What causes premature ejaculation?

Health How Pelvic Floor Exercises Can Help Reduce Incontinence and Improve Sexual Performance in Men

Here’s how and why you should be including them into your workouts

By Mens Health

This article is a repost which originally appeared on Men’s Health

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key takeaways:

Men often face incontinence as they get older

Maintaining pelvic floor fitness can help to alleviate incontinence and maintain/improve sexual performance

The Kegel Exercise is widely recommended for pelvic floor health

A common health issue that many men face as they get older is incontinence. Erectile dysfunction and low libido are also problems that come with ageing. Thankfully, there are specific exercises you can do to reduce the impact of these issues and stop them from occurring frequently.

In a recent interview with the Daily Mail, Joe Ward spoke about his health issues after emergency back surgery and surviving sepsis. Following the incident, Joe, at the age of 30, experienced double incontinence and was unable to function sexually. To further complicate things, he was told he would have to use a catheter for the rest of his life.

‘For six months, I had to use pads — like someone 50 years older than me — because I was having leakages and accidents,’ Ward told the paper. ‘It was tough, especially in social situations. And for a long time, I didn’t feel like a real man because I couldn’t function sexually, which was very upsetting.’

Despite the effect this was having on multiple areas of his life, he was shown some simple pelvic floor exercises to improve these issues, exercises which he believed made a significant improvement.

Pelvic floor exercises have been shown to support a range of health problems. According to research, pelvic floor exercises could benefit men who are effected by erectile dysfunction, premature ejaculation, urinary problems and those who would like additional help in the bedroom. Published by NeuroQuantology, the study showed that pelvic floor exercises effectively reduced urinary incontinence and improved erectile function in those recovering from prostate operation.

What Are the Pelvic Floor Muscles?

The pelvic floor muscles stretch from the tailbone to the pubic bone. They work as a supportive sling of muscles that support the bladder and bowel organs as well as assisting sexual function while protecting the organs.

According to the NHS, the pelvic floor muscles contract when you cough, sneeze or laugh; preventing leakage of urine. They are kept under slight tension so that when you pass urine or open your bowels the muscles should relax and then tighten afterwards. This prevents leakage and controls the passing of urine, bowel and gas motions.

What Are Pelvic Floor Exercises?

Pelvic floor exercises include engaging your pelvic floor muscles and squeezing them for a certain amount of time. This can also be referred to as a ‘kegel’ exercise. To do so:

  • Stand, sit or lie comfortably with your legs slightly apart.
  • Engage your pelvic floor by imagining you are trying to stop yourself from passing wind or passing urine.
  • Squeeze the muscles and hold before relaxing again.

Once you have mastered these steps, the NHS recommends you try to hold the contraction for as many seconds as possible up to 10 seconds. It then recommends to rest and then repeat the process 10 times. After this you can repeat quick contractions for 10 repetitions.

Factor beyond hormone: What impacts male sexual health and why it is related to mental wellbeing

Sexual problems in men can occur on and off and at any age and most of them can be easily dealt with

Dr Lalitha Palle June 19, 2023 16:57:15 IST

This article is a repost which originally appeared on Firstpost.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Testosterone and sperm level decline, hormonal imbalances, and male pattern baldness are becoming a more common occurrence in younger men.

‧ It’s believed various contributing factors are the cause.

‧ Negative relationship dynamics and emotional concerns can contribute to worsening sexual health.

The topic of male sexual health has gained importance recently as an alarming number of reports reveal reduced male hormones i.e Testosterone levels, in younger men, reduced sperm counts, and increasing incidence of erectile dysfunction, premature ejaculation, male Infertility or impotence and early onset of male pattern baldness among younger men, becomes a common occurrence.

There are also reports that state that with the alarming rate of male hormone imbalance, India is set to become the Impotency capital of the world! It is thus high time that we take note of this silent yet fast-spreading condition and start by understanding its causes and impact and how we can at least start by destigmatizing conversations around male sexual health.

Male sexual health is influenced by a variety of factors, including physical, psychological, and emotional well-being. While physical factors such as hormonal balance, cardiovascular health, and neurological function play important roles, mental well-being can significantly impact male sexual health for several reasons:

Psychological Factors: Sexual desire, arousal, and performance can be influenced by psychological factors such as stress, anxiety, depression, and self-esteem. Negative emotions and mental health conditions can affect libido, sexual confidence, and overall sexual satisfaction.

