can include nausea, dry mouth, drowsiness and decreased libido.

Desensitizing lubricants can also be used to treat premature ejaculation. They contain a mild anesthetic (7.5 percent benzocaine) that causes a temporary numbing sensation after being applied to the skin. The purpose of this desensitization is to help men to keep their erections and to postpone ejaculation. Since the penis has less sensation, sexual pleasure could be reduced. Wearing a condom when you use these products can help so that the lube can�t rub off onto your partner's body, diminishing sensation and pleasure for him or her as well. Desensitizing lubes are water-soluble, not oil-based, and so they can be used with latex condoms. They are available over the counter...

**All the information above has been gathered from the weblink of the Brown University and we Thank the University.

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