ERECTIONS ∙ 4 minutes read

Erectile dysfunction & premature ejaculation

By Kirsty Mason | Medically reviewed by Dr Jon Eriksson

Male sexual health problems are rife, with our Numan survey revealing that two in 10 men ejaculate quicker than they'd like to during sex. Erectile dysfunction and premature ejaculation are the two most prevalent male sexual health problems. We take a look at the common causes of each and what the most effective methods of treatment are.

It's extremely common for a man to experience erectile dysfunction or premature ejaculation during a sexual encounter. In both cases, there are several reasons why it might occur. The experience can be confusing and psychologically distressing but there's good news - plenty of treatment options are available.

Let's get to grips with what the conditions actually are, the reasons why they may occur and what you can do to tackle the problem.

What is erectile dysfunction?

Erectile dysfunction (ED) can be defined as the persistent inability to attain and maintain an erection long enough to permit satisfying sex. It's extremely common and can occur as a one-off (for example, after a heavy night of drinking) or repeatedly. If you're consistently experiencing ED, it may indicate an underlying health condition such as high cholesterol or low testosterone. You can do an at-home Erectile Dysfunction Test Kit to check for these conditions.

What is premature ejaculation?

Premature ejaculation (PE) is when ejaculation occurs too quickly. In our survey, two in 10 men revealed that they ejaculate quicker than they would like to during sex but it’s likely even more common than that. Although international guidelines state that PE can be defined as ejaculation in less than a minute, if you or your partner are consistently left feeling unsatisfied by the time taken to ejaculate, then it’s worth exploring treatment options.

ED and PE can sometimes arise as a pair. That’s not because they’re related physiologically. It’s because they can reinforce each other in a cognitive loop. If you worry about losing your erection during sex, you focus on your sexual arousal but find yourself ejaculating too soon. If you try to cool yourself down mentally, to delay ejaculation, you face a possible loss of erection.

The ensuing anxiety about sex can make your ED and your PE worse.

That brings us on to the causes of erectile dysfunction and premature ejaculation...

What causes erectile dysfunction?

There are four main functions that lead to an erection. But this process doesn’t always run smoothly. Along the route of this physiological response, there are all sorts of issues that can prevent you from getting or maintaining an erection.

Although there are several different explanations for ED, some are more common than others. Here are the issues that most frequently disrupt each of the four main functions:

Psychological issues: Psychological barriers can inhibit your ability to get an erection. Erectile dysfunction is notably higher in men who suffer from depression, and the same can be said for men with anxiety. Relationship issues, body image anxiety and performance anxiety all contribute to ED. If you think your ED is psychological, understanding the reason why it's occurring is the first step to tackling the issue.

Nerve signalling: When a man is sexually aroused, the nerves surrounding the penis receive signals that inform the blood vessels to relax, resulting in richer blood flow to the genitals. If your nerves have been damaged in some way - for example, after a prostatectomy - this could explain why you're experiencing ED.

Blood flow: Blood flow is critical for a healthy erection. When the vessels fill with blood, the penis becomes hard. ED is often down to issues with blood flow, whether the issue is with blood flow itself, or blocked arteries that prevent a sufficient amount of blood from filling the vessels. Conditions that affect blood flow include diabetes and high cholesterol. In some cases, you may be able to control these conditions by following a prediabetes diet plan or a high cholesterol diet plan. To identify your risk of these conditions, you could take a blood test. ED medications such as sildenafil, Viagra, and tadalafil work by encouraging greater blood flow and are effective treatments for men who are struggling to maintain an erection.

Hormonal imbalance: Hormones play a vital role in how our body operates. One hormone that plays a particularly important role in encouraging an erection is testosterone. Low levels of testosterone are linked to decreased libido, which can result in ED. As men age, it's normal for testosterone levels to decline. For some men, this can lead to a male version of menopause, also known as 'andropause'. A blood test will measure your levels of testosterone.

Your doctor can help you to identify and investigate the core issue that's causing your ED, whether that be cardiovascular disease, metabolic problems, neurological syndrome, or any of the conditions noted above.

What causes premature ejaculation?

Sometimes, premature ejaculation is down to a medical condition. Most notably, it can be caused by hormonal abnormalities or thyroid problems. Psychological problems are also a common cause of PE. Anxiety or depression can lead to the condition but it may also stem from sexual trauma, such as having to ejaculate quickly as a teenager to avoid getting caught by parents.

It’s important to note that PE is a subjective experience and only needs treatment if it’s causing some sort of distress. The causes of the condition are multifactorial and yet to be fully understood. A clinician can help you determine what’s causing your PE and recommend the next steps.

Just as there are a number of reasons why sexual dysfunction occurs, there are several different ways to treat it. The best treatment for you will be determined by what’s causing your sexual dysfunction.

How to treat erectile dysfunction

You have several options when it comes to treating ED, depending on what’s driving it. The standard first-line medications on the market are sildenafil and tadalafil. Viagra Connect is also available over the counter. You can try out more unusual methods of treating erectile dysfunction, such as penis pumps, but this is very unlikely to be your first method of treatment. If you're not sure what's causing your ED, you should take an erectile dysfunction blood test and speak to a clinician. The recommended treatment will depend on the underlying condition. If PDE5-inhibitors (which encourage blood flow) won’t help the condition, then you may be recommended mindfulness or cognitive behavioural therapy (CBT). These sorts of treatments target psychological causes of ED such as performance anxiety and body image issues.

How to treat premature ejaculation

Luckily, there are several methods of treatment available for premature ejaculation. If the condition is severe, you may be prescribed a drug that alters your serotonin levels. This has the effect of delaying the biochemical process that leads to ejaculation. 

Other treatments include Delay Wipes and Delay Spray, which both contain a mild anaesthetic, slightly reducing the sensitivity of sexual stimulation and leading to longer-lasting erections.

You can also try more natural methods of treating premature ejaculation, including exercise and wearing condoms. 

The bottom line

Erectile dysfunction and premature ejaculation are common male sexual health issues. There are several different explanations for both conditions. Getting to the root of what’s causing your ED or PE will help you to overcome the problem.

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