Relationship Dynamics: The quality of relationships and emotional connection with a partner can have a significant impact on male sexual health. Relationship issues, unresolved conflicts, or lack of intimacy can contribute to sexual difficulties and dissatisfaction.

Performance Anxiety: Many men experience performance anxiety, which is the fear of not being able to perform sexually to their or their partner’s satisfaction. This anxiety can stem from various sources, such as societal expectations, personal insecurities, or previous negative sexual experiences. Performance anxiety which is very common, especially in younger men, can interfere with sexual arousal, leading to erectile dysfunction or premature ejaculation.

Body Image and Self-esteem: Body image concerns and self-esteem can affect sexual health. Men who have negative perceptions of their bodies may feel self-conscious and anxious during sexual encounters, impacting their ability to fully engage in the experience.

Stress and Lifestyle Factors: High levels of stress, unhealthy lifestyle habits, and poor self-care can contribute to sexual health problems. Stress can disrupt hormone production, reduce libido, and impair sexual performance. Lifestyle factors such as smoking, excessive alcohol consumption, and lack of exercise can also negatively impact sexual function.

It is essential to address both the physical and mental aspects of male sexual health. Seeking support from healthcare professionals, therapists, or counsellors can help individuals navigate and address the underlying psychological factors that may be affecting their sexual well-being. Open communication with partners, healthy lifestyles, and stress management can also contribute to overall sexual health and satisfaction. Sexual problems in men can occur on and off and at any age and most of them can be easily dealt with. Not speaking or discussing them will only lead to a vicious cycle of negative mental health and poor performance. Men should break free from the so-called ‘taboos’ and ‘stigmas’ to improve their lives’ quality.

How Men Can Take Care of Their Sexual Health

What Men Can Do to Ensure Their Sexual Health Is Strong

Mental and physical care are both critical to a man’s libido and reproductive well-being.

Author: Helen Massy
Published: March 06, 2023

This article is a repost which originally appeared on Giddy

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Maintaining good sexual health is important for men.

‧ Mental health will have a large impact on sexual well-being.

‧ 20-30% of men in their 20s and 30s experience some form of ED.

Sexual health is an essential part of every man’s life. As well as protecting yourself from sexually transmitted infections (STIs) and diseases (STDs) or preventing unwanted pregnancies, sexual health is about having safer, satisfying sex and a positive and respectful approach to sexuality and relationships.

Understanding how to look after your sexual health benefits both you and your partner.

The best place to start is by getting to know your body and your reproductive system, and what’s normal and what’s not normal. This way, you can quickly identify any problems and seek medical support to address them.

There are multiple aspects to men’s sexual health, including physical health and mental health. Lifestyle factors influence all of these elements, either in a positive or negative way.

Men’s health and sexual health

A few of the essential aspects of a male’s sexual health are desire, erections and endurance, explained James J. Elist, M.D., a urologist in Beverly Hills, California, who specializes in impotence and male sexual dysfunction.

Being sexually healthy enables a man to fully participate in and enjoy sexual activity.

The body can’t just rely on physical health to create desire, erections and endurance, though. Physiology, mental health and emotional health can affect both libido and sexual function.

Male sexual health isn’t just about the ability to enjoy sex. It’s also about preventing STIs/STDs and identifying any problems with fertility. It’s about understanding how to prevent unwanted pregnancies and ensuring sex is consensual, respectful and safe for both partners.

Mental health and men’s sexual health

Mental health can directly impact sexual health and vice versa.

“Low libido, erectile dysfunction [ED] and premature ejaculation can all be exacerbated by negative mental health experiences, whether that’s traumatic experiences, relationship or professional workplace stress, depression or anxiety,” Elist said.

He explained that those negative mental health experiences can lead to worsened sexual performance, which in turn leads to more strains on mental health, driven by decreased self-confidence and self-worth as a result of poor performance in bed.

This leads to a negative cycle in which one feeds into the other.

“As such, it’s important to seek solutions early on to prevent any issues from worsening. Taking care of one’s mental health through therapy, meditation, etcetera can often improve sexual health issues as well,” Elist said.

If you find your mental health is affecting your sexual health, or problems with sex or sexuality are affecting your mental health, you can explore a number of options with your healthcare provider to address either issue.

Physical health and men’s sexual health

“It all begins with male libido,” Elist said of the connection between physical health and sexual health. “A man must have the desire to engage in sexual activity in the first place.”

