Erectile Dysfunction And The Mind

Problems in the bedroom

Some men in their mid-forties would have repeatedly asked themselves why they are unable to “perform” as well as before. The initial reaction would be to suspect a case of Erectile Dysfunction but later begin to question that self-diagnosis as nocturnal erections and erections during masturbation are still possible, just not in the bedroom. The thought of not being able to satisfy one’s partner can add more stress to the existing emotional stresses originating from outside the bedroom. So then begs the question, is Erectile Dysfunction (ED) psychological?

Before we can even begin to explore such a possibility, it is important to fully comprehend what it really means to have ED in order to create a possible link between ED and psychological causes. Simply put, ED is the inability to generate an erection or hardening of the penis in order to maintain an erection long enough to be able to achieve sexual penetration and orgasm. During sexual stimulation, the brain sends signals to the nerves in the penis which cause the relaxation of smooth muscles surrounding the blood vessels in the penis, leading to widening of the blood vessels which eventually leads to more blood flowing into the corpora cavernosa, the spongy tissue in the penis which will become turgid as it fills with blood. The tunica albuginea membrane surrounding the two chambers of the corpora
How Does Viagra Workcavernosa will aid in keeping the blood within the corpora cavernosa to maintain the erection.

 

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After the climax, the contraction of the penile muscles restricts blood flow to the spongy tissue of the penis. The veins in the corpora cavernosa carry blood away from the penis into the body. If this mechanism is disrupted at all either by physical damage to any of the blood vessels/muscles in the penis, neurological damage to the nerves, hormonal or even by psychological means, then a person could likely develop ED.

According to the Massachusetts Male Ageing Study, roughly 1 out of 2 men in the 40 to 74 age group experience ED at some point in their lives, of which 10 to 20% of cases are caused solely by psychological issues such as depression, anxiety and stress. Such a figure may bring some degree of relief to most men. In fact, statistics more often than not suggest that most cases of ED tend to be due to physical reasons rather than psychological reasons. However, there have been increasing cases of ED caused by both physical and psychological issues. It is also likely that patients experiencing ED of physical origin may experience additional stress that will only serve to worsen the condition.

So how bad can it get? 

Patients suffering from depression or anxiety may find it challenging to engage in intimate sexual relations due to lack of interest. Sex may not be the focus of their attention due to work-related issues, financial issues or even family problems. Even if they do not experience ED, it is possible that overwhelming stress may force that person to engage in behaviour such as alcoholism or smoking as a means of distraction. Alcoholism and smoking have been known to actually increase the risk of ED.

Relationship problems spawned from the issue of a cheating partner or spouse may remove the intimacy of the relationship. Sexual intercourse becomes less enjoyable when one partner questions the sincerity and degree of commitment of the other partner. Relationship issues could potentially be the cause of psychiatric conditions such as depression.

Patients in long-term sexual relationships may fear for their ability to continually satisfy their partner. Sex has reached a point where it has become boring and repetitive. To make things harder, the partner is unable to think of new ways to make sex more exciting and invigorating. These fears only serve to make it difficult for men to achieve or sustain an erection during intercourse.

Interestingly, even people nervous about sex can develop ED. They might be trying their level best to impress their new partner only to end up with an inability to perform in the bedroom. Such inability stems from the self-consciousness of one’s image, which only results in the person being unable to achieve and erection.

Any reasons for this? 

Not surprisingly, physiological mechanisms explaining how the human body works can describe the psychological reasons for ED. Sexual behaviour is mediated by the parasympathetic pathway of the autonomic nervous system responsible for excitatory responses during sex. However, in depressed patients, the sympathetic pathway takes over instead, leading to a loss of sexual arousal. The sympathetic pathway is commonly employed in responses to highly stressful life events like bereavement, work stress and relationship issues among other things.

Stressful episodes eventually lead to the adrenal gland of the body producing a chemical known as cortisol, which is a steroid hormone released in response to these events. (3) High levels of cortisol are known to facilitate degeneration of the neurons in the hippocampal area of the brain’s limbic system which is responsible for emotions. (3) This may serve to inhibit any potential for any sexual arousal in men feeling stressed or depressed. The exact mechanism is not yet fully understood but it is believed that necessary chemical mediators for an erection to occur such as nitric oxide (NO) are in insufficient amounts in a depressed person.

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Product Description

How does Viagra and Sildenafil work?

Viagra (Sildenafil) helps men to get and maintain an erection when sexually stimulated and/or excited. The medicine relaxes the blood vessels in the penis which results in more blood flowing to the penis when you are sexually excited.

How do I take it?

You should take Viagra (Sildenafil) approximately 1 hour before planning to have intercourse. Within a window of between 30 minutes and 4 hours after you take the medicine, it will be easier to keep and maintain an erection when you are sexually excited. If you take this medicine after a meal with a high fat content it may take a little longer to start working. This medicine will only work when you are sexually excited. You won’t get an erection just by taking Viagra (Sildenafil).

Dosage

The standard recommended dose for Viagra (Sildenafil) is 50mg and this will be suitable for most people.  If this dose is not effective, you can try 100mg and if 50mg gives you side effects you can also reduce the dose to 25mg tablets.

You must not take more than 100mg daily of Sildenafil/ Viagra. Clinical trials have been conducted in patients taking up to 200mg sildenafil and it was found that ‘doses of 200mg did not result in increased efficacy but did increase the incidence of adverse reactions (headache, flushing, dizziness, dyspepsia, nasal congestion, and altered vision).’

