A men’s doctor and a sex therapist share solutions.
Erectile dysfunction is one of the most common health issues that men face, especially as they age, but talking about this often difficult subject is a whole different story.
Penis problems are a major taboo for men, and many of them will do just about anything to avoid facing the problem. But it’s not good for anyone – including their partners – and things will never get better unless they are addressed directly.
To clear up this complicated situation, we spoke to two professionals with extensive experience in this field to get the inside scoop on the medical issues behind erectile dysfunction, how they’re treated, how to navigate erectile dysfunction in your relationship, and more. .
What are the health implications of erectile dysfunction?
According to Jesse Mills, MD, director of the UCLA Men’s Clinic and author of A field guide to men’s healtha patient’s erectile abilities tell a much bigger story than just how they behave in the bedroom.
“A question I ask every man that walks into my office is, do you still wake up in the morning with erections?” says Dr. Mills. “It’s a very good indication of overall men’s health. We know that for an erection to occur, a man must have a good cardiovascular system, a good hormonal system, a good nervous system and a good psychological system.
It is particularly instructive in terms of cardiovascular health. Many men who suffer from erectile dysfunction, especially if they are under 50, may also have underlying cardiovascular disease that has not yet been diagnosed.
“If you have a problem like cholesterol, it affects arteries everywhere,” says Dr. Mills. “The artery that supplies the erect penis is a bit smaller than the artery that supplies the heart, and the smaller the pipe, the sooner you will have a problem. So if a man has erectile dysfunction in that tip, it could be that his coronaries or his brain aren’t too many years behind themselves.
How does a doctor investigate erectile dysfunction?
Dr. Mills begins with an interview to find out more about the frequency and intensity of erection problems: is the patient totally unable to have an erection, or is the problem not as strong or long-lasting what before? The answer indicates how a doctor will approach treatment in the future.
Then it’s on to the physical exam, which will include a heart check, blood tests to assess the risk of problems like high cholesterol or diabetes, and possibly a prostate exam, depending on age. (Dr. Mills says prostate screenings are generally recommended to start between ages 45 and 55, depending on risk factors and family history.)
Testosterone levels are another important piece of the puzzle, and they can be affected by issues you may not realize are related, such as sleep quality. “If someone isn’t sleeping, their brain won’t send the signal to the testicles to make testosterone, so guys who sleep poorly almost always have low testosterone levels,” says Dr. Mills.
The doctor will also perform a genital exam, check the health of the testicles, and assess any abnormalities. One thing Dr. Mills looks for is scar tissue on the penis, which could be a sign of a condition called Peyronie’s disease. If he finds anything, he can perform an ultrasound to get more information.
What are the mental effects of erectile problems?
Erections can be a physical response, but an inability to sustain them has a substantial effect on the mind as well. Just starting a discussion about it is tricky, says sex therapist Shamyra Howard, LCSW, who describes the condition with her clients as “erectile dissatisfaction.”
“When people have problems with their penises, one of the associated stigmas is the word ‘dysfunction,'” she says. “When they hear ‘dysfunction,’ the erection problems they have feel aggravated.”
In Howard’s experience, the mental effects can include issues of depression, anger, lack of confidence, and guilt over being unable to perform. Many men feel deep shame over what they perceive as a personal shortcoming, which can also cause them to emotionally withdraw not only from their partner, but also from their male friends. In fact, concerns about how their problems will make them appear to other men extend even to therapists.
“Men will go to a woman to talk about their erection problems in therapy before going to see a man, and that’s also been my experience and that of other colleagues,” Howard tells us. It all goes back to how men learn to define themselves by the size of their penis and how much (or how often) they use it. “They feel embarrassed to talk about their penis issues with another man because a lot of them have learned to wear their egos in their underwear, so talking to a woman is less threatening.
One of the most common emotional effects is a feeling of inadequacy, and this doesn’t just apply to the person struggling to get an erection.
“Their partner may think, ‘Oh my God, he can’t maintain an erection and it’s because of me. He doesn’t want me. What can I do to make his erections last longer? Howard says, “So now we have both people in the relationship feeling inadequate for the same reason.”
How should you talk to your partner about erectile dysfunction?
Whether the barriers to erectile happiness are physiological, psychological, or a combination, the most important factor in successfully overcoming this as a couple is clear, open, and unashamed communication.
For the person with erectile dysfunction, one option is to state it clearly: “You can say, ‘Hey, I have a problem. I think I need to get it checked out, and I wanted to let you know,” Howard said. “It opens the conversation.”
It’s also helpful to relate to how these issues can affect your partner as well: “You can say, ‘I don’t know if you’ve noticed, but I’ve been a bit distant from you sexually, and I want to talk to you about why.'”
On the other hand, if you’re looking for a way to address erectile issues with a partner you suspect is dealing with them, Howard says it’s important to use “I” statements that center your own experience. rather than “you” statements that blame your mate.
“Saying ‘You rejected me for sex’ is the wrong thing to do. You mean, “I feel a little distant from you sexually, and I want to talk about what’s going on with that,” Howard explains. “Tell them you’ve noticed things are different and want to discuss what you can do to improve the sexual relationship.”
But you don’t have to blindly jump into such a complicated conversation. Howard says anyone whose partner is struggling with their erections could benefit greatly from talking to a sex therapist themselves, for help on what kind of language to use in your specific situation.
And while many couples may think that the inability to maintain an erection means the end of their sex life, Howard strongly disagrees. In fact, she frequently works with clients to redefine sex beyond a simplistic understanding that is limited to penetration.
“Sex is a mental, physical, emotional, spiritual and erotic connection, so it can literally be whatever you want,” she says. “It’s a big change for people to explore other forms of sex like outdoor or oral sex. Watch mutual masturbation or find different places in the house to be intimate. Do something in a different place that might to seem risky.It is a question of increasing the eroticism while decentering the penetration.
What is the treatment plan for erectile dysfunction?
The treatment most of us are familiar with is ubiquitous for a reason, says Dr. Mills.
“The little blue pill is still an incredibly well-prescribed drug,” he explains. “Viagra has been around since 1998, and it’s generic, so you can go to your local supermarket and get it for about 20 cents a pill.”
Although Viagra is Dr. Mills’ “first-line therapy for everyone,” he adds, it doesn’t work for everyone, and if it does, there are other options.
“One of the main things I do surgically is something called a penile implant, which is a bit like a knee replacement,” he says. “We make a small incision in the penis and insert two cylinders which inflate with salt water. I hook him up to a reservoir and put a little pump in his scrotum, so every time he wants to have sex he just pumps this little device, and like magic, his penis comes to life. It’s a great way to restore intimacy for men who don’t have other options that work conservatively.
Unfortunately, medical intervention – whether it’s a pill or a procedure – can sometimes intensify men’s feelings of inadequacy because they bristle at the thought that they need help. to be efficient. But Howard has a simple approach to helping patients deal with this concern.
“If a doctor told you that you needed medicine to get your heart beating, would you say, ‘Oh man, I don’t want to take it because I want my heart to beat on its own?’ It’s the same thing – it’s a part of the body, and we’re going to have a lot of problems with different parts of the body as we age and grow.