Unfortunately, he said, as guys get older, libido tends to decrease as testosterone decreases. Obviously, for a man to be able to perform sexually, he must be able to achieve and maintain an erection. You can take steps to address this issue.

“As with testosterone and libido, erectile function also relies on staying healthy, particularly maintaining cardiovascular health, avoiding cigarettes and exercising frequently to get the blood pumping,” Elist said.

Once a man achieves an erection, he must maintain the erection and be able to last long enough to enjoy a sexually satisfying experience for both himself and his partner.

“Often, premature ejaculation can get in the way, which is why it’s important to limit stress and practice pelvic floor exercises if that’s an issue an individual deals with,” he said.

There is no need to suffer in silence if you have any problems with your libido, erection, ejaculation or performance. Seek help from your healthcare provider if you are experiencing problems, as many treatment options are available to help you feel comfortable and satisfied when having sex.

What’s a ‘normal’ sex drive?

Sex drive varies depending on a man’s age. Elist explained what happens to libido across the stages of life:

‧ In his early 20s, an individual can desire sex almost daily.

‧ Starting in his mid-30s, an individual’s testosterone levels begin to decrease by approximately 1 percent per year.

‧ Upon reaching his 60s, sexual desire may lessen even further for many men.

While there’s no “normal” level of sex drive for men, Elist stressed it is normal for levels to decrease over time.

“However, that trend can be partially mitigated and offset through regular exercise, eating healthy and maintaining a consistent sleep schedule,” he said.

Sexual health and reproductive health

“There are various issues that can impact an individual’s reproductive health and fertility, from stress to smoking to excessive testosterone use,” Elist explained.

To look after reproductive health, men should undertake a testicular self-exam routinely to ensure that there are no signs of lumps or tumors. Cancer is obviously a concern here, but fertility comes into the picture, too.

Testicular self-exams and examinations by a physician can help men identify the presence of a varicocele, a dilated vein inside the scrotum that can increase the temperature of the testicles and negatively affect sperm development, according to Elist.

Sperm counts decrease by an estimated 40 percent for every degree the testicles rise in temperature.

Elist also highlighted that the excessive use of testosterone or androgens could damage the testicles. Tobacco and frequent marijuana use can also decrease sperm count. All of these factors should be considered if a man is experiencing fertility issues.

Your healthcare provider can use various tests to help establish fertility problems, including the following:

‧ STI/STD testing
‧ Semen analysis
‧ Urinalysis
‧ Hormone testing
‧ Ultrasound scans
‧ Testicular biopsies

Complications and related conditions

The most common male sexual dysfunctions men should be aware of, according to Elist, include:

‧ Low testosterone
‧ Low libido
‧ Erectile dysfunction
‧ Premature ejaculation

ED is an issue that impacts more than half of all men at some point in their lives.

“While many think erectile dysfunction is an issue that only affects older men, it can actually impact 20 percent to 30 percent of men in their 20s and 30s,” Elist said.

Premature ejaculation is an issue that impacts nearly 40 percent of all men.

“It is characterized by sexual activity that often lasts one minute or less and sexual experiences which cause stress and frustration,” Elist explained.

You can address premature ejaculation issues with a combination of solutions that could include meditation, pelvic floor exercises, supplements, lidocaine sprays or prescription SSRIs, or selective serotonin reuptake inhibitors.

“Other issues, such as delayed ejaculation, retrograde ejaculation and Peyronie’s disease, are less common, but if an individual is experiencing any of those issues, then it’s important to discuss them with a urologist,” he added.


Explained: Why men must not ignore sexual health problems

While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

IANS Updated Jul 24, 2022 | 06:43 AM IST

This article is a repost which originally appeared on TIMESNOW

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Men are usually hesitant to discuss sexual matters with others in a social setting.

· Professional consultations for sexual problems have more than doubled since 2020.

· Discussing sexual concerns can help to relieve stress and to discover potential solutions.

When was the last time you heard a man discussing his sexual wellness in a peer group or a social setting, or even with his loved ones? Chances are, you’ve never heard of such a thing. These conversations, while critical, just do not happen.
While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

Just like physical and mental well-being, men must take care of sexual wellness to lead a healthy and happy life. Thankfully, we’re on our way to speaking out loud about these issues as a society. Sexual wellness consultations increased by almost 139% in the year 2020 compared with the previous year.

