Erectile dysfunction can be a very concerning problem for men. Thinking about it ahead of time makes you feel worried about what may happen with your sex life when you grow older. But there are different types of erectile dysfunction.
Some of them are independent of your age or any other organic cause. Luckily, most of them are temporary cases of erectile dysfunction. Is that your case?
In this article, we’re reviewing the topic thoroughly. First, we’re describing temporary erectile dysfunction and when it happens. Then, we’re contrasting this type of ED with long-term erectile problems.
Finally, we’re taking a look at what doctors do to diagnose and treat this problem.
Short term ED
Temporary erectile dysfunction is also known as short-term ED. You can also find it as transient ED or situational erectile dysfunction. All of these names imply that you won’t have this problem from now on. In some cases, you can take control of the issue. In others, you will recover your erectile function after a while.
Sexual health and sexual behavior are both very complex, and the topic is also a bit complicated. Many causes lead to short-term ED. The only aspect they have in common is that you can actually recover your erectile function. You won’t depend on pills, surgery, or a penile implant, and in the future, you might get a spontaneous erection.
Then, how can we define short-term ED (1,2)?
It is the inability to achieve an erection or maintain its hardness during sexual intercourse in some situations. For example, it can be that you’re stressed out and cannot concentrate. Maybe alcohol is causing your temporary problem, or you’re feeling anxious about sex. But then, you have a spontaneous erection, later on, have no issues when masturbating, and you probably wake up with an erection every day or every now and then.
If we’re talking about temporary erectile dysfunction, we can also mention prostate surgery. After removing your prostate due to BPH or prostate cancer, you might experience erectile problems for a while. But it is usually a temporary problem. After some rehab and a bit of patience, erectile function goes back to normal. But this type of erectile dysfunction is highly variable.
Some men would experience the issue for months and sometimes one year. So, it is temporary but not precisely what we call short-term ED.
To summarize, the causes of temporary erectile dysfunction include (3):
- Stress: Being under pressure and feeling stress causes a release of adrenaline and other chemicals. It is known that adrenaline works as a penile erection inhibitor. It creates tension in the muscles and constriction in the blood vessels of the penis. Thus, chronic stress can be a cause of erectile dysfunction. It is a temporary problem that improves as you feel more relaxed. However, after a stressful day, and even if you feel somewhat relaxed at night, you can experience an episode of erectile problems.
- Depression: People with major depression do not feel motivated to do anything. They may even lose interest in their former hobbies, favorite shows, and past times. Hypoactive sexual desire is one of the symptoms of depression. Additionally, using anti-depressive medications can further contribute to the problem. Another psychiatric condition that causes ED is post-traumatic stress disorder.
- Performance anxiety: This is a common problem in young men with limited sexual experience. They often feel anxious about their little background and how to please their partner. This anxiety has the same effect as stress, releasing chemicals that kill their erection.
- Fatigue: Being tired interferes with your ability to focus on sex. Feeling tired reduces your libido, and you don’t feel stimulated. Thus, erections are not easily triggered. This is particularly the case if you have temporary erectile dysfunction in the evening. A stressful and tiring job can cause male sexual dysfunction as well.
- Alcohol abuse: This is a widespread cause of temporary erectile problems. One glass of wine or one drink can make you feel relaxed. But too much alcohol depresses your nervous system. Then, it interferes with sexual stimulation and other nervous functions.
- Medications: Certain medications can give you short-term ED. For example, if you take sleeping pills, anti-depressives, or anxiolytics, you can expect transient erectile problems. The same happens if you have benign prostatic hyperplasia and use tamsulosin and similar drugs. They relieve your BPH symptoms but may cause temporary cases of erectile dysfunction.
- Relationship problems: Relational issues can also lead to short-term ED. Not being on good terms with your sexual partner or feeling upset about something in the relationship can have this effect. This sometimes happens in couples after many years of relationship. Things start to become a habit, and sexual activity may not be as exciting as before.
