When a man suffers erectile dysfunction (ED), it is easy to jump to conclusions and focus on his inadequacies, rather than consider the distress his partner can experience. Partners of ED sufferers tend to internalise their feelings of self-blame, and it is easy for them to assume that they are no longer attractive to their partner. A lack of education about the causes of ED can contribute to anxiety, and sometimes, even feelings of hurt and anger when the problem occurs. Erectile dysfunction is medically defined as the inability to achieve or sustain an erection long enough for sexual intercourse. Just about every man experiences some erection failures at certain points in their lives, but ED sufferers experience this issue far more frequently than the average man. It can affect any man at any age, and over 50 per cent of men aged between 40 and 70 suffer from the condition to some degree. In a recent study of men in China, it was found to have a prevalence rate of over 40 per cent. However, the problem is beginning to affect younger men between 18 and 40 the world over, and it is affecting as many as three in every 10 men in their prime. It is more challenging for young men to cope with “performance problems”, as they are more sexually active, says Dr Kristin Zeising, clinical psychologist and certified sex therapist at MindnLife, a Hong Kong-based private psychology practice. Male sexual arousal has physical as well as psychological aspects. Hormones, emotions, muscles, nerves and blood vessels and the brain all play a part in how a man’s body responds sexually, she says. Physical, social/emotional and relationship factors all have a significant impact on the prevalence of erectile dysfunction. “There can be multiple causes or one simple cause depending on the person. A physical cause could be heart disease, diabetes, high cholesterol, obesity, high blood pressure or a history of stroke,” Zeising explains. In reality, there are different levels of erectile dysfunction and many of them can be addressed with medication or sex therapy Dr Kristin Zeising, clinical psychologist and certified sex therapist “Trauma to the body, such as an injury or accident, can also impact the penis and cause erectile dysfunction. Medications such as antidepressants, high blood pressure medications or pain medications can cause or worsen erectile function. Even if medical factors are the initial cause, a man can then lose his confidence, feel more performance anxiety, and have relationship problems, leading to a vicious cycle which can maintain erectile dysfunction.” Lifestyle factors can also play a vital part. According to Zeising, erectile dysfunction is more prevalent in men who watch more than 20 hours of television per week, those who drink heavily, smoke, and are overweight. Men who are physically active have a 30 per cent lower risk of erectile dysfunction than men who have little or no physical activity. Research shows that men who maintain an active lifestyle into their later years, drink alcohol moderately and do not smoke can maintain healthy sexual function into their 50s, 60s and even 70s. Impotence and erectile dysfunction are used interchangeably. Both are related to a man’s inability to obtain and maintain an erection sufficient for intercourse. Although they are the same thing, erectile dysfunction is the preferred terminology. Impotence is a term that has more negative connotations, as its origins implied a man is psychologically powerless and therefore cannot get an erection. As well as erectile dysfunction, there is the condition of erectile dissatisfaction, which is not a clinical term but more to do with feeling unhappy because your penis is not performing like it used to, Zeising says. “With erectile dissatisfaction, you may wish you could have the stamina and erection that you used to but it has declined with age, for example. This term has been used to describe what looks like a non-clinical experience causing the occasional loss of erection, or not getting an erection when you’d like it, needing more stimulation to get an erection, or your erection isn’t as firm as you would like it to be,” she explains. “These changes are all common with age. “However, anyone can experience these symptoms occasionally and it’s important to recognise that all men can have erection trouble from time to time. Unfortunately, people tend to think of clinical erectile dysfunction as a total and irrevocable condition. In reality, there are different levels of erectile dysfunction and many of them can be addressed with medication or sex therapy.” She says it is important to share your concerns of erectile dysfunction with your doctor because there are treatments that can help if it is due to a physical problem. It’s also important to have a doctor evaluate you if you think you have ED because it could be a sign of an underlying medical condition. Erectile dissatisfaction can also be treated. It may require some sex education and reframing what is considered “normal”, like how our bodies change as we age, including our sexual response. There are ways you can improve your mood, such as using relaxation techniques to calm the mind and the body. There is also mindfulness meditation to decrease depression and anxiety. It can help you to be connected more with your body and less with your head, which is helpful in having a fulfilling sex life. “There is also the technique of reframing your expectations. If you expect that your penis will always perform on command, then you are expecting a lot from this organ,” Zeising says. “Recognising that penises go up and down, and that it’s even normal for them to vary in their hardness during sex, is important.” It is important not to overthink the situation and make it a psychological issue. You cannot force an erection to happen. Trying too hard is likely to cause erectile problems, she warns. “Work on letting go of distracting or negative thoughts and bring yourself back to the moment. Focus on all your sensations in your body. Sex requires you being present and involved,” Zeising points out. A positive sexual experience is best measured by pleasure, not the firmness of your penis Dr Kristin Zeising The common problem is many couples equate sex with penetration. Now that intercourse has become difficult, they do not know what to do. All they need is to reframe what constitutes “sex”. It does not necessarily need to be intercourse. That helps take the pressure off the penis to maintain a firm erection. Zeising’s advice is to explore other ways to pleasure each other; kissing, touching, licking, and fondling all different parts of the body can be immensely pleasurable and reduce performance anxiety. Other options include thinking about ways to increase the stimulation to help you get aroused. As we get older, we often need a higher level of stimulation, and this is the case for both men and women. Talk about ways in which you can satisfy each other, and use “props” in the bedroom, such as sex toys, outfits and other aids. It also helps to discuss the different ways you can help your partner achieve orgasm, which can be achieved either through manual or oral stimulation, both of which are just as satisfying, Zeising adds. When you are having a sexual interaction and lose an erection, keep the session going and do not stop; just move on to other activities. That way, your partner will not feel rejected and you aren’t reinforcing that once you lose an erection the session is over. “Engage in playful flirtation and teasing to build up sexual tension. Sensual massage can help bring your attention to all the erogenous zones of the body and can be very pleasurable,” Zeising says. “Remember, erectile dysfunction is a situational problem and it does not mean you are any less of a man. It means you have a human body that does not always do what you want when you want it to. A positive sexual experience is best measured by pleasure, not the firmness of your penis. “Discuss with your partner that it isn’t about them. Make sure to reassure them constantly and focus on the problem in an objective manner.” Nine healthy habits to maintain ● Get sufficient sleep ● Exercise regularly ● Eat a balanced healthy diet ● Avoid smoking, or at least reduce your nicotine intake ● Maintain a healthy weight ● Drink alcohol moderately ● Avoid sedentary behaviour ● Attend to your relationship and communicate about any issues that can positively impact your state of mind ● Talk about your sexual needs and desires in an open manner Luisa Tam is a senior editor at the Post