1. Performance Pressure: Sexual health and effectiveness are taboo in society and specifically for men for various reasons. It is often assumed that sexual activity comes more naturally to men than women. While that is untrue, this notion gets even more troublesome when men aren’t able to perform in bed. Men suffer from performance anxiety a lot more than women, which is a leading cause of erectile dysfunction.

2. Erectile Dysfunction: The commonly used term for ED is impotence. The mere association of this word with men arouses discomfort in social circles and, more often than not, leads to a scarred image. But the problem is not as rare, just less talked about. As per the Massachusetts Male Aging Study, nearly half of the men in the age group of 40 to 70 face this issue due to reasons varying from arterial malfunction or other abnormalities that can be checked and treated. ED can be caused by endocrinological diseases such as prostate malfunction, hypogonadism or even diabetes. Trouble maintaining an erection could very well be caused by fibrosis or atrophy, which is a sufficiently organic process but could also be caused due to drugs or smoke. Another myth surrounding men’s sexual health is that ED is a psychological disorder. While the cause could be neurological, the issue definitely needs to be probed for clarity and subsequent treatment.

3. Low Libido: Libido comes naturally to all genders, given they’re in a suitable space in their head. Sexual pleasure is a recreational activity that does not need to be and ideally is not supposed to be imposed upon anyone. So, not being in the right mind space, like experiencing stress or anxiety, could lead to low libido. There could be very many reasons that need to get checked by an expert.

4. Premature Ejaculation: Generally, one out of three men has been known to complain about premature orgasm. This creates a lot of pressure upon men as they feel they’re somehow incapable of pleasing their women. This further causes a loss of self-confidence, adversely impacting their mental health and even leading to severe problems. Those days are gone when there wasn’t any scientific explanation for biological processes. Society has advanced a great deal to know for sure that there are underlying causes for many of the activities affecting sexual health. All the community collectively needs to do now is talk openly about sexual diseases and discomfort like other diseases. The bubble needs to burst now more than ever when we are experiencing a time when multiple genders exist in society.

Sexual pleasure, like any other need in life, is an individual’s responsibility. But acceptance in relationships plays a significant role in bringing that sort of communication out loud. This helps improve relationships and emotional health and leads to enhanced confidence and perspective in all aspects of life. Again, acceptance is the key in the end.

(Nilay Mehrotra, Founder & CEO of Kindly)






Inner Demons: When it’s All in Your Head (from The Ultimate Guide To Male Enhancement)

The following is a chapter taken from the book: The Ultimate Guide To Male Enhancement.

The top cause of impotence today is due to performance anxiety or fear. There are many ways in which fears can originate. These include: inexperience, self-loathing, pressure from a partner, or even a partial physical cause which contributes to the equation.

Why does this seem to be such a growing epidemic- especially among younger men?

According to self-reports, most men have experienced some form of performance anxiety in their lives. How you handle incidents of erectile dysfunction can have a very huge impact on whether or not it sticks around.

One huge contributor of ED among younger men comes from unrealistic expectations obtained by watching porn.  Not only will most men be intimidated by the fantastic dimensions observed in many porn films, but the orchestrated reactions that become expected from these films also interferes with normal expectations.

Another aspect of ED caused by porn use involves detraining. This is discussed in much greater details further in this publication under the section titled “The Detraining Effect – Understanding and Reversing Negative Habits To Improve Erection Quality and Sexual Confidence,” but to summarize here, it’s when you become so accustomed to being an inactive participant in masturbating to porn, such that when real emotions and expectations are encountered (as in a real live sexual scenario), anxiety sets in.

The simplest answer to this is, when the sexual response is replaced by anxiety (or something intensely distracting to arousal), the penis isn’t allowed to function in an unencumbered fashion. The use of direct will in attempting to force an erection often has the opposite results. What becomes necessary in scenarios like this is getting to the root cause of the issue. Anxiety itself is merely a symptom of this.

In most cases, psychological ED is very temporary and has an ephemeral quality. In most cases, a man will shake this off- or if he’s generally very secure with himself, he may learn to laugh it off.

It’s usually when one strings together several worsening episodes does the situation become chronic and in need of professional treatment.

The Ultimate Guide to Male Enhancement

Should you be exercising your penis?

Rumours relating to hacking your sex life with the likes of ‘penis gyms’ and ‘penis training programs’ have been doing the rounds in recent weeks. So far so curious. But are these practices *really* a thing and if so, who is doing them and do they *actually* work?

