Erectile dysfunction—a persistent failure to achieve or sustain an erection—is a widespread problem; in the USA alone, estimates suggest there are around 18 million men who are afflicted. Achieving sexual arousal involves an intricate combination of brain, nerve endings, hormones, emotions, and blood vessels; it is not surprising that things can go wrong.
We are all probably familiar with some causes of erection failure: old age, smoking, alcohol misuse, and diabetes. But there are a number of other, more obscure factors that can contribute to the male member failing to rise to the occasion.
10High Blood Pressure
To achieve an erection, the penis needs to be inflated with blood. We might reasonably expect that someone with high blood pressure would possess a more powerful pump to achieve this aim and therefore might be less likely than the average man to suffer erectile failure.
Research has shown, however, that around two-thirds of males with high blood pressure (a disorder known medically as “hypertension”) experience some degree of erectile dysfunction. Persistently high blood pressure is believed todamage the blood vessels that supply the penis, preventing their full expansion and consequently denying the penis a sufficient blood supply. In addition to impeding the ability to gain an erection, high blood pressure may also dampen sexual interest and prevent ejaculation.
If a man’s erection manages to survive the effects of high blood pressure itself, it still might succumb to the medications used to treat it. Both diuretics (often referred to as “water pills”) and beta-blockers, commonly employed to reduce blood pressure, can dampen erectile potency.
We could be forgiven for assuming that pills that improve mood and counter misery would enhance a person’s sex life. But this is often not the case. Both the older type of antidepressant (the “tricyclics”) and the newer versions (the “SSRIs”) cause a range of sexual difficulties in both sexes, including erectile problems in males.
The reason for this unfortunate side effect is that antidepressants change the levels of our nervous system’s chemical messengers, such as serotonin and dopamine. This has the effect of dampening the sensitivity of the sexual organs and impairing both sexual interest and arousal. Serotonin may be particularly potent in this regard due to its inhibition of nitric oxide, a chemical that plays a central role in the relaxation of smooth muscle to allow blood flow to the penis.
So on top of the despair and feelings of worthlessness associated with depression, the medication widely used to treat it will often inflict the shame of impotence upon the sufferer. Who said that the pharmaceutical industry didn’t have a wicked sense of humor?
A German research study suggested that excessive snoring might contribute to erectile problems. The study proposes that both the maintenance of an open airway and ensuring sufficient blood flow to the penis rely on the same biological mechanism. The implication for the ladies is that the louder and more persistent the snoring from the man sleeping next to you, the less likely he’ll be to provide sexual satisfaction when he wakes up.
However, the evidence for a direct link between snoring and erection failure is inconsistent. A questionnaire study of over 800 men in Minnesota compared heavy, moderate, and non-snorers on a range of sexual measures. While those in the “heavy snoring” category reported significantly less sexual satisfaction, no significant differences between the groups were found for ejaculatory function, erectile problems, and sex drive. It seems, therefore, that snoring is associated with a general reduction in sexual fulfillment (particularly in older men) rather than erectile dysfunction per se.
7Trying Too Hard
No pun intended, but trying too hard to achieve a stout erection might be the very reason why it fails to materialize. Unlike most tasks in life, where the amount of effort we expend corresponds to the likelihood of success, excessive mental and physical energy devoted to realizing a rock-hard penis may be counterproductive.
Particularly unhelpful is a process often referred to as “spectatoring,” whereby the man continuously tries to monitor his performance during sexual activity. Attending to the potential consequences of not performing impairs sexual arousal. Rather than enjoying the erotic sensations, the man typically asks himself questions: How am I performing? Am I satisfying my partner? Is my penis hard enough? It’s as if he is not directly involved in the physical intimacy but is, instead, watching his own performance like a spectator at a sporting event. The associated anxiety can be self-fulfilling, with the apprehension around sustaining an erection directly causing its demise.
Peyronie’s disease is a disorder that afflicts around 1 percent of men. It involves the buildup of scar tissue along the penis, causing it to bend—painfully—during the process of arousal, thereby softening the erection. The causes of the disorder are unknown, although experts believe it might be a combination of genetic inheritance and injury to the penis. The speed of onset of the disease varies considerably, ranging from very gradual to a rapid, overnight emergence.
In a non-aroused, flaccid state, the problem may not be apparent, but during erection pain is experienced and a bend in the penis becomes visible. In rare instances, the curvature can be severe. In up to 20 percent of the cases, the disorder will spontaneously rectify itself without treatment. The majority of sufferers, however, may require active intervention involving either medication or surgery. Nevertheless, given the potential for natural improvement, doctors often recommend watchful waiting for a couple of years before starting active treatment.