In addition, in patients taking more than 100mg daily, there have been reports of rhabdomyolysis (a breakdown in skeletal muscle tissue the byproducts of which can lead to kidney failure), visual perception changes, vertebral artery dissection (a tear in the artery supplying blood to the brain), heart attacks and aggressive behaviour.

If the 100mg strength doesn’t work for you, there may be alternatives you can try and we recommend that you call us for a free consultation with our pharmacist or doctor to discuss any underlying conditions you may have. We recommend that all men taking medicine for erectile dysfunction have regular tests for blood pressure, cholesterol, diabetes and hormone imbalances. For instance, it may be that by fixing a hormone imbalance such as testosterone, your Viagra medication will be even more effective.

In addition, drug manufacturers do not advise patients to split tablets in half to get the correct dosage as they cannot guarantee that the active ingredient will be distributed evenly throughout the tablet.  For instance, if you cut a 100mg tablet in two, you may find that you get 80mg in one half of the tablet and 20mg in the other half leading to either an overdose (increased risk of side effects) or a suboptimal dose (the medication may not work).

It is important that you choose the correct dose for you. If you wish to talk to our pharmacist or doctor about this, please contact us in the pharmacy on 01625 460621 or email [email protected]

Side Effects

Viagra (Sildenafil) is normally well tolerated, however, side effects can include:

  • Headache
  • Dizziness
  • Nausea

Side effects normally subside after a few hours, however, if you experience a prolonged or painful erection (longer than 4 hours), then you must contact your doctor immediately.

Drug interactions

There are a number of medicines which interact with Sildenafil/ Viagra. For an exhaustive list please see the patient information leaflet (see section below) or call us in the pharmacy to discuss your specific situation. The main drug interactions are listed here:

Recreational drugs such as ‘poppers’ or amyl nitrate
Alpha blockers used for urinary retention or blood pressure problems (eg Flomax or Cardura)
Anti- arrhythmic drugs such as disopyramide
Antibiotics such as erythromycin
Antifungals such as itraconazole
Antivirals such as drugs used to treat HIV
Bosentan
Cobicistat
Calcium channel blockers to treat blood pressure and angina such as amlodipine
Dapoxetine (Priligy – used to treat premature ejaculation)
Grapefruit juice**
Nicorandil
Nitrates
Riociguat
Cimetidine (to treat stomach ulcers)

Please do not take Sildenafil/Viagra if you have taken any of the above drugs within the last 60 days without first consulting with either us in the Pharmacy ([email protected] / 01625 460621) or via email with our doctor [email protected]k.

**We advise not to take Sildenafil/Viagra with grapefruit juice as the blood concentration of Sildenafil will possibly be increased resulting in side effects.

Patient Information Leaflets

Please click here for the patient information leaflet for Viagra.

For Actavis Sildenafil please see the following leaflets: 100mg, 50mg, 25mg.

Storing Medicines Safely

Please keep your medicine out of the reach of children and store at room temperature.  Unwanted medicine can be disposed of by returning it to any local pharmacy or indeed to us here for us to dispose of it for you.

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Can it be reversed? 

Sex and ViagraA regimen of antidepressants should be useful in reversing this mental state. It is important to note though that antidepressants, namely Selective-Serotonin Reuptake Inhibitors (SSRIs), can instead worsen the existing ED. (1) Therefore, it is worth discussing this with a qualified medical professional before starting on a course of antidepressants.

How is ED diagnosed in this case? 

Diagnosing ED, in this case, involves ruling out physical causes of ED. The taking of medical and sexual history by a qualified GP will aid in that respect. One of the best ways to determine whether ED is psychological or not is by conducting a nocturnal erection test. Basically, it involves the patient wearing a plastic, ring-like device around the penis overnight. The device will break if the patient has an erection while sleeping at night; thus, proving that the ED is more likely due to psychological reasons than physical ones. A healthcare professional may even prescribe other tests such as blood tests or injection tests to further rule out physical causes.

SildenaflilNaturally, the most appropriate way to deal with ED of psychological origin is by treating the underlying problems, namely the emotional or psychological issues plaguing the patient. An interview with a qualified healthcare professional such as a GP is a good step in that direction. Counselling may be necessary if the healthcare professional is confident that the ED is due to psychological reasons. (1) In some cases, medication such as Viagra and other therapy may also be required if the ED is caused by both physical and psychological reasons.

Here at Assured pharmacy, you can be assured that our pharmacy team and GP are well-trained to carry out private consultations to help you determine if you have ED of psychological origin. In the long term, finding out the root cause of ED could bring about necessary lifestyle interventions as ED of physical nature could be a sign of high blood pressure or cardiovascular disease. The saying, “It’s all in your head”, really doesn’t apply anymore, does it?

 

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References 

1. Erectile Dysfunction [Internet]. Niddk.nih.gov. 2016 [cited 3 April 2016]. Available from: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/erectile-dysfunction/Pages/facts.aspx

2. Knott D. Erectile Dysfunction. Causes; treatment of erectile dysfunction | Patient [Internet]. Patient. 2016 [cited 3 April 2016]. Available from: http://patient.info/doctor/erectile-dysfunction

3. THE BRAIN FROM TOP TO BOTTOM [Internet]. Thebrain.mcgill.ca. 2016 [cited 3 April 2016]. Available from: http://thebrain.mcgill.ca/flash/i/i_08/i_08_cr/i_08_cr_dep/i_08_cr_dep.html

 

Assured Pharmacy is not liable for the currency or accuracy of the information contained in this blog post. For specific information about your personal medical condition, please contact our doctors or pharmacists for advice on [email protected].