This article is a repost which originally appeared on ES Magazine

Edited for content.

Our Takeaways:

· There are exercises which you can perform to improve penile/sexual function

· Certain devices can be used to aid the process of developing sexual and penile fitness

· Research and care should be taken when you first undertake a penis training routine

You are by now probably familiar with the concept of biohacking, namely the self-improvement trend started by a handful of individuals who, venturing into the unknown, made it their mission to find whatever means, from microdosing to eccentric exercise trends and extraordinary diets to enhance their physical, cerebral and even spiritual function.

Five or so years later Silicon Valley caught on with the likes of Twitter founder Jack Dorsey and former Facebook president Sean Parker joining the brigade and forking out tens of thousands of dollars to improve everything from their productivity to muscle condition. Often they turned to the world’s biohacking ‘gurus’, self-experimenting guinea pigs and lifestyle enhancers such as Ben Greenfield, Tim Ferriss and Gwern, as their guides, eschewing traditional medical professionals, presumably preferring the more macho and unconventional approach. It’s perhaps worth mentioning that approximately 90% of biohackers are men…

Washington State based Greenfield is an elite biohacker who says he has a biological age of nine and makes a successful living documenting his quest for the world’s most effective means of physical and cerebral enhancement. While his practice is vast and varied, covering everything from microdosing LSD to supplementation and a process described as a ‘full-body stem-cell local’ whereby every joint in the body is injected with stem cells, it is arguably his reporting on sexual performance technologies and comments on penis gyms (he wrote a blog post entitled ‘how to make your penis stronger with a Private Gym’), which have garnered most attention. On day one of the 30-day Private Gym program Greenfield wrote, ‘I start round one of my training: contract, relax, contract, relax, five rounds done. 20 rapid flexes, done. 20 second hold, done. My penis quivers (oh geez, did I just write that?) under the weight towards the end.’ It’s undeniably attention-grabbing stuff.

And before those of you with a better-than-average anatomical knowledge flag – correctly – that contrary to popular belief the so-called love muscle contains no muscle and therefore can’t be trained, we know. And so does Greenfield. What he colloquially refers to in this way is in fact – less thrillingly – known as pelvic floor training.

Editor’s Note: The penis does contain smooth muscle tissue, which is different from skeletal muscle tissue. It should also be noted the Bulbocavernosus muscle which supports the base of the penis and extends to part of the shaft is indeed composed of skeletal muscle tissue.

Long considered a woman’s work, pelvic floor exercises tone the muscles that support the uterus. Done daily they can ease childbirth, prevent incontinence and even improve your sex life. Now however, experts are keen to flag that men have the same network of muscles as women. Extending like a hammock from the tailbone to the pubic bone they support the back, abdomen, bladder and bowel helping to maintain faecal and urinary continence. In male bodies these muscles also surround the base of the penis and are activated during erection, orgasm and ejaculation, as well as being responsible for the surge of blood flow to the penis.

Medical evidence suggests that done correctly male pelvic floor exercises taught by the likes of Professor Grace Dorey a professor emeritus of physiotherapy and urology at The University of West England can improve pelvic floor control, urinary function (particularly after radical prostatectomy surgery to treat prostate cancer) and sometimes even sexual function. Doctors explain that like all muscles, pelvic ones weaken with age, but can be strengthened by tightening the muscles used to cut off a flow of urine midstream. Held for a few seconds this contraction is then released and the motion repeated 10 to 15 times.

There is unsurprisingly, a budding market of systems to aid men with such ‘exercises’. Greenfield’s preferred Private Gym for example, includes an instructional DVD and small, ultralight weights on a silicone band that fits around the penis and is intended for men who want to add a little resistance training to their routines. The KegelPad meanwhile is another tool designed to aid good practice. Of the former Professor Dorey, has gone as far as to say ‘ It’s as good as Viagra, without the costs and the side effects…the pelvic floor muscles provide the base for the erection — for the penis to sit on, if you will.”

That said Karl Monahan of London’s The Pelvic Pain Clinic recommends that patients practice due diligence when purchasing such items, taking the time to identify companies that are legitimate and well intentioned. ‘Choose those which offer sound, medically supported programs and clinical trials,’ he says. Moreover, many of the symptoms associated with poor pelvic health actually have separate root causes that should be professionally diagnosed and treated. ‘Working with an experienced specialist is the best way for men suffering with pelvic floor related symptoms,’ he explains. ‘Unguided programs can also lead to patients overdoing their pelvic floor exercises, which can in turn, have dramatic effects on their pelvic health.’

