Male sexual disorders

Erectile dysfunction is the medical term used for not being able to get or maintain an erection, making it difficult to have sex.
This can often be an embarrassing problem, but it is actually quite common. It can happen occasionally, or become more regular or even permanent.
It occurs more in older men, but can be easily treated in most cases.


  • Erection disorders are frequent and increase with age.
  • As you become older, spontaneous morning erections are less frequent, and erections are less firm and take longer to develop.
  • Erectile dysfunction affects more than 50% of men between 40 and 70, and approximately 70% of those above 70 years old.
  • From the age of 50, a man often needs more recovery time and stimulation to obtain a satisfactory erection.
  • Only 25% of men consult a doctor regarding male sexual problems.

What is a normal erection?

  • When you are sexually attracted or stimulated, your brain sends hormone signals that cause the blood vessels in your penis to dilate.
  • These blood vessels then fill up with extra blood flow, and hence then your penis becomes hard and erect.
  • This allows penetration for sexual intercourse.

Causes of erectile dysfunction

Medical Causes

It is important for you to consult your GP to rule out any medical causes which are responsible for 80% of erectile problems. These are highlighted below:
  • Diabetes: this is the most common cause of erectile dysfunction as diabetes affects the blood flow and nerves to the penis.
  • Hormonal causes: a lack of testosterone hormone made by the testes causes a loss of desire and a reduction in night and morning erections
  • Reduced blood flow to the penis which is usually due to the arteries being narrowed with atheroma (or cholesterol plaques).
    • The main risk factors for this are smoking, high cholesterol, high blood pressure, diabetes, excess weight and increasing age.
  • Kidney failure is a very frequent cause, as more than 40% of men affected by chronic kidney failure have erectile dysfunction.
  • Medication side-effects: Some antihypertensive, psychiatric, anti-epileptic medications have a negative impact on erections.
  • Neurological abnormalities: problems with the nerves that supply the penis - this can happen in conditions such as multiple sclerosis, Parkinson's disease, or after a stroke. Also, nerves can be affected after trauma to the spine or surgery (for example, prostate surgery)
  • Alcohol: alcoholism can be responsible for more than 50% of erectile problems
  • Illicit drug use
  • Smoking

Other Causes

  • 20% of erection disorders are of psychological origin which include:
    • Stress
    • Depression
    • Anxiety
    • Relationship problems
    • Exhaustion
    • After trauma or sexual violence
  • Of note, you may continue to have night and morning spontaneous erections.

Premature ejaculation

  • Premature ejaculation is ejaculation which occurs involuntarily either before or only a few seconds after penetration, so both parties are unable to enjoy sex.
  • This can become a vicious circle as it can cause stress and anxiety, and in turn this can worsen premature ejaculation.
  • Motivation and patience are essential to treat premature ejaculation.
  • Physiotherapy and sexual training exercises can help.
  • Masturbation, withholding ejaculation, or applying anaesthetic cream can also make it possible to delay ejaculation.
  • Anti-depressant drugs are sometimes prescribed at low doses , but they must be taken for a long period to ascertain their effectiveness.

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