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I am 22 years old, male, and have had some serious stress with women over my life. I have had serious erection problems, and don't think I can get an erection rigid enough for sex, and have had several problems getting an erection with different girls. I have had sex with one girl, but I never got to the point of my erections I would get before. I believe my erection problems are caused from serious heartache over serious heartbreak, among many women over my life. I am on medication for my performance anxiety, but still don't have the confidence. My psychiatrist telling me to "relax" is no good, I have had this problem for about 4 years. I no longer trust women, I am too scared of letting myself go, or too afraid of being heartbroken again. I have had my testosterone levels checked - they are fine. I was a college athlete and I'm in great condition, and don't do drugs. Are there any books I could read? Any medications I could take (I'm going to try extenze), or anything else I should do? Please help. I am in need of serious help. Thanks.
This question was submitted to the HSAB by an actual iFriends user, and answered for recent publication.
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Erectile problems are categorized as being either organic, functional, or some combination of both, and primary, secondary, or some combination of both.
Common organic (biological) causes include such things as diabetes, Peyronie’s disease, cardiovascular disease, substance abuse (especially methamphetamines, cocaine, caffeine, nicotine, and alcohol), and medications such as hormones, anti-depressants, anti-anxiety drugs, high blood pressure, and diuretic medications. Essentially, the body is saying "I cannot physically handle this" – and the penis shuts down.
Common functional (psycho-sociological) causes include pressure to perform, anxiety, hyperactivity, fear, anger, being in a poor relationship, being with someone whom you are not physically attracted to, boredom with one’s partner, boredom with a sexual script ("this is the way we always do it") and recurring thoughts about being sexually abused or being hurt in a prior relationship. In this case, the body is saying "I have feelings and these are not good ones" – and the penis shuts down.
Erectile problems are classified as primary when they have existed for a very long time, typically dating back as far as a person can remember (or close to that time). The man may report always having had difficulties getting a full erection, even when masturbating. If this is the case, the erectile difficulties are usually organic in nature. The problems are classified as secondary when the symptoms are fairly new, especially if they came on rapidly, and are frequently seen as a response to a novel situation. While there are definite organic causes, the difficulties are typically functional when a man reports difficulty getting full erections with a sexual partner, but still gets full erections when masturbating on his own.
There are many difficulties when it comes to testing one’s testosterone levels. Testosterone levels for one man vary widely depending on what part of the day it is, food he has recently eaten, medications he is on, and environmental factors he is exposed to. Therefore, getting a reliable baseline count may be difficult. Furthermore, most doctors do not order, and most labs do not run, "free vs. bound" testosterone checks. This is important, as this particular test is usually considered the best for assessing the impact testosterone has on libido.
Even if these tests are conducted, there is debate as to what the results indicate. For example, most doctors see an overall testosterone level count of over 200 as being healthy, while most sexologists see this as too low for adequate sexual functioning. The situation is further complicated by the usual lack of a long-term baseline count for any one given man. For example, an overall count of 400 might be fine for most twenty-something year olds, but would be a very poor count for a man of the same age whose number typically runs around 600. Finally, testosterone is very important for libido, but not so important for erections. Erections are determined more by blood pressure and blood flow. The bottom line is that testosterone levels are not a good indicator for predicting erectile abilities. Still, you may want to read "Listen To Your Hormones: A doctor’s guide to Sex, Love and Long Life especially for men" (2004) by Abraham Harvey Kryger, M.D., D.M.D. for more details on this subject.
While it appears from the description in your question that your erectile problems are most likely functional and secondary in nature, I would advise you to see a qualified urologist for a full assessment. This will hopefully rule out any organic problems you are unaware of. If the urologist determines that your erectile difficulties are in fact organic in nature, he/she will be able to assist you by prescribing more modern erectile medications, such as Levitra or Cialis. Hopefully, the results of this assessment will, instead, indicate that your problems are functional in nature. Regardless of the outcome, working with a Certified Sex Therapists will be very helpful in either assisting you in overcoming the difficulties altogether or learning to cope with any difficulties for which there is no adequate treatment for.
So ask around, find a highly recommend urologist in your area and make an appointment to see him/her right away. Also, check out the website for the American Association of Sexuality Educators, Counselors and Therapists (AASECT) at www.aasect.org for a referral to a Certified Sex Therapist in your area. You may also want to get and watch "A Man’s Guide To Stronger Erections: Overcoming Erectile Difficulties," part of "The Better Sex Video Series" by The Sinclair Institute (www.sinclairinstitute.com) for an excellent overview of medical and sexological assessment and treatment possibilities.
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Men's Sexual Health