It is often claimed that bald men are more virile than their hairy counterparts. If there is any truth to this assertion, it may be because the hairless men opted not to resort to medications in an attempt to reverse their baldness. Several studies have linked the popular hair loss drug, Propecia, to subsequent erectile failure. During the 1990s, the drug company Merck & Co., the manufacturers of Propecia, had reported that any sexual side effects associated with the medication were rare and could be reversed by stopping the drug. Both these assertions were later shown to be incorrect.
The erectile impairments caused by Propecia are due to its active ingredient, finasteride, interfering with the metabolism of testosterone. A recent study in The Journal of Sexual Medicine described how 20 percent of hair loss patients who took the drug suffered sexual difficulties after three months of treatment. Strikingly, almost all the men in this sample continued to suffer sexual dysfunction for many months (sometimes years) after discontinuing the drug.
The teardrops of weeping women may dampen more than their cheeks.
In a bizarre experiment, men were instructed to sniff the tears of women who had recently watched sad movies. Afterward, their sexual interest and arousal were compared with a control group of men who had sniffed a salt solution. The research study involved a “double-blind” design in which neither the participants nor the researchers knew whether the liquid being smelled was tears or saline. The tear sniffers were subsequently found to be less sexually aroused by pictures of women and to have reduced levels of testosterone circulating in their systems.
One explanation is that female tears may contain a chemical that lowers testosterone as a means of countering male aggression, a function that might have evolutionary benefits. The subsequent dampening of sexual arousal may be a secondary effect.
Ladies, the next time you find yourself drooling over a muscular male body in the gym, bear in mind that all that masculine bulk might contrast starkly with what resides beneath the Speedos. Many bodybuilders resort to anabolic steroids as a means of accelerating muscle development and to help them recover more quickly from intensive training sessions.
But these benefits might come at a cost. Although steroids boost the level of testosterone and might therefore be expected to enhance sexual arousal, prolonged use interferes with the body’s natural production of the hormone. This has the effect of shrinking the testicles and increasing the risk of erectile failure. Awash with all this additional, artificially induced testosterone, natural producers of the male sex hormone become lazy. Therefore, when the person stops using anabolic steroids, the body is often rendered incapable of generating sufficient amounts of testosterone to achieve erections.
Those of us who listened in a school biology class will know that our bowels and intestines are physically and functionally separated from our genitals. Yet research has shown that over three-quarters of men who underwent bowel surgery to remove cancerous tissue suffered erectile dysfunction in the aftermath.
The reason for this link between bowel surgery and sexual malfunction is that nerves supplying the sexual organs are often damaged during the operation. As a result, the messages to the penis to generate an erection are weakened or even lost altogether.
Doctors often deploy “nerve-sparing” procedures during bowel surgery in an effort to minimize the collateral damage, but sometimes the key nerves are obscured from the surgeon’s view. Even when a skilled surgeon manages to avoid severing these essential, erection-producing nerves, the trauma of the operation often impairs their functioning, causing temporary erectile problems that may last up to two years.
Riding a bicycle on a regular basis is an excellent form of exercise that burns calories and strengthens the heart. But some experts have suggested that too many hours in the saddle might be associated with an unwanted side effect. A serious male cyclist, perched on a narrow saddle, may put the bulk of his weight on the perineum—the strip of skin between the anus and testicles. Since the perineum acts as a conduit for the nerves and blood vessels supplying the penis, its prolonged compression can evoke erectile dysfunction. The risk is highest in those men who spend more than three hours per week in the saddle.
The risk of erectile failure can be reduced by deploying a wider saddle with a less prominent “nose,” thereby allowing the man’s weight to be redistributed so that the buttocks absorb more of the pressure. The good news is that erectile dysfunction associated with cycling is almost always a temporary affliction. Furthermore, numbness and tingling in the perineum will act as an early warning sign long before erectile failure develops into a significant problem.
A recent study has challenged the idea that there is a direct causal link between cycling and erectile problems. Yet the findings did suggest that long periods in the saddle may increase the risk of prostate cancer in men over 50 years of age.
I am a freelance writer who recently opted for early retirement following 33 years of continuous employment in the UK’s psychiatric services, mostly as a clinical psychologist. Since retirement, my writing focus is shared between criticisms of western psychiatry, general interest articles and humor. My book, Tales from the Madhouse: an insider critique of psychiatry, is due to be published by PCCS books in January 2015.