Greenfield too warns against seeing biohacking and hacking technologies as quick fix. ‘A negative implication of the proliferation of these self-improvement methods is that people are inherently lazy and so in many cases [think] these biohacks can be used as a shortcut,’ he tells us. ‘But biohacking is not a shortcut. It’s the use of science or technology to enhance human biology, but always needs to be paired with actual hard work and dedication.’








How Common Is Erectile Dysfunction?

How Common Is Erectile Dysfunction?

By Katie Wilkinson, MPH, MCHES

Published on September 28, 2021
Medically reviewed by Matthew Wosnitzer, MD

This article is a repost which originally appeared on verywell health

Edited for content.

Erectile dysfunction (ED), or impotence, is the inability to achieve and maintain an erection for sexual activity. While the occasional failure to get an erection is not uncommon, if it happens consistently, or more than 50% of the time, it may be ED. It can be a temporary experience, or develop into a long-term condition that requires treatment.


On a global scale, ED affects 3% to 76.5% of all men. The wide range is due to the different measures used in studies to evaluate ED.

In the United States, it’s estimated that 30 million men experience ED.2 Worldwide, there are about 150 million men living with ED, and by the year 2025, it’s predicted that over 300 million men will have ED.

Common Causes

ED can be caused by a number of factors relating to physical and mental health, including:

  • Physical and health conditions that involve different systems in the body, such as the vascular, neurological, or endocrine systems; can include issues with nerve signals or blood flow to the penis
  • Side effects from medication, which can include antidepressants, medication to manage blood pressure, tranquilizers, sedatives, ulcer medication, and prostate cancer therapy
  • Psychological or emotional causes such as depression, anxiety, fear associated with sexual performance, general stress, or low self-esteem
  • Lifestyle behaviors and health-related factors that are associated with ED include smoking, being overweight, lack of exercise, and substance (alcohol or drug) use

Risk Factors

Certain risk factors have been found to increase the likelihood of experiencing ED. They can include:

    • Age: The chances of developing ED increases with age, particularly in men over 60 years old.
    • Tobacco use: Research has found that smokers are 1.5 times more likely to experience ED than nonsmokers.
    • High blood pressure (hypertension): About 30% to 50% of people living with hypertension also experience ED.
    • Type 2 diabetes: Between 35% and 90% of diabetic men will develop ED.
    • High cholesterol: Statins used to treat high cholesterol showed improved erectile function.
    • Hypogonadism: This is a condition where the body doesn’t produce enough sex hormones, including testosterone. Since testosterone is necessary for the ability to maintain an erection, people with hypogonadism who are treated with testosterone replacement therapy can see improved erectile function.
    • Obesity: Several studies have indicated that men with a body mass index (BMI) greater than 25 begin to experience a 1.5 to three times greater risk of ED than those with lower BMIs.
    • Depression: Men living with depression are two times more likely to experience ED. Treating depression with selective serotonin uptake inhibitors (SSRIs) can also increase risk of ED.

Stress and anxiety, particularly performance-related anxiety, can also cause issues with sexual activity and erectile function.

Associated Conditions

In addition to diabetes, hypertension, and hypogonadism, the National Institute for Diabetes and Digestive and Kidney Diseases also lists the following conditions and diseases as associated with ED:

  • Heart and blood vessel conditions, including atherosclerosis
  • Injuries of the spinal cord, penis, prostate gland, bladder, or pelvic area
  • Prostate or bladder surgery
  • Chronic kidney disease
  • Multiple sclerosis
  • Peyronie’s disease, a condition where scar tissue develops and creates a bend in the penis


Treatment for ED can take many forms and depends on the root cause of the individual’s ED. Because of ED’s impact on sexual relationships, it’s worth discussing treatment options with your sexual partner.


Avoiding or stopping the use of tobacco, alcohol, and other drugs may help with ED.

Increasing physical activity and maintaining a healthy weight can also be a way to improve erectile function.

Mental Health Counseling

Because emotional and psychological concerns can play a role in ED, speaking with a mental health professional can be beneficial. They can help identify ways to manage anxiety and work through stress that may be impacting sexual performance.


