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Erectile dysfunction (ED) is a common problem in men, with the incidence increasing with age. There are 4 main causes of ED: psychological, hormonal, vascular and neurological. Many men will have more than one cause, although one usually predominates. An erection is a hydraulic process. Arteries to the penis relax, allowing blood to flow in. At the same time, the veins become compressed, preventing the blood from flowing out. This causes the pressure to rise in the penis and the penis enlarges and becomes more rigid, similar to a balloon being filled with air. After a man ejaculates or stops being stimulated, the arteries constrict, decreasing blood flow into the penis. At the same time the veins relax, allowing blood to flow out more easily. This is akin to the balloon being deflated.
In men less than 40 years old, psychological factors are is by far the most common problem, usually due to “performance anxiety”. Both younger and older men may also have a problem with low testosterone. Testosterone is needed to maintain a healthy sex drive and the proper responsiveness of the penis to stimulation. Low testosterone can lead to a decreased sex drive, ED, depression, weight gain and a feeling of lethargy.
As men grow older, vascular and neurologic problems become much more common. There are two types of vascular problems. The first is insufficient blood flow into the penis and the second is venous incompetence. Insufficient blood flow in is usually caused by atherosclerosis (hardening of the arteries) or by anti-hypertensive medication. The cause of venous incompetence is not clear and is very difficult to treat. Neurological problems are caused by diabetes which leads to neuropathy or by spinal cord injury.
There are a variety of diagnostic tests which are used to determine the underlying cause of ED and to suggest the best treatment option. A variety of treatments are available, including tablets, suppositories, injections, constriction devices and surgery.
More information: Wikipedia | Erectile Dysfunction
Premature ejaculation is one of the leading male sexual dysfunctions affecting about 30% of men of all ages regardless of race and socioeconomic group. This can be a temporary problem but in some men a life-long problem. PE is often is confused by physicians and patients to be erectile dysfunction (ED) for which treatment does not appear to reliably satisfy the patient.
Only 9% of men actually seek treatment from a physician for premature ejaculation. This occurs for two main reasons: (1) they're embarrassed or (2) they don't believe that physicians have anything effective to offer them. We're here to make you comfortable and provide you with a safe, effective solution.
The exact cause of premature ejaculation is not well known and often varies from one man to another. Studies have shown a variety of factors alone or in combination may contribute to PE:
Premature ejaculation can be caused by temporary depression, stress, or anxiety about a relationship, unrealistic expectations about performance, or a history of sexual problems.
A number of biological factors could be the cause of premature ejaculation including abnormal hormone levels, abnormal reflex activity of the ejaculatory system, hyperthyroidism, and inflammation or infection of the prostate or urethra.
It is believed that the neurotransmitter serotonin (5HT) plays a central role in controlling ejaculation. It has been concluded that low levels of serotonin in specific areas in the brain could cause premature ejaculation. It has been shown that increases in serotonin levels can help delay ejaculation in some men.
Many physicians believe that penile hypersensitivity plays a predominant role in the ejaculatory response while others believe that PE is the result of a combination of multiple contributing factors. The success of topical medications provides strong reason to believe that penile sensitivity does contribute to premature ejaculation.
We recommend that you visit us for an evaluation. This is a problem which may be evaluated and treated with a single office visit. This is especially true if you have "acquired premature ejaculation", meaning that it has been occurring more recently versus a lifelong problem.
Some patients may want to start with some behavioral techniques such as the start / stop or squeeze methods. Generally, patients report a better outcome if they combine this technique with oral medications or topical treatment.
Some men respond well to low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the levels of serotonin in certain areas of the brain. During the treatment of men with depression, it was discovered that many men took a longer period of time to reach ejaculation. These medications require a prescription.
Topical anesthetic medications are often the first course of action for premature ejaculation. They are easy-to-use, cost effective and only need to be applied when you want to engage in sexual relations and have a negligible risk of significant side effects.
Our patients are having good success with a new product, Promescent®. Our office has Promescent® available for purchase or you may purchase directly from their website without a prescription.
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Urologists Dr. Steven M. Berman, MD and Dr. Mark Stein, MD specializing in Prostate, Kidney Stones, Erectile Dysfunction, Prostate Cancer, Kidney Cancer, Enlarged Prostate, Bladder Problems, Incontinence, and Female Urology.