Erectile dysfunction is a common disorder affecting almost 50% of men between the age of 40 and 70. But due to the embarrassment associated with it, only a few men consult a doctor. ED is a condition where a man cannot get or maintain an erection firm enough for sex. Occasional ED is common, but a frequent problem could be a sign of an underlying health condition. 

An erection occurs when blood flow to your penis increases. Blood flow is stimulated by contact with your penis or sexual thoughts. When you are sexually excited, penile muscles relax and allow increased blood to flow through penile blood vessels. 

This increased blood flow fills two chambers in the penis, causing the penis to grow rigid. An erection ends when the accumulated blood flows out of the penile blood vessels. Problems at any stage of the erection process may result in ED. There are many reasons for ED, and its type depends on the underlying cause.

Three main types of ED are premature ejaculation, delayed ejaculation, and organic erectile dysfunction.

Premature Ejaculation

Premature ejaculation (PE) is not exactly a type of ED but is more of sexual dysfunction. Sexual dysfunction refers to any problem that prevents a couple from enjoying sexual activity. However, you may experience ED along with PE.

What is Premature Ejaculation

Ejaculation is the release of semen from your penis during an orgasm. When ejaculation occurs faster than you would like, it is known as premature ejaculation. PE is also known as a premature climax, rapid ejaculation, or early ejaculation.

What causes premature ejaculation

There are emotional or physical components to PE, but many other causes may also contribute to it. Some emotional components could be temporary. For instance, a man may have PE during early sexual experiences, but he may learn strategies to help delay ejaculation as he grows older.

PE can also be caused by underlying conditions, including:

  • Low self-esteem or poor body image
  • History of sexual abuse
  • Depression

Other things that may cause PE are:

  • Anxiety about limited sexual exposure
  • Worrying about early ejaculation
  • Problems in your current relationship
  • Stress
  • Guilt

Besides, physical causes may also result in PE. Some common ones are:

  • Low testosterone levels
  • Inflammation of urethra or prostate
  • Low levels of neurotransmitters

Read more about Erectile Dysfunction Causes here.

Symptoms

The key indicator of PE is the regular inability to delay ejaculation for more than a minute during sexual intercourse. Early climax during masturbation may also be a sign of PE.

Depending on your symptoms, PE can be of the following two types:

  • Primary or lifelong PE: In this type of PE, you have had this experience always or almost always. 
  • Secondary or Acquired PE: Here, you have had long-lasting ejaculations before but later developed PE.

Diagnose Premature ejaculation

Your doctor will ask you about your health and sexual history and may also do a physical examination to diagnose PE. If you have both PE and ED, they may also advise you to get your testosterone levels checked or other tests.

Treatment

In some cases, it may be possible to reverse PE by bringing changes in your sexual routine. 

Your doctor may advise you to masturbate at least an hour before intercourse, as this might help you delay ejaculation during sex with your partner. You can also try to avoid sex entirely and engage in other sexual activity with your partner. This may help in relieving the pressure of performance during sex.

Here are some techniques that can help you with PE:

Start-and-Stop Method

Here, your partner stimulates your penis till you are close to ejaculation. Now, your partner should stop until you get back the control. Your partner can repeat this two more times. During the fourth attempt, allow yourself to ejaculate.

Experts recommend trying this at least three times a week until you feel that you can control when you ejaculate.

Squeeze Method

In this method, the partner stimulates your penis until you are about to ejaculate. Now, your partner squeezes your penis until the erection starts to weaken. This helps you understand the sensation just before the climax so that you can delay ejaculation.

Kegel Exercises

Exercises that involve male pelvic floor muscles also help to manage PE. One of the most common and effective exercises is the Kegel exercise. To perform this, tighten your pelvic muscles for a count of three. Now, relax them at the count of three. You can do it for ten repetitions three times a day.

To find your pelvic floor muscles, stop peeing during midstream. The muscles you use to stop urination are your pelvic floor muscles. Be careful not to use buttock or abdominal muscles instead of pelvic floor muscles.

Training your muscles may take time. Give it sometime before you start to see some benefit.

Counseling

In some cases, your doctor may advise counseling, especially if an underlying emotional problem is responsible for PE. Counseling sessions can help reduce performance anxiety and find ways to cope with stress.

Counseling works best when used with medications. With premature ejaculation, you may feel ashamed, angry, or upset and turn away from your partner. This may cause you to lose closeness with your partner. 

This might even affect your partner. PE may cause partners to feel less connected, and sex therapy or counseling may help you here.

Medicines

  • Topical anesthetics: Anesthetic sprays and creams with a numbing agent such as lidocaine, prilocaine, or benzocaine can help manage PE. These creams have to be applied on the penis 10-15 minutes before sex. Numbing agents reduce sensation and delay ejaculation.
  • Phosphodiesterase-5 inhibitors: Some medicines used to treat ED, such as sildenafil, vardenafil, and tadalafil, may also help manage PE.
  • Antidepressants: Certain antidepressants cause delayed ejaculation as a side effect. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, escitalopram, and paroxetine are used to delay ejaculation.
  • Analgesics: Tramadol is a common medicine used for pain relief. Just like SSRIs, this drug also has delayed ejaculation as its side effect. It is used if SSRIs have not been effective.

