The difficulty in ejaculating is known as delayed ejaculation. Men with delayed ejaculation may be unable to ejaculate or may only be able to ejaculate after prolonged — 30 minutes or longer — intercourse or manual stimulation. This can be a frustrating problem for both partners.
Medical causes of delayed ejaculation include:
- Trauma to the pelvic nerves, which control orgasms, such as from injury or pelvic surgery
- A side effect of certain medications, including some antidepressants
- Excessive alcohol use or illicit drug use
- Neurological diseases, such as stroke or nerve damage to the spinal cord
However, the most common causes of delayed ejaculation are psychological. These may stem from concerns about performance or cultural or religious taboos. Another psychological cause is conditioning resulting from certain masturbation patterns. For example, a man who is used to masturbating with a very fast motion may find it difficult to climax with the slower process of intercourse.
A medical history and thorough physical or neurological exam can determine if delayed ejaculation is due to an underlying medical condition or a side effect of medication. Treatment of delayed ejaculation depends on the underlying cause but may include:
- Sex therapy with a therapist who specializes in this area, if the cause is psychological
- Changing medications, if the cause is thought to be a side effect of medication
- Discontinuing use of alcohol or illicit drugs
n a few small trials, some herbal supplements — such as , ginseng and propionyl-L-carnitine — seemed to offer modest benefit for erectile dysfunction treatment in some men. This limited research is considered preliminary, however. The results are intriguing, but the effectiveness or safety of herbal supplements in the treatment of erectile dysfunction hasn’t yet been established.
In addition, the popular herbal supplement yohimbe — which is marketed as a sexual stimulant — can be dangerous if used in excessive amounts. Adverse side effects may include high blood pressure and heart failure.
Occasional erectile dysfunction is normal. But if erectile dysfunction persists or becomes a recurring problem, consult your doctor for an evaluation. He or she can help you understand erectile dysfunction treatment options — such as lifestyle changes, medications or devices to help sustain an erection — as well as weigh the risks and benefits of specific herbal treatments for erectile dysfunction.
Erectile dysfunction is a common problem for men who have diabetes — but it’s not inevitable. Consider prevention strategies, treatment options and more.
Erectile dysfunction is a common complication of diabetes. In fact, men who have diabetes are three times more likely to have erectile dysfunction as are other men, according to the National Institute of Diabetes and Digestive and Kidney Diseases . Left untreated, erectile dysfunction can leave you feeling frustrated, discouraged or depressed. But it doesn’t have to be that way. Take an active role in treating — or preventing — erectile dysfunction.
Erectile dysfunction and diabetes:
Erectile dysfunction is the inability to achieve or maintain an adequate erection for satisfying sexual activity. Your penis may simply fail to become or stay hard enough to have sex. Any man can develop erectile dysfunction. Causes are varied, from fatigue, stress or depression to trauma and medication use.
But when you have diabetes, there’s more to the story.
- Excess sugar (glucose) in your blood can damage the nerves and blood vessels responsible for erections. Your brain might be ready to have sex, but that information isn’t relayed to your penis — so it doesn’t respond.
- Conditions that often accompany diabetes, such as cardiovascular disease, can narrow or harden your blood vessels. This may reduce blood flow to your penis, which makes it tough to achieve or maintain an erection.
- Poor blood sugar control can inhibit the release of a chemical known as nitric oxide. Too little nitric oxide may hamper blood flow to your penis, which — again — makes it tough to achieve or maintain an erection.
Up to an estimated 85 percent of men who have diabetes may experience erectile dysfunction. The longer you’ve had diabetes and the more severe it is, the more likely you are to have trouble with erections.Erectile dysfunction: A sign of heart disease?
Erectile dysfunction can be a wake-up call that you’re at risk of heart disease. The same factors that contribute to heart disease can cause erectile dysfunction.
Though erectile dysfunction is distressing, it isn’t life threatening. But heart disease can be. Erectile dysfunction — trouble keeping an erection sufficient for sex — can be an early warning sign of heart disease. Understanding the connections between erectile dysfunction and heart health can help you recognize signs and symptoms of heart disease early on. Likewise, if you have heart disease, getting the right treatment can help you maintain or improve erectile function. Factors linked to heart disease that can cause erectile dysfunction include:
- Atherosclerosis. This damaging process reduces blood flow to your heart and contributes to coronary artery disease. It can also affect the blood vessels to the penis, causing erectile dysfunction. Conversely, if you’re having trouble with erections, it could be a sign that your heart is also at risk.
- Medications. Some prescriptions that men take to protect their hearts can cause erectile dysfunction. Additionally, medications that are often prescribed for erectile dysfunction may not be safe when combined with certain heart medications.
