"Erectile Dysfunction" (ED) or "Impotence" is the inability to achieve or sustain an erection.
It is important to understand that most men will experience this phenomenon at least a few times, that they want an erection, but are unable to get one. This is entirely normal, and is nothing to worry about. Often, an occasional failure to get an erection can be related to stress, fatigue, insufficient stimulation, or intoxication. Some men have situational erection problems. For instance, they can get an erection when they are masturbating, but are unable to get one when they are with their partner. This usually means that the problem is primarily 'psychogenic'.
Performance Anxiety
"Performance anxiety" is a common problem. If a man is more focused on how well he is performing with a partner, rather than on enjoying the sensations in the sexual act, it may be difficult to achieve or maintain an erection. This can become a vicious cycle, where the anxiety about whether or not one will have an erection becomes so intense that he is unable to become to have an erection, which leads to more anxiety, and so forth. The way to fix this problem is to relax. The more you relax and enjoy the experience of sex (whether you have an erection or not), the more likely you are to be able to get an erection. Other men are unable to become erect in any situation, whether alone or with a partner. This usually suggests that the problem is primarily organic (physical).
Organic erectile dysfunction
Organic causes of erection problems may include diabetes, nerve damage, hormonal factors, kidney disease, multiple sclerosis, Parkinson's disease, injuries to the spinal cord or brain, atherosclerosis or other vascular problems, chronic alcoholism and / or other drug use, surgical procedures (e.g., prostate or bladder surgery), reactions to certain medications especially hypertension medications, antipsychotics and antidepressant drugs.
Psychogenic erectile dysfunction
Psychogenic causes may include stress, anxiety, guilt, anger, mood disorders, relationship difficulties, and past traumatic events.
Anxiety about impotence ranks first in order of prevalence, in all the sexual fears that men have. Ironically, the fear itself is the greatest cause of impotence. In 90% cases of impotencies, the cause is stemming from the mind (psychogenic). It is only in 10% cases that the cause is biological.
Just as it is not possible to make saliva, tears and digestive juices flow, similarly there is no possible way a man can 'will' himself to have an erection. These things happen on their own in response to situations and circumstances. If one involves oneself in 'relaxed' foreplay, without 'spectatoring' at the organ (waiting for the erection to happen), the erection happens on its own accord. Behind the fear of failure to get an erection is a fundamental anxiety - the fear of being rejected. The partner's patient understanding and co-operation plays a very important role in getting over such psychogenic impotence.
What is the treatment?
If erectile dysfunction is due to psychogenic or situational causes, the treatment is "sex counselling" and "supportive therapy". If the cause is organic or constitutional, then appropriate medical or surgical measures will have to be undertaken. It is necessary to find out the cause (diagnosis) of this problem first, through history taking, examination and investigations. Once the cause is found, only then can the treatment be advised.
Diabetes and erectile dysfunction
The prevalence of erectile dysfunction in diabetes ranges from 35% - 75%. Uncontrolled diabetes affects the blood vessels as well as causes neuropathy, due to which one starts finding difficulty with having an erection.
To treat the erectile dysfunction, you will have to first get yourself properly treated for diabetes. Once your diabetes is controlled through diet and medication, your erectile problem may get corrected itself, or then it will be easier to treat it even separately.
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