Erection Problems (2)

Blood pressure medicine: Beta blockers, Verapamil (Calan), Reserpine (Hydropes), Clonidine (Catapres), Methyldopa (Aldomet)
Diuretics: Thiazides, Spironolactone (Aldactone), Hydralazine
Antidepressants: Prozac, Lithium, MOA's, Tricyclics
Stomach medicine: Tagamet and Zantac, plus other compounds containing Cimetidine and Ranitidine or associated compounds
Anticholesterol drugs
Antipsychotics: Chlorpromazine (Thorazine), Pimozide (Orap), Thiothixine (Navane), Thiordazine (Mellaril), Sulpiride, Haloperidol (haldol), Fluphenazine (Modecate, Prolixin)
Heart medicine: Clofibrate (Atromid), Gemfibrozil, Diagoxin
Hormones: Estrogen, Progesterone, Proscar, Casodex, Eulexin, Corticosteroids
Gonadotropin releasing antagonists: Zoladex and Lupron
Cytotoxic agents: Cyclophosphamide, Methotrexate, Roferon
Non-steroidal anti-inflammatories

Others include: Alprazolam, Amoxapine, Chlordiazepoxide, Sertraline, Paroxetine, Clomipramine, Fluvoxamine, Fluoxetine, Imipramine, Doxepine, Desipramine, Clorprothixine, Bethanidine, Naproxen, Nortriptyline, Thioridazine, Tranylcypromine, Venlafaxine, Citalopram

And yet more: Alcohol, Amphetamines, Metoclopramide, Opiates, Anticonvulsants, Cocaine...well, I am sure you get the idea. 

Based on: Beyond Viagra by Alfred  Newman, MD, published by Starhill Press, Alabama, 1999. And Principles and Practice of Sex Therapy by Sandra Lieblum, the Guilford Press, New York, 2000.

It's not easy to separate problems with the penis that originate in the mind from those that originate in the body.

But if a man gets an erection fairly easily when he masturbates, or during the night, the problem with his penis is not likely to be physical.

Here are some guidelines which may help to indicate if a penis problem is physical:

1 A man does not get a decent erection when he masturbates

2 He does not get nighttime erections or wake up with a morning erection

3 He does not get an erection with oral sex

4 His erections are unpredictable and erratic

But even if all of the above applies, the problem can still be psychological. Only a very competent urologist or andrologist, who knows what he is doing, can sort this out. 

But if the the problem is physical, what can be done? There are various erections aids and devices which serve to help a man - the ErectAid, for example, is a band which fits around the base of the penile shaft to prevent blood outflow. There's also a vacuum device which a man can use to - temporarily - inflate his penis with blood, and cock rings of various kinds. There are some references to websites where you can purchase these items if you feel so inclined. But perhaps the best therapy of all is Viagra, a minor miracle for many men, especially when combined with talking to a competent sex therapist.

Deep seated impotence due to psychological issues

Some men have never had sex because their penis literally goes limp at the moment when they try to penetrate their partner, As you may well imagine, this is often due to very deep seated psychological issues, such as:

Childhood abuse so severe that it leaves a man unable to trust anyone

A mother who figuratively "took over" a boy's penis and sexuality and made it her own (we can call her the castrating mother). This means that the boy develops into a man who cannot communicate effectively with women. He can't share his feelings, wishes or desires. As he grows progressively more out of touch with his own emotions, he may lose his ability to get an erection.

Deep seated impulses that contradict what a man is trying to do or be. The most common example of this is homosexual impulses in a man who resolutely prefers to see himself as heterosexual. Other common causes of impotence include intense fear of intimacy, or a lot of guilt and fear around sex. All of these emotions can inhibit the penis and stop it performing as it should.

But most erection problems are simpler than that!

When you work with men who have erection problems, you often find that a bit of education at some point in their lives would have helped to prevent the problems they are facing. The things that men need to know, but don't, are important, and they all contribute to keeping a healthy sexual attitude - and a penis in full working order!

I mentioned above the men who develop an erection problem because they are out of touch with their penis. There is another group of men whose penises don't work because they have lost touch with some important stuff going on in their heads. Here's what I mean by this.

There's a widespread view - among some men and women, anyway - that a man should be a sex machine, ready, willing and able to have sex with any woman who cares to approach him, or who takes his fancy. But life isn't like that - a man's sexual response is much more fragile, and so is the ability of his penis to maintain its erection, day in, day out. So let's look at some of the more common beliefs which can cause erectile difficulties:

A man shouldn't be nervous about sex. But the problem is that it's very common for a man to be nervous when he's sexual with a woman, especially if he wants to please her. (Which is something that can happen when a man takes responsibility for his partner's sexual satisfaction.) Anxiety about whether he can perform, or whether he's good enough in bed, is more than enough to make a man's penis wilt. And if he can't admit to his partner that he has an erection problem, then he may well find that focusing on both his anxiety and his softening pens just makes matters worse. 

