You Gotta Get Up to Get Down

The infamous limp pecker. Most of us have suffered this affliction occasionally for various reasons. Nerves, physical health problems, booze, or mental health problems. But the bottom line is that most of our sexual performance issues are reversible and completely avoidable. Let's take ED (erectile dysfunction). The most common physical causes of erectile dysfunction are related to circulation and blood pressure. Heart disease, atherosclerosis, high cholesterol, and high blood pressure impact the amount of blood flowing to the penis. Diabetes contributes to ED by damaging your nerves and blood vessels. Smoking is a killer in more ways than one. Certain medications are culprits. There are other causes to be sure such as this "person" you share your bed with…maybe he/she's the problem. Maybe it's the stress of kids, job, money, or you no longer have any interests. Incidentally, if you don't have an interest and it is not due to some variable I just mentioned, you probably don't have a diagnosable problem. Some men just don't care about sex anymore. It happens, but of course, in this male-driven culture, a real man would never admit that. But that's another blog. In other words, if it's not a problem for the man, it's not a problem even IF it's a problem for the partner. It happens more often than not. For example, you can't "get it up" with Bill or Susan, but if you can to your favorite porn video, fantasy, or magazine, then I am pretty sure you don't have ED. Even that in and of itself is not the problem. Tumescence is swelling or becoming swollen, especially as a response to sexual arousal. Morning wood would indicate you are physically okay, and chances are your inability to get a hard-on has something to do with that external variable. I am not a doctor of medicine, but I would figure that out before I down some sildenafil or other PDE5 inhibitors. A phosphodiesterase type 5 inhibitor (PDE5 inhibitor) is a vasodilator. These drugs dilate the corpora cavernosa of the penis, thereby causing the erection. Here is a little-known bit of knowledge. Did you know you can take a PDE5 inhibitor, but without stimulation, there is a really good chance you are not going to get an erection? In other words, swallowing a pill does not automatically mean a raging hard-on. A high-fat meal before ingesting the pill is not optimal either. For me, an even more sure-fired reason to think before you swallow is the side effects. Those can be raging indigestion, dizziness, fatigue, and the list goes on. I have taken Sildenafil (for experimental reasons). I can report that it did what it was designed to do, but indigestion for hours afterward was not worth it.  And here is something to really think about.  According to MansMatters, some studies have shown that fluoride in toothpaste can suppress nitric oxide synthesis, which is essential for a good erection.  Where is a commonplace nitric oxide produced?  The mouth. Where do you use toothpaste?  The mouth. Hmmm....I don't know about you, but if I have problems getting it up, I might reconsider what I put in my mouth.  I have not used toothpaste for years, and my teeth are gorgeous.    As with most things, I feel we can develop a dependence on these medications. Not dependence as in addiction but association. It is quite "easier" to take a pill, get some stimulation, and perform, as opposed to working on the real issues at hand that contribute to the inability to get erect.

Besides, the inability to get an erection where there are no external variables at play, like relational issues, is a good indicator that there could be underlying medical concerns. A red flag event, if you will. If all is well in my life and I simply cannot get an erection under the best of circumstances, then I might wanna see my trusty medical doctor. There could be an underlying physical reason of which you might not have been aware. Suffice it to say, long-term erectile problems can cause significant stress, affecting your confidence and contributing to relational problems with your significant other.

     I cannot stress this enough as a clinician and patient. Embarrassment is deadly. Your healthcare provider has heard it all. Be upfront with your healthcare provider regarding your condition and your concerns. Don't be ashamed or embarrassed. Hey, if you gotta bend over or whip it out to be examined, do it. It sure is better than the alternative. Besides, these guys are trained professionals, and if by some chance you get a less-than-professional doctor, tell him what he can do with his practice and leave…find a better doctor. Nothing pisses me off more than to confide in my physician my personal information only to be lectured or talked down to and, the worst, to read his/her hypocritical comments on Facebook. I knew of one doctor who routinely would post on Facebook about promiscuous behavior leading to sexually transmitted infections, and then you would go to his office for treatment, and he would give you a blowjob.  I mean, WTF?  That clown is doing the same thing. The location of one's sexual behaviors does not mean you are more or less at risk. The streets, the bar, the back seat of your car, or your ivory tower. STIs are STIs. You get the point.

     If you are having trouble getting an erection, keeping an erection, reducing sexual desire, etc... See a health care provider. If you feel it is a mental construct, see a sex therapist, and together, you both can decide what is the most appropriate treatment route. If you don't have a mental health therapist, your family doctor is a good place to start. This goes for other sexual health concerns such as delayed or premature ejaculation, and without need, any lumps, bumps, bruises, etc..on the penis itself warrant a doctor's visit. I am constantly amazed at men, especially gay men in my experience, who are only concerned about HIV in terms of sexual health. No thought is given to herpes, syphilis, gonorrhea, chlamydia, human papilloma (warts), etc… There is a lot of stuff out there besides HIV.

     The best way to prevent erectile dysfunction is to make healthy lifestyle choices. I am dumbfounded at the individual who sits before me, loaded up on pills, smoking, obese, and stressed out, telling me they have no idea what the problem is. Is it denial? Is it a total lack of insight? I have my suspicions. In any case, work with your doctor to manage your physical health and mental health professional to manage your mental health. By the way, a Psychiatric Nurse Practitioner IS NOT A COUNSELOR or a THERAPIST. She/He is a nurse with a master's degree trained in the writing of drugs and treating physical health problems (and poorly, in my opinion). Do not be duped. So, stay healthy, eat right, exercise, reduce stress…

Dr. B. K. Wise

The Master Counselor