Background Information On The Diagnosis Of Erectile Dysfunction

In the early 1970s the choices for treatment of erectile dysfunction, whether mostly physical or psychological in origin, were basically psychosexual therapy or penile implants.

This approach was very limiting in terms of therapy. When direct intracavernous injection therapy and the use of vacuum erection devices started to become more common in the early eighties, erectile dysfunction was stopped more easily - often within a few days or weeks before a man with psychological (or "psychogenic") erectile dysfunction could achieve a good erection following the injection of one of the vasoactive drugs.


Up to 65 percent of men with erectile dysfunction related to anxiety gradually became less dependent on the injections, and often arrived at a point where the injections could be stopped and they would still have spontaneous erections.

Needless to say, the advent of Viagra has proved to be a great asset in continuing this trend.

But to stop erectile dysfunction which has a psychological origin has many aspects.

First and foremost, we must ask how comfortable most doctors are in dealing with sexual dysfunction in general and erectile dysfunction in particular.

The following is a summary of information adapted from assessment and treatment guidelines for male sexual dysfunction in a primary care setting.

If doctors don't ask men about sexual function, it is unlikely that it will be addressed at all.

Three examples: first, a survey of men over twenty five found that over 80% would like to discuss a sexual problem with their doctor but the vast majority were too apprehensive to do so.

Second, a recent study of cardiac patients found that almost all of them wanted their doctor to talk to them about sexual issues, but three quarters of them felt that their doctor was uncomfortable with the idea, while fully 40% said their doctor had never discussed sex with them.

It is in fact possible that doctors collude with patients to avoid these uncomfortable discussions, and stop erectile dysfunction being discussed.

Third: increasing numbers of men seen in doctors' surgeries are being treated with SSRI antidepressants, and almost half of these men will have impaired erectile function. To make this worse, doctors continue to underestimate the frequency of antidepressant-associated sexual dysfunction.

Screening for sexual dysfunction by doctors can help to disclose other medical conditions. One study found that taking a sexual history revealed important medical information in a quarter of men.

For example, about 60% of apparently healthy men complaining of erectile dysfunction (ED) have abnormally high cholesterol levels.

Recently, pharmacological treatment of erectile dysfunction has become more important (by which we mean Viagra, Cialis and Levitra).

But of course these drugs do not address or resolve relationship problems or psychological issues - which are often the real causes of anxiety and anxiety-related sexual dysfunctions (including erectile dysfunction).

While the introduction of these drugs has apparently massively increased the success rate of treatment for erectile dysfunction, we all need to keep in mind that many sexual problems can be effectively dealt with by providing basic information, adjusting misconceptions and suggesting how sexual behavior can be improved or altered.

Many men enter the doctor's office anxious or concerned about some sexual problem that has its origins in a lack of good information or unrealistic expectations about male sexual function. Doctors can help with this only if they themselves are fully informed about male sexual functioning.

 For example: middle-aged and elderly men can enjoy sexual activity, but many of them do not know that sexual desire, frequency of erections, and hardness of erections, will gradually decline as a natural consequence of the aging process, and physical touch from their partner may be needed to produce an erection.

Doctors should be telling all men, of all ages, these facts.

And again: men with diabetes, heart disease, prostate cancer, spinal cord injuries, and so on, may well lack information on how these conditions can affect their erectile functioning and what they can do about it. And of course, as we have said before, many common medications such as SSRI antidepressants can impair a man's ability to get an erection.

There are many ways of changing your lifestyle that can help to improve sexual function. This includes taking regular cardio-vascular exercise, stopping smoking, and reducing stress levels. These simple things may well improve your sexual functioning. Other things that can help include only having sex when you are well-rested and relaxed, and avoiding sex after a heavy meal or excess alcohol.

In some cases, this will be enough. But erectile dysfunction is common among men, so common that perhaps all men need to be screened for sexual dysfunction. 

Almost all male sexual problems occur in one of the four phases of the sexual cycle (see below). Sexual dysfunctions can be further classified as lifelong or acquired (has it always been there or did it start recently?) and generalized or situational (does it always occur or only in specific situations?). These classifications are important factors in determining the origin and treatment of sexual dysfunctions - including erectile dysfunction.

Types of Male Sexual Dysfunction
Desire Low Sexual Desire
Sexual Aversion
Arousal Erectile Dysfunction
Orgasm Delayed/absent ejaculation (aka retarded ejaculation)
Premature ejaculation
Pain Dyspareunia, Peyronie's disease, non-genital pain linked to sexual activity
Classifications of Male Sexual Dysfunction
A sexual dysfunction which has always been present; for example, the life-long absence or failure of a man's  erections
A sexual dysfunction which follows a period of normal sexual function
Generalized This means a problem occurs with all partners in all sexual situations
Situational Occurs only with specific partners in certain situations
Origin of Sexual Dysfunction: Other Factors
Predisposing Prior life experiences such as childhood sexual abuse; inherited characteristics such as diabetes
Life events around the time of the initial onset of the sexual dysfunction, such as work stress, divorce, and so on
Maintaining Continuing life circumstances or physical conditions that are part of the cause of a sexual dysfunction
Biological or medical vascular, hormonal, neurological and pharmacological
Psychological cognitive, affective
Social or relational Social and cultural influences such as religious background, sex roles, communication, relationship issues
Phases of the Male Sexual Response Cycle & Erectile Problems
Phase Question Possible Indications
Desire Do you still feel in the mood for sex, feel desire, or have sexual thoughts or fantasies? A reduction in desire may be a sign of hormonal or relationship problems, the side-effects of medication, or a symptom of depression.
Arousal Do you have trouble getting an erection or maintaining it?