A man should know exactly what to do and when during sex. Oh dear. Again, it just isn't that simple. Men are not mind readers, any more than women are, and they can't predict what their partners want or wish for during sex if they are not communicating it. But a man who assumes he should know all this without being told has a serious problem during sex, for he takes on the burden of responsibility for satisfying his partner and giving her pleasure. An erect penis is often not hard enough to bear such a load, and if she offers him no help in the practicalities of sex, he can also run into trouble - for example, suppose he can't find the way into her vagina (especially when he's in the man on top position). He pushes his penis ineffectually at his partner's vulva. She's too shy or too inhibited to take his cock in her hand and guide it in, so eventually he gets so uptight that he loses his erection. He then goes into a cycle of anxiety and loss of erection which makes it even harder for him to have sex....the cycle gets worse, until his confidence is so reduced that neither does his penis get hard, nor does he have the nerve to try penetrating his partner.

A man should be able to get an erect penis and keep it so even when his partner is either wrong for him (he doesn't want sex with her) or she herself hates sex and doesn't respond to his sexual moves. A man may well find that when he is with a woman who doesn't want sex that he loses his erection - and that's the most natural thing in the world. Many women with sexual issues develop vaginismus - a condition where the muscles of the mouth of the vagina tighten so that penetration becomes difficult, if not impossible. But, would you believe, men who have girlfriends with vaginismus, or girlfriends who don't like sex, may never give a moment's thought to the possibility that actually they don't have a problem when they can't get an erection with a woman who doesn't want sex!

It's a curse, the way men blame themselves for so many issues. Sex is not an activity which we undertake in isolation - well, not always, anyway - and it takes two people to make it successful. True, only one of them has to have a penis - preferably an erect one - but then again, that penis wants to be enveloped by a juicy and willing vagina whose owner looks forward to receiving this male flesh.

The peculiar ting is that the female partners of many of the men in this situation actually blame them for the erection problems they have it! In one case, a woman who had never had an orgasm in her life, either on her own or with her partner, blamed her male sexual partner for her problems, even though her vagina was too tight to permit his penis in!

The problem, of course is that men come to believe they are responsible for female sexual pleasure.

Another belief is that men should be able to have sex whether they are in a relationship or outside one. But the truth is rather different. One simple example is the man raised in a religious household with strict prohibitions on sex outside marriage. He may well have deep seated beliefs that sex is only permissible in a faithful, committed relationship. Little does it matter what he thinks he would like to do - fuck around, take women to bed in a series of one night stands, or whatever: if his internal conscience dictates that he should have sex in a relationship, he may well need faithfulness and commitment before he can get erect and stay erect.

As Eva Margolies so memorably says: "A man who does not listen to his penis usually finds that his penis does the talking for him anyway."

Some facts you may not know about erectile problems

This is the kind of information many men need to know - it stops them worrying about what the suddenly think of as erectile inadequacy. Did your father ever tell you these things? No? Then how would you ever have found out about them?

Men over 30, or sometimes 40, years of age often need to be physically stimulated before their penis becomes erect. In fact, the spontaneous erections of youth may be nothing more than a memory by the time a man is 50, and at some point before that he is likely to need physical stimulation before he can become fully erect. That's a fact of life. Like it or not, the penis responds to declining levels of testosterone in the blood by becoming less responsive to sexual thoughts and fantasy. As we've already seem, this means that a man who is aware of his arousal both in his body and his head is likely to make this transition through mid-life more successfully than one who simply relies on his body to respond automatically with an erection to sexual stimuli.

A man does not have to have a firm, hard erection to have sex. It is in fact perfectly possible to penetrate and thrust with a less-than-hard penis, and sex can be just as pleasurable as it would be with a full erection.

Lastly, it's important to know that a penis is never going to stay erect all the way through sex, no matter what age you are. It can be surprising to a man when he finds that his penis, initially rigid and erect as he, say, starts to give his girl oral sex, gradually wilts and becomes flaccid again as time passes. He can't understand this p after all, he has his face buried in his girlfriend's cunt!  Yet this is natural. Almost all men lose their erections during sex at some point, and some level of physical stimulation will be needed in all but the most horny young men to maintain an erection over a long period of time.