Delayed Ejaculation

Delayed ejaculation (DE), also known as impaired ejaculation, is a condition where a man needs more than 30 minutes of sexual stimulation to ejaculate. Some men with DE are unable to ejaculate at all.

DE is temporary in some cases, but it could be life-long in others. While DE does not pose a risk to your health, it may indicate prolonged stress. It may also affect your personal and sex life. However, the good news is that many treatment options are available.

What cause delayed ejaculation

There are many causes of DE, including chronic health conditions, psychological concerns, and side-effects of medications.

Psychological causes of DE include:

  • Anxiety
  • Depression
  • Relationship stress

Besides, constant anger, poor communication in a relation, and religious taboos may affect DE. Disappointment in sexual life as compared to sexual fantasies may also cause DE. In such cases, the man can ejaculate during masturbation but not during sexual stimulation with the partner. 

Moreover, the following medicines may also cause DE:

  • Antipsychotics, such as thioridazine
  • Antidepressants, such as fluoxetine
  • Diuretics
  • Alcohol
  • Antihypertensives, such as propranolol

Trauma or surgeries may also cause DE. Some common causes include:

  • Prostate surgeries that may damage nerve
  • Damage to the nerves in the pelvis or spine
  • Heart disorders affecting blood flow to the pelvic region
  • Urinary or prostate infections
  • Low testosterone levels
  • Low levels of thyroid hormones
  • Stroke or neuropathy
  • Congenital disabilities that may hamper the ejaculation process

Symptoms

The main indication of DE is a man requiring more than 30 minutes of stimulation to ejaculate. While some men can ejaculate with oral or manual stimulation, others cannot ejaculate at all.

There are two types of DE, a life long DE and generalized DE. In life long DE, the problem develops in later life. In generalized DE, the problem occurs in all sexual situations.

One more type of DE is known as situational delayed ejaculation, where the problem occurs only in certain circumstances or partners.

Diagnose Delayed ejaculation

Your doctor will ask for your symptoms and carry out a physical examination to diagnose DE. If they suspect a long-standing health condition as the cause, you might be advised additional tests, including urine and blood tests.

These tests will help your doctor to find out hormonal imbalances or infections. Testing how your penis reacts to a vibrator may help them figure out if your problem is physical or psychological.

Treatment

Treatment of DE depends on the underlying cause. For instance, if a particular medicine is causing DE, your doctor will change the medicine regimen and monitor your symptoms.

Managing alcoholism or illicit drug use may also help to manage DE. If a low testosterone level is the cause of DE, taking testosterone supplements may help fix DE.

Besides, psychological counseling can help to treat an underlying mental health disorder such as anxiety or depression. Sex therapy can also help to manage the underlying cause of sexual dysfunction.

Some medicines may help with DE, such as:

  • Amantadine
  • Cyproheptadine
  • Buspirone

So, DE can be resolved by managing the underlying physical or mental causes. Once they are treated, DE often reverses.

Organic Erectile Dysfunction

ED may be a result of a psychological or an organic cause. If ED occurs due to an organic cause, such as neurogenic, drug-induced, vascular, or hormonal, it is known as organic erectile dysfunction.

The erection is a complex process and involves the reaction between nervous, vascular, and hormonal systems. Problems in any of these systems may result in organic ED.

What causes Organic ejaculation

Some common causes and risk factors for organic ED are:

  • Advancing age
  • Cardiovascular diseases
  • Diabetes mellitus
  • Cigarette smoking
  • Hormonal disorders such as hypothyroidism, hypogonadism, or hyperprolactinemia
  • History of pelvic surgery or injury
  • Hypertension
  • High cholesterol levels
  • Obesity
  • Peyronie disease
  • Venous leakage
  • Use of certain medications such as benzodiazepines, antihistamines, and selective serotonin reuptake inhibitors
  • Neurologic conditions such as multiple sclerosis, paraplegia, stroke, Alzheimer disease, Parkinson disease, or quadriplegia
  • Illicit drug use such as methamphetamine or cocaine

Symptoms

The primary indication of organic ED is unable to achieve an erection firm enough for sex.

Diagnose OE

As with other types of ED, your doctor will ask for a detailed history and do a physical examination to find out the underlying cause of ED. They may also recommend other tests, including blood and urine tests for the same.

Treatment

The main aim of treating organic ED is to treat the underlying cause. So, for instance, the hormonal disorder is responsible for ED; treating it will help you reverse ED.

Some treatment options include:

  • Medications to treat the underlying cause: For instance, thyroid hormone supplements if thyroid disorder is the cause.
  • Medications for ED: Medicines such as sildenafil, vardenafil, avanafil, tadalafil boosts blood circulation to the penis and thus help in getting an erection.
  • Vacuum pumps: This device helps you to get or maintain an erection. It can be left in place for about 30 minutes.
  • Surgery: Vascular surgery or implants help in cases where other treatment options could not treat ED.

You can know more about the treatment of ED here.

Final Thoughts

ED is a common condition and can be easily reversed if the underlying cause is treated. Depending on the cause, ED is mainly classified as premature ejaculation, delayed ejaculation, and organic erectile dysfunction.

If you feel you may any type of ED, consult your doctor, and they will help you manage or even reverse the condition. And if you feel embraced and don’t want to visit your doctor you can consult them virtually using any of the online pharmacies and get your prescription at your home along with the medications.

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