It often is a mystery about men are able to achieve and hold an erection.  Even more mysterious is what are the causes of failure of erections and to fix the problem.  It is not uncommon for me to feel uncomfortable broaching the topic with their physician.  Fortunately, after the introduction of oral medication to treat impotence or erectile dysfunction in 1999, men are talking about their problems in the bedroom with their physicians.

In this blog I will discuss some of the most frequently asked questions about ED and the treatment for this common condition that impacts over 14 million American men.

  1. Why does Viagra fix the problem?

An erection requires an increase in the blood supply to the penis and more blood has to rush into the chambers of the penis than comes out of the penis.  When this happens, an erection will occur. Viagra helps blood vessels relax and increases the blood supply to the penis.

  1. Does the male hormone, testosterone, have a role in the erection process?

Testosterone acts on a series of different areas of the body to enhance bone development, muscle growth, sexual interest and function. Testosterone is primarily responsible for the libido or sex drive.  The testosterone level slowly decreases at a rate of about 1% a year starting around 25.  By middle age, most men start experiencing signs and symptoms of testosterone deficiency and men often need hormone replacement therapy.  This can be accomplished with injections, topical gels, or pellets of testosterone inserted under the skin.

  1. Why does sex feel good?

There is a high concentration of nerve endings in the penis and vagina, which triggers stimulation and orgasm. Dopamine is triggered and there is a pleasant feeling in the brain during ejaculation. It could also be an evolutionary thing. When we were cavemen with only animal instincts, the fact that sex feels good encouraged us to reproduce to keep the species going.

  1. Do sexually transmitted disease cause erectile dysfunction?

Gonorrhea and chlamydia are both sexually transmitted diseases that are caused by direct and unprotected sexual contact. Both STDs live in reproductive genital tracts of men and women and can be cured with antibiotics. If both STDs go untreated, it can lead to infection that will lead to infertility in men but usually does not cause erectile dysfunction.

5 Why does sex hurt?

The obvious reason is if the man’s penis is much larger than a woman’s vagina opening. The other possibility is that women have a decrease in lubrication of the vagina and the friction is a source of pain and discomfort usually for the men but also for the male partner as well.

Bottom Line:  Impotence is a common condition especially in middle age or older men.  Treatment is available and most men can be helped.  Talk to your doctor.

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