Erectile Dysfunction And Premature Ejaculation
When things don’t work in the bedroom, it can be embarrassing and awkward. But sexual dysfunction happens to more men than you might think – about 40% of American men have had erectile dysfunction and up to 31% of American men have experienced premature ejaculation. Because it can be uncomfortable to experience.
The two most common male sexual problems are premature ejaculation (PE) and erectile dysfunction (ED), but it is less widely known that these two sexual dysfunctions often come as a pair. Both are forms of male sexual dysfunction, but they’re quite different – and depending on the cause, there are treatment options available.
ED (erectile dysfunction) is when a man is unable to get or maintain an erection, while PE (premature ejaculation) is when a man ejaculates quickly during sexual activity.
Here are the key differences between erectile dysfunction and premature ejaculation and what you can do about it.
What is erectile dysfunction?
Erectile dysfunction, commonly referred to as ED, is defined as the inability of a man to achieve or maintain an erection that is firm enough for sexual intercourse. The three most common symptoms of
ED are:
- Difficulty getting an erection
- Softer erections
- Erections that cannot be maintained
What causes ED?
It’s quite common for men to be unable to get it up in the bedroom, but if it’s happening more than 50% of the time, you may have a medical issue that’s worth investigating. Both physical and psychological factors can cause impotence. Common physical causes of ED include:
- Diabetes
- Cardiovascular disease
- High blood pressure or hypertension
- High cholesterol
- Unhealthy lifestyle
- Anxiety
- Depression
- Stress
- Negative thoughts related to sex
Depending on the underlying reason for your erectile dysfunction, there are different treatment approaches. For example, counselling and therapy would be good options if you’re feeling anxious or stressed about sex and, in turn, unable to get an erection. If an unhealthy lifestyle is causing ED, losing weight, quitting smoking and adopting a healthier diet could all help treat ED.
What is premature ejaculation?
Premature ejaculation also referred to as PE, is when a man ejaculates sooner than he or his partner would like. There are a few indicators that could cause you to seek professional treatment, including:
- Always or almost always ejaculating within one minute of penetration
- Unable to delay ejaculation during sex every time or almost every time
- Avoiding sexual intimacy due to feeling distressed and frustrated from PE
What causes PE?
There are two different types of PE: lifelong premature ejaculation and acquired premature ejaculation.
Lifelong premature ejaculation describes when a man experiences PE during his first sexual encounter and it occurs almost every time, or every time, he engages in sexual activity.
Acquired premature ejaculation develops after previous sexual experiences without ejaculatory problems, but now it happens every time or almost every time.
- Both types of PE can be caused by physical or psychological reasons. Common physical reasons include:
- Chemical imbalances in the part of the brain that controls ejaculation
- Hormonal imbalances such as thyroid disease or hypertension
- Urological conditions concerning the prostate or urethra
- Hereditary traits
Psychological factors that could cause PE to include:
- Anxiety
- Stress
- Depression
- Poor body image or self-esteem
- Sexual abuse and negative sexual experiences
- Interpersonal problems within the relationship
What’s the difference between Erectile Dysfunction and Premature Ejaculation?
As you can see, there’s quite a big difference between erectile dysfunction and premature ejaculation. However, it’s possible to experience both at the same time. Here’s an easy breakdown to understand the main difference between the two:
- When you get an erection
- When you ejaculate
Can erectile dysfunction cause premature ejaculation?
If you, like many men, have experienced erectile loss during sex, you may have found yourself in a vicious circle whereby you try to focus on your sexual excitement to avoid this loss. Unfortunately, this increase in sexual excitement can speed up ejaculation. To avoid ejaculating too soon, you find yourself focusing on reducing your sexual excitement, which leads to the loss of your erection.
All the while this process is going on in your head, you become a spectator to your experience during sex and suffer from performance anxiety. So you are not very present in the moment, neither enjoying your partner’s body nor focusing on the pleasurable sensations of being touched by your partner.
The dilemma that unfolds offers two unsatisfactory choices during sex: ejaculate too soon or lose your erection. It is no surprise then that sex can become something to avoid; for fear that it will lead to disappointment, frustration and embarrassment.
Anxiety can make ED and PE worse, and many individuals or couples facing this double whammy may not know which issue to address first.
Typically, addressing ED first means your confidence in maintaining erections increases. This means that anxiety tends to reduce, which helps prevent premature ejaculation.
Techniques to help with erectile dysfunction and premature ejaculation
Learn to relax
Lower your anxiety in general, by exercising regularly and practising ‘mindfulness techniques.’ There are many internet resources and apps to help to do these quick and simple breathing exercises daily to train you to stay focused and relaxed. Being relaxed during sex will help you to focus your attention on pleasurable sensations, rather than being preoccupied with your erection or ejaculating too soon.
