Two common men’s sexual health issues are erectile dysfunction (ED) and premature ejaculation (PE). Both erectile dysfunction and premature ejaculation result in the loss of an erection. However, with premature ejaculation, the loss of erection always occurs after ejaculation while with erectile dysfunction, loss of erection may occur at any time during sexual activity.
If you should have concerns or experience symptoms of sexual health disorders or diseases, you should speak with you physician for diagnosis and recommended treatment.

What causes an erection

Erections arise from sensory or mental stimulation, most the time being both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa (erectile tissue in the penis) to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the erectile tissue, making the penis expand. Blood is trapped in the corpora cavernosa, maintaining an erection. When muscles in the penis contract to stop the inflow of blood and open outflow of blood, the erection is reversed.

What causes ejaculation

The ejaculation process is regulated by the central nervous system (brain and spinal cord) by neurotransmitters (brain chemicals). As cerebral and spinal centers get stimulated, they induce contractions in the muscles of the pelvic floor, resulting in ejaculation. Serotonin is considered the key inhibitory neurotransmitter involved in the process of activating ejaculation.

Erectile Dysfunction

Erectile dysfunction (ED) is defined as persistent difficulty achieving and maintaining an erection sufficient to have sex. Causes are usually medical but can also be psychological issues or a combination of both. Physical causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis. Some common medical issues are:
  • Heart disease
  • Clogged blood vessels (atherosclerosis)
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Obesity
The brain plays a key role in causing an erection, starting with feelings of sexual excitement. Psychological factor that can affect an erection are:
  • Depression, anxiety, or other mental health conditions
  • Stress
  • Relationship problems
Examples of lifestyle risk factors are smoking, alcoholism, and drug use.

Current Treatments

Pharmaceutical treatments are PDE-5 inhibitors: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) and avanafil (Stendra). Other less common options include topical application or injection of prostaglandin E1, Vacuum devices and penile implants.

Side Effects

Side effects of PDE-5 inhibitors are facial flushing, visual abnormalities, hearing loss, indigestion and headache.

Premature Ejaculation

Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners. Often it is within 1 minute. The exact cause of it is unknown although it is proposed that psychological factors such as depression, anxiety, guilt, and/ or biochemical factors such as deficient serotonin levels in the CNS attribute to PE.
  • Depression, anxiety, and guilt decrease ejaculation time
  • High amounts of serotonin in the brain may increase the time to ejaculation and low amounts can shorten the time to ejaculation.
  • PE is a common issue affecting approximately 1 in 5 men
Current treatments for PE

Treatments include topical anesthetics to reduce sensation, behavior modification therapies, and off-label use of oral anti-depressants (SSRI-like) or serotonin reuptake inhibitors (SSRIs). In the US, there are no pharmacologic drugs approved specifically for PE.

Side Effects

SSRIs often have numerous negative side effects including nausea, headaches, dermatologic reactions, anticholinergic effects, fluctuation in body weight, erectile dysfunction, and loss of libido.

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