Do you sometimes wake up in the mornings with an erection?

Can you get an erection when you masturbate?

If you wake up with an erection it may mean that you have pychogenic (emotionally or psychologically based) erectile dysfunction (ED).

Having erections when you masturbate but not during sexual intercourse with a partner may suggest situational and psychogenic erectile dysfunction (ED).

Orgasm Do you feel you ejaculate (come) too quickly?

Do you ever have difficulty reaching orgasm or ejaculating?

A man's belief that he comes too quickly may indicate premature ejaculation.

And if he has a problem reaching orgasm, he may have  delayed (retrograde) ejaculation.

Resolution Do you have pain after sex? This may indicate the presence of Peyronie's disease.

Sexual Dysfunctions Affecting Men

As noted in the table above, there is a range of sexual dysfunctions that can affect men. The three most common male sexual dysfunctions are erectile dysfunction, premature ejaculation, and low desire.

Erectile Dysfunction (ED)


Surveys suggest that ED is very common among men in the general population.

The National Health and Social Life Survey in the United States of America found that in one twelve month period, 7% of men aged between 18 and 29 and 18% of men aged between 50 and 59 had had trouble achieving an erection or maintaining it.

And the Massachusetts Male Aging Study (MMAS), a detailed study conducted in the early 1990s, suggested a prevalence of all degrees of ED of 52% among men aged 40-70; 35% of these men admitted to moderate or complete ED. As you might expect, the MMAS showed that all kinds of ED are related to age, with a twofold to threefold increase between the ages of 40 and 70. The prevalence of complete ED (no erection whatsoever) tripled from 5% to 15% in men between the ages of 41 and 70.

The frequency of ED is considerably higher among men with renal and liver failure, diabetes, heart disease, treated high blood pressure, depression, ulcer (perhaps because of the anxiety or emotional stress), arthritis, allergy, and Parkinson's disease

Smoking is a big factor in impaired erectile function. One large study of over 32,000 men found a relative risk of 2.2 among men who smoked compared to those who did not.

And incredibly, doctors have estimated that more than 80% of men with ED are not treated: either because they have not sought medical attention or because their doctors have not discussed their sexual problems with them, and the men have been too shy to raise the subject.

Diagnostic Criteria

Erectile dysfunction is the persistent inability to achieve or maintain an adequate erection until the end of sexual activity. (Remember that almost all adult men will occasionally not be able to achieve or maintain a sufficient erection.)

The term "generalized ED" means that a hard erection does not develop under any circumstances; while "situational ED" means that full erection develops in certain circumstances only (for example, with a specific partner).

Generalized ED

With generalized ED, a man does not develop a full erection under any circumstances including:
-sleep (nocturnal erections are common in men without generalized ED)
-when he is masturbating
-use of erotic materials such as sexually explicit magazines or videos
-sexual play with a partner
-attempted sexual intercourse

Situational ED

With situational ED, an erection may well occur in certain circumstances but not others. For example, a man may achieve and maintain a erection:
-when he is asleep at night but not when he is awake
-during masturbation when alone but not when he is having sexual activity with his partner
-when enjoying in non-intercourse sex play with a partner but not during sexual intercourse itself
-when he is relaxed and well rested but not when he is tired and stressed.

Conditions Associated with Erectile Dysfunction

Aging Hyperprolactinemia Peyronie's disease
Circulatory problems Hypothyroidism or Hyperthyroidism Priapism
Diabetes mellitus Penile injury / disease Pelvic radiation
Heart disease Life style issues, obesity, lack of exercise Prescription drugs
Hypogonadism Pelvic trauma
Hypertension Cigarette smoking Psychological problems
Lipid disorders Chronic alcohol abuse Depression
Renal failure Neurogenic factors Anxiety
Liver disease Spinal cord injury Social stress
Vascular disease Multiple sclerosis Trauma / injury
Endocrine problems Herniated disk Pelvic surgery
Drugs Associated with Erectile Dysfunction

A wide range of drugs have been associated with erectile dysfunction. However, the most frequently associated with erectile dysfunction are antidepressants. There have been various reports on the impact of antihypertensive (high blood pressure) medications on erectile function.

Continued here

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Other sources of information on stopping erectile dysfunction and impotence, its treatment and the cures:

WebMD on erectile dysfunction

Mayo Clinic on erectile dysfunction