What causes erectile dysfunction?
“A variety of things cause it. Some psychological and some physical,” says Dr Tomlinson. "Psychological issues tend to affect younger men, such as first night nerves and so on. Often, these problems don’t persist. But there can be more serious psychological problems about sex that need the help of a psychosexual therapist.”
Worries about work, money, your relationship, family, and even worrying about not getting an erection, can all be factors.
Physical reasons for erectile dysfunction include:
Medical conditions that cause erectile dysfunction
- heart disease
- raised blood pressure
- raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow (1-2mm in diameter compared with around 10mm in the heart artery)
- low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex.
Drugs that cause erectile dysfunction
- some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure, and antidepressants, antipsychotic drugs and anticonvulsant drugs
- recreational drugs such as cannabis and cocaine
- smoking: nicotine affects the blood supply to the areas of the penis that cause erections
What causes premature ejaculation?
"Either just being very excited with a new partner, or an acute sensitivity of the local nervous system, which triggers orgasm too suddenly," says Dr Tomlinson.
It can also be linked to anxiety about sexual performance, stress, unresolved issues in a relationship, or depression.
What should I do if I have premature ejaculation?
See your GP, or a psychosexual therapist. A therapist can teach you techniques to try to delay ejaculation.
What treatment is there?
“A lot of men and their partners don’t worry, and they work around it," says Dr Tomlinson. "But if you’re very unsatisfied, there are some things you can try.”
- Have sex again soon after the man ejaculates. The second time, it will take longer to reach an orgasm. Older men might find this difficult as it may take too long to get a second erection.
- Creams (available from sex shops) can be put on the penis to numb sensation. “But this tends to transfer the numbing sensation to the partner, which they don't always like,” warns Dr Tomlinson. Some find using a condom useful.
- The man’s partner can squeeze his penis in a certain way to prevent him ejaculating. “A man needs an extremely willing partner to do this, and some partners don’t feel comfortable with it,” says Dr Tomlinson.
- Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can slow ejaculation, but only for a year or so. “We’ll try every other treatment first before starting on drugs,” says Dr Tomlinson.
- Psychotherapy might help in terms of relaxing or exploring problems in the relationship.