Oral (PDE5 inhibitors), injectable, or suppository medications can be prescribed to help achieve and maintain an erection. For those with low testosterone (hypogonadism), testosterone replacement therapy may be prescribed.

Treatment may also involve adjusting or changing current medications that hinder the ability to get an erection.

Devices and Procedures

The following devices and procedures can be used to treat ED:

  • Penis pump: This device uses vacuum action to pull blood into the penis to create an erection. It has a tube where the penis is placed and a pump that draws air out of the tube and creates suction. Once the blood is pulled into the penis, an elastic band is placed at the base of the penis to prevent the blood from going back into the body and to keep the erection for about 30 minutes.
  • Arterial repair surgery: Procedures to repair clogged blood vessels in the penis may increase blood flow to allow for erections. This treatment is usually reserved for patients under the age of 30.
  • Implantable devices: These include surgically placed devices that either inflate or include semi-rigid rods to help a person achieve an erection.

A Word From Verywell

While many men might feel embarrassed by their erectile dysfunction, it should be a comfort to know that it is a very common condition, affecting at least 150 million men worldwide. It is also a very treatable condition.

Talk to your healthcare provider if you experience issues achieving and maintaining an erection. Even though it may be uncomfortable to talk about, proper sexual functioning is a key part of your overall health and well-being.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Erectile dysfunction. Updated October 14, 2019.
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for erectile dysfunction. Updated July 2017.
  3. Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU International. 2019;124(4):587-599. doi:10.1111/bju.14813
  4. Kalsi J, Muneer A. Erectile dysfunction – an update of current practice and future strategies. J Clinic Urol. 2013;6(4):210-219. doi:10.1177/2051415813491862
  5. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of erectile dysfunction. Updated July 2017.
  6. DeLay KJ, Haney N, Hellstrom WJ. Modifying risk factors in the management of erectile dysfunction: a review. World J Mens Health. 2016;34(2):89-100. doi:10.5534/wjmh.2016.34.2.89
  7. Mourikis I, Antoniou M, Matsouka E, et al. Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation. Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-y
  8. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for erectile dysfunction. Updated July 2017.
  9. Urology Care Foundation. What is erectile dysfunction? Updated June 2018.
  10. Nguyen HM, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men—a review of the prevalence and risk factors. Sexual Medicine Reviews. 2017;5(4):508-520. doi:10.1016/j.sxmr.2017.05.004
  11. International Society for Sexual Medicine. Can a vasectomy cause erectile dysfunction (ED)?
  12. Ssentongo AE, Kwon EG, Zhou S, Ssentongo P, Soybel DI. Pain and dysfunction with sexual activity after inguinal hernia repair: systematic review and meta-analysis. J Am Coll Surg. 2020;230(2). doi:10.1016/j.jamcollsurg.2019.10.010

Male Sexual Worries: Trends in the Post-Viagra Age

Male Sexual Worries: Trends in the Post-Viagra Age

This article is a repost which originally appeared on SciTechDaily

Edited for content

Trends in reasons for visiting a the San Raffaele sexual health clinic. Credit: This diagram appears with the permission of the authors and the International Journal of Impotence Research. The EAU thanks the authors, and the journal for their cooperation.

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

Presenting the work at the European Association of Urology (virtual) Congress, after recent acceptance for publication, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said:

“Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about.”

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Paolo Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems.”

Dr. Capogrosso continued “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence.”

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press*. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,**” said Dr. Capogrosso.

Commenting, Dr Mikkel Fode (Associate Professor of Urology at University of Copenhagen), said:

“Although these data are somewhat preliminary as they stem from single institution they are interesting because they allow us to formulate several hypotheses. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise, the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

Dr. Fode was not involved in this work, this is an independent comment.


* “Trends in reported male sexual dysfunction over the past decade: an evolving landscape” by Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Walter Cazzaniga, Rayan Matloob, Eugenio Ventimiglia, Davide Oreggia, Nicolò Schifano, Luigi Candela, Costantino Abbate, Francesco Montorsi and Andrea Salonia, 1 July 2020, International Journal of Impotence Research.

** “The Prevalence of Peyronie’s Disease in the United States: A Population-Based Study” by Mark Stuntz, Anna Perlaky, Franka des Vignes, Tassos Kyriakides and Dan Glass, 23 February 2016, PLOS ONE.
DOI: 10.1371/journal.pone.0150157
PMCID: PMC4764365

Common Causes of Impotence

Common Causes of Impotence

By Sara Ryding, B.Sc.