Practise losing and gaining erections
A useful exercise for ED is to practise getting an erection, then letting the penis go flaccid (either with or without your partner), until you become used to the idea that with the right state of mind and stimulation, erections come, go and come back again. Also, it can be helpful to get more acquainted with your flaccid penis – it is not the enemy and can give you and your partner pleasure.
Experimenting with an erection ring
An erection ring is a round elastic-plastic cylinder that is worn at the base of the penis to help maintain an erection. They can only be worn for a limited time during sex.
Pelvic floor exercises
Pelvic floor exercises may help with ejaculatory control and erections. Your pelvic floor muscles are situated between your legs from your tailbone to pubic bone. You can squeeze and relax them by imagining you are holding in wind or urine. Squeeze and relax these muscles, both as quick flicks and slowly by holding for 10 seconds and resting for four seconds a few times a day.
N.B. Make sure you are not also squeezing your buttocks, thighs or tummy muscles and don’t hold your breath whilst doing these pelvic floor exercises.
Practise the ‘stop-start technique’ for PE
A useful exercise for PE is to stop and start your arousal so that you really get to know your own arousal process and can identify the point before you are going to ejaculate. With lots of practice, you should become more confident at controlling your arousal and ejaculation.
Stimulation
Try stimulating your partner so their arousal is heightened, then ejaculating quickly upon penetration may not be such an issue.
Open up and talk
If you are in a relationship, try talking to your partner first. Many couples are amazed at how effective talking about sex and other related issues can be. If you feel you need further help, you may wish to consider seeking specialist psychosexual and relationship therapy.
Treatment Of ED & PE
Note: If you experience both ED and PE, your doctor may recommend a combination treatment plan to help manage both conditions.
What ED treatments are available?
Prescription Medications
The oral medications for erectile dysfunction—phosphodiesterase-5 (PDE5) inhibitors—work by enhancing the effects of nitric oxide, a naturally-occurring substance that relaxes blood vessels to allow blood to flow into the penis. With this effect in place, it’s possible to get an erection in response to sexual stimulation and to sustain it.
Viagra (sildenafil): May be effective within 30 to 60 minutes and can last up to 12 hours
Cialis (tadalafil): May be effective within 60 to 120 minutes and may last up to 36 hours
Levitra or Staxyn (vardenafil): Maybe effective within 30 to 60 minutes and can last up to 10 hours
Stendra (avanafil): Maybe effective within 15 to 30 minutes and can last up to 12 hours
Keep in mind—for Viagra, Levitra, and Stendra—eating a high-fat meal may delay the absorption of the drug, which can prolong the time it takes to get an erection and diminish the drug’s overall effectiveness.
Be sure to talk about PDE5 inhibitors with your doctor, making sure that they know your entire medical history and all other medications and supplements that you take.
If a PDE5 inhibitor is ineffective or contraindicated, your physician may suggest you try penile injections. This is where a liquid medication such as Caverject (alprostadil for injection) or TriMix (papaverine, phentolamine and alprostadil [PGE]) is injected into your penis with a fine needle.
Another treatment option includes penile suppositories like Muse (alprostadil urogenital) that are inserted into the urethra.
Both of these methods will bring on an erection within five to 15 minutes without a need for major sexual stimulation.
Prescribed medications like selective serotonin receptor inhibitors (SSRIs) or phosphodiesterase inhibitors such as Viagra (sildenafil)—especially when taken together—can be effective for PE. Studies have found that combining phosphodiesterase inhibitors and behavioural therapy is successful.
They also won’t cause you to develop an erection on their own. Instead, they just make it easier to get an erection when you’re already in the mood for sex.
There are five PDE5 inhibitors approved by the U.S. Food and Drug Administration (FDA) for the treatment of ED:
- Viagra (sildenafil) tablets, approved 1998
- Cialis (tadalafil) tablets, approved 2003
- Levitra (vardenafil) tablets, approved 2003
- Staxyn (vardenafil) dissolvable tablets, approved 2010
- Stendra (avanafil) tablets, approved 2012
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What PE treatments are available?
Combining medications with psychological therapies may, according to Dr Althof, offer the best of both worlds. The effect of certain medications to delay ejaculation can help to build confidence before psychological therapies are used. In time, the man can be taught not to fear his arousal and to attend to other sensations. Once achieved, many men can be weaned off medication completely.
Prescribed medications like selective serotonin receptor inhibitors (SSRIs) or phosphodiesterase inhibitors such as Viagra (sildenafil)—especially when taken together—can be effective for PE. Studies have found that combining phosphodiesterase inhibitors and behavioural therapy is successful.