- Depression and anxiety. Researchers have found a connection between depression, heart disease and erectile dysfunction. Feeling anxious can also lead to erectile dysfunction. If you have heart disease, you may worry that having sex could trigger a heart attack.
Atherosclerosis: Where erectile dysfunction and heart disease meet
Atherosclerosis, a buildup of plaques in arteries, can prevent enough blood flow from reaching your heart, legs and brain — and your penis. If atherosclerosis has made your arteries in one part of your body narrow and stiff, arteries elsewhere in your body are probably also affected. When atherosclerosis affects blood flow to your penis, the blood can’t sufficiently fill the penis to allow a suitable erection.
The same factors that raise your risk of atherosclerosis in the arteries in your penis also increase your chances of heart disease. Because the arteries supplying your penis are smaller than the ones to your heart, symptoms may first show up as erectile dysfunction. If you haven’t been diagnosed with heart problems, consider erectile dysfunction a wake-up call. It could be a warning sign that the blood vessels feeding your heart might also be in trouble.
Risk factors for heart disease and erectile dysfunction
A number of risk factors can contribute to both heart disease and erectile dysfunction. They include:
- Diabetes. Men who have diabetes have more problems getting an erection than do men who don’t have diabetes. The problem is partially due to the diabetes-related damage to blood vessels that supply the penis.
- Obesity. Overweight men are more likely to have heart disease and erectile dysfunction.
- High cholesterol. A high level of low-density lipoprotein (LDL, or “bad”) cholesterol contributes to atherosclerosis in blood vessels, raising the risk of erectile dysfunction.
- Smoking. Smoking cigarettes raises your risk of developing atherosclerosis. Not only does smoking increase your chances of heart disease, but it can make you nearly twice as likely to develop erectile dysfunction.
- High blood pressure. Over time, high blood pressure damages the lining of your arteries and accelerates the process of atherosclerosis — which can lead to heart disease and erectile dysfunction.
Medications and erectile dysfunction
Some medications that treat heart disease can make you more likely to develop erectile dysfunction. These include:
- High blood pressure medications such as clonidine (Catapres), and beta blockers such as metoprolol (Lopressor)
- Diuretics such as spironolactone (Aldactone), used for high blood pressure as well as heart failure
Although you can’t stop taking your medications, there may be other drug options that are less likely to cause erectile dysfunction. Discuss your symptoms and potential options with your doctor.Erectile dysfunction: A sign of heart disease?
Erectile dysfunction medications and nitrates: A dangerous mix
Medications prescribed for treatment of erectile dysfunction may cause significant side effects when mixed with certain heart drugs called nitrates.
Nitrates are often prescribed to reduce chest pain, dilate the blood vessels and lower blood pressure. Because erectile dysfunction medications, such as sildenafil (Viagra), also reduce blood pressure, combining these two types of medication can cause a dangerous drop in blood pressure.
Do not take sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) if you use nitrate medications (NitroBid, Nitro-Dur, Imdur, others) for chest pain.
If you have coronary artery disease or have had a heart attack in recent months, check with your doctor before you begin taking any of these drugs for erectile dysfunction.
Anxiety: The worry of heart disease and sex
Men who’ve had a heart attack or surgery to treat their heart disease are often anxious about resuming an active sex life. However, intercourse seldom causes heart attacks. Sexual activity with your usual partner in a familiar setting doesn’t lead to a particularly high blood pressure level or heart rate. Even if you’re at high risk of having a heart attack, weekly sexual activity only slightly raises the risk. Talk to your doctor about when you can resume sexual activity after you’ve had heart problems or surgery.
Depression, heart disease and erectile dysfunction
There’s mounting evidence that depression is associated with an increased chance of having heart problems — and erectile dysfunction. Work with your doctor to make sure you’re getting the right treatment if you’re feeling down. Treatment can help alleviate erectile dysfunction and may prevent heart problems.
Depression is treated with counseling and medications. Although treating depression can help with erectile dysfunction, some antidepressants have sexual side effects. If you do have bothersome sexual side effects, you may need to try another antidepressant. Your doctor can also decrease the dose or add another medication to offset the effects of the antidepressant on erectile dysfunction.
Is your erectile dysfunction linked to heart disease?
Seeing your doctor for erectile dysfunction may have a silver lining. It could be a tip-off that you have underlying health problems linked to heart disease that need to be checked out and treated. If your doctor thinks you may be at risk for heart disease, making simple lifestyle changes may be enough to help keep your heart healthy — and improve your ability to have an erection. If you have more serious signs and symptoms of heart disease, you may further tests or treatments.
If you have this over a period of more than a few months you should see your doctor and take his advise for this. It is more common than you think. Do not suffer in silence or put up with it due to embarrassment. In most cases it can be helped