Reviewed by Emily Henderson, B.Sc.

This article is a repost which originally appeared on NEWS MEDICAL

Edited for content

Impotence, which is also known as erectile dysfunction, is the inability to get and maintain an erection for intercourse. While the occasional issue with impotence is not considered rare or cause for concern, persistent issues can cause severe stress and be a sign of an underlying health issue. The causes of impotence can include physical and psychological sources.

Impotence and sexual arousal

The processes around sexual arousal are complex and can be difficult to distinguish. For males, the sexual arousal process involves the brain, hormones, emotions, nerves, muscles, and blood vessels to achieve an erection.

As such, impotence can stem from any of these areas or a combination of them. For example, impotence caused by blood vessel issues can be worsened by subsequent stress and mental health concerns.

Physical causes of impotence

Vascular causes of impotence are among the most common causes of impotence. In some cases, impotence can be a symptom of progression towards cardiovascular disease. For example, impotence is common in people with atherosclerosis and can later progress into heart disease. If the veins are unable to close during an erection, this can cause impotence as it hinders the erection from being maintained. This is called veno-occlusive dysfunction.

Veno-occlusive dysfunction can be caused by the development of venous channels that drain blood from the corpora cavernosa where blood would otherwise be trapped during health erections. Veno-occlusive dysfunction can also be caused by deleterious alterations to the tunica albuginea, which would otherwise be responsible for stopping blood from leaving the penis. These alterations can occur as a result of old age, diabetes, or Peyronie’s disease. Other causes include traumatic injury, alterations to muscles around the area, and shunts that are acquired during certain surgery.

Neurological issues are another physical cause of impotence. This can occur as a result of diseases, such as Parkinson’s or Alzheimer’s disease, or due to trauma and injury. These can cause impotence by both decreasing libidos and by inhibiting the onset of an erection. In the event of spinal cord injury, the effect on impotence can depend on the nature, location, and extent of the injury. Similarly, neurological issues can be the cause of impotence in old age as sensory stimuli abate with age.

There is some evidence that hormonal issues can cause impotence. A deficiency in androgen, a hormone needed for male sexual characteristics and sex drive, can lower nocturnal erections and decrease libido. However, there is also evidence that erections in response to sexual stimulation still occur in patients with decreased hormonal activity, meaning androgen is not essential.

Psychological causes of impotence

Psychological issues were previously believed to be the main cause of impotence, and it is still considered a common cause of impotence. If the onset of impotence is sudden, this might indicate that the cause is psychological rather than physical.

Psychological issues can range from serious mental disorders, such as schizophrenia, to issues in the relationship with whom impotence occurs. The brain is a starting point for sexual arousal, and issues at this stage can be detrimental to the onset of an erection.

Mental health issues such as depression have a particularly strong link to impotence. This can be due to a lack of libido, performance anxiety, or persistent loss of interest and enjoyment. In schizophrenic people, lowered libido is the main cause of impotence. Some drugs to treat schizophrenia can increase libido, but there can still be persistent issues with erections and orgasms.

Risk factors of impotence

While the causes of impotence can be physical and psychological, there are certain lifestyle and medical factors that can increase the risk of these causes. For example, using tobacco can restrict blood flow the veins and arteries and can thus, over time, lead to vasculature issues which lead to impotence.

Age is one of the biggest risk factors in impotence. Impotence occurs in around 20-40% of older men. Studies have found that the risk of impotence rises by 10% every year in men aged 40-70 years old. The reasons for this are numerous: the penis becomes less sensitive to stimulation, hormone levels decrease, cardiovascular issues become more common, and libido naturally decreases with age.

Other risk factors include obesity, injuries that damage nerves or arteries that are involved in erections, persistent drinking, or alcoholism. Impotence can be avoided by sometimes making changes to lifestyle, such as reducing drinking and smoking but may sometimes need focused treatment. Other times, medical treatments such as radiation treatment or prostate surgery can be risk factors for impotence and may be needed to save the patient’s life.


  • Mayo Clinic. 2020. Erectile Dysfunction – Symptoms and Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776> [Accessed 26 August 2020].
  • Lue, T., 2000. Erectile Dysfunction. New England Journal of Medicine, 342(24), pp. 1802-1813.
  • Wyllie, M., 2005. The underlying pathophysiology and causes of erectile dysfunction. Clinical Cornerstone, 7(1), pp. 19-26.