Sexual problems are common for men and women. The condition of male erectile dysfunction (ED) in particular becomes increasingly common in men as they reach midlife and beyond.

Here are answers to some of the questions men routinely ask about ED.

Q: Why am I having trouble getting and keeping firm erections?

A: This is usually the first question men ask regarding ED. To understand why this occurs, it is helpful to know how erections happen. The mechanism of an erection is complex. However, simply put, an erection begins in the brain. Sexual thoughts and stimuli send a signal down through the nervous system to the penis, which causes a series of chemicals in the penis to be released. These chemicals trigger sponge-like tissue in the penis to become filled with blood, causing an erection.

The condition of ED results from one or more problems in this process.

Q: But why is this happening to me? I know I'm 60 years old, but I'm extremely fit and now is the time for my wife and I to really enjoy each other because we have the time!

A: Frustrations like this are understandable. Fortunately, there are several different types of solutions. But finding the right solution for each man depends on identifying the exact cause of the problem first. This involves visiting your doctor in order to determine what the problems is, because there are a number of conditions that can cause erectile dysfunction.

The signal that triggers an erection must pass all the way from the brain through the nervous system, so, if the nerves are damaged in some way, the signal from the brain can't get through. This can be caused by:

  • diabetes
  • excessive alcohol
  • neurological conditions including multiple sclerosis
  • pelvic surgery (especially to the prostate)

Also, some common medical conditions can interfere with the series of chemicals that need to be released in the penis for the erection to occur. These conditions include:

  • diabetes
  • high blood pressure
  • high cholesterol
  • smoking can also have a similar effect

Q: I don't have any of these medical conditions. My doctor said he thought my problem is psychological. How does he know?

A: The clue is if under certain conditions, at times when you are free of interfering thoughts or worries (such as waking from sleep or during masturbation), you have no problem with erections.

Q: My ED problem is affecting my relationship. What can I do?

When you have ED, your sexual relationships often worsen because your partner mistakenly believes that the problem has something to do with them. The result is often a "snowball" effect that can cause even greater stress and anxiety, and weaker erections. Your partner may think "I don't want to pressure him" and may become hesitant, avoiding intimacy or playfulness. In the downward spiral, your partner may also worry about not being attractive, and may even wonder "is there someone else?" Of course, your partner's withdrawing only makes matters worse. All types of sexual interaction may eventually stop because often men with ED believe that they "should be able to follow through." This is particularly common for heterosexual couples. So in addition to needing medical help to restore firm erections, help is needed to get your sexual relationship back on its feet.

Q: Sometimes I wake up with a very firm erection that won't go away for quite a while. Is this because my bladder is full in the mornings when I wake up and it is pressing on my penis making it firm?

A: No, consider all the other times that a bladder may be full and yet doesn't lead to an erection. However, waking up with erections is an important fact. This means that the brain can, in fact, signal the penis to become erect and that the mechanism for having erections is working correctly.

Q: So if everything is all right, why doesn't it work as well when I am with my partner?

A: This can happen when the signals from the brain to the penis are not clear. In other words, the message to the penis may be mixed or muddled, and confused. For example, when a man is getting aroused, there may be many other conflicting stimuli preventing the erection from occurring. There are many sources for these conflicting stimuli and thoughts, such as worries about work or family, and the stress about not being able to "perform."

Sometimes there are some problems with the signalling, such as interfering nonsexual thoughts, plus some difficulty with the mechanism in the penis itself. In this case, both signalling and penile problems can significantly compound each other.

Q: Once I started having problems, I then began to worry I would keep having more problems and found that the more anxious I got about failing, the more likely I would fail. Where do I go from here?

A: It is important to try and identify the various stresses and worries, and also to check out what is happening between you and your partner, not just sexually but generally, since this helps to uncover the source of interfering thoughts. Very often, the conflicting thoughts have to do with the relationship. Therefore, it is important that both partners speak to a doctor to clarify what the issues really are and to help decide what each partner wants to do about them.

Rosemary Basson, MD 
in association with the MediResource Clinical Team