- Unfamiliarity with condoms: This issue is also pervasive if you’re not used to wearing condoms. To wear a condom, you need to stop stimulation. Then, the process of putting it on can deflate your penis. It happens to young men who are starting their sexual activity. It also happens with older and experienced men who need constant stimulation to maintain their erection.
Long term ED
Long-term erectile dysfunction often has to do with more permanent causes. It is not transient. It is not easy to solve with homemade measures. Sometimes it requires surgery and other invasive methods such as penile injections. It is often associated with an organic cause, which can be neurologic, hormonal, or related to blood circulation.
Most cases are even more complicated because there are organic causes on the baseline. But then, men have some difficulty achieving an erection and start feeling anxious. Thus, the causes are mixed between organic and psychogenic.
Let us review each one of the causes and what happens in each (4):
- Neurologic problems: Patients with a neurologic disorder may also affect their erectile function. Two examples are Alzheimer’s disease and Parkinson’s, which mostly affect seniors. But even young men can experience a neurologic cause of impotence. For instance, after cerebral trauma in contact sports or a stroke. Spinal cord injuries and multiple sclerosis also lead to erectile problems. The main reason is that they are failing to start nerve impulses that initiate an erectile function. They either have sensory issues that impair their sexual arousal or dysfunction in the reflex mechanism of spontaneous erections.
- Hormonal issues: Hormonal problems in men are usually triggered by androgen deficiency. Another hormonal problem causing ED is hyperprolactinemia. In both cases, there is a reduction of the testis function to produce testosterone. This is known as hypogonadism, and there are various types. Testosterone is essential to achieve and maintain an erection. Without a proper supply of testosterone, men start losing their libido. Their sexual desire is lower, and they could not feel aroused by the same stimuli. Even if they are sexually aroused, low testosterone levels impair nitric oxide release. This substance is essential to relax the blood vessels of the penis and fill the cavernous bodies with blood.
- Vascular disease: Different vascular problems can lead to erectile dysfunction. It is usually caused by chronic disease factors that lead to penile arterial insufficiency. In other words, the arteries of the penis are not getting enough blood flowing through. The trigger of penile arterial insufficiency can be varied. The most common is hypertension (high blood pressure). It can also be triggered by cigarette smoking, diabetes, and high blood lipid levels. In men who sustain trauma in the pelvic floor, the penile arteries can start losing flexibility. This is focal stenosis, and it is a likely cause of long-term erectile dysfunction after a bicycle accident. The problem can also be in penile veins instead of arteries. To achieve erections, they should remain shut to maintain the blood in the penis. But veno-occlusive dysfunction can occur. Then, the veins won’t close properly, and the penis deflates. This is what happens in diabetes mellitus or Peyronie’s disease.
- Systemic disease and aging: It is expected to find a decline in sexual function as we age. Even in healthy seniors, the period between stimulation and achieving an erection can increase. The ejaculation volume can be lower, and it can be less forceful. Penile sensitivity is sometimes reduced, especially in patients with lower testosterone levels. However, all of these changes are worsened in patients with systemic disease. Diabetes mellitus is an important example. As time passes, diabetes affects microcirculation throughout the body. That includes the circulation of the penis. It may also affect the nerve terminals in the corpora cavernosa. As a result, there’s a reduction of neurotransmitters and insufficient blood flow. Another systemic disease that causes long-term ED is chronic renal failure. This condition causes vascular insufficiency as well. It may also affect your testosterone levels. Additionally, there’s a chance that you’re taking different medications that contribute to ED.
- Post-surgical erectile dysfunction: As noted above, we can expect to find some degree of erectile dysfunction after prostate surgery. New surgical procedures preserve erectile function by sparing nerves from injury. However, you can still experience erectile problems due to the pulling of organs. This is temporary erectile dysfunction, but it is usually maintained for some time. These patients can go through rehabilitation to improve their sexual function. They often experience significant improvements in a few months. Others take a bit more to improve, but the process should not take more than one year.
Diagnosing temporary ED
The diagnosis of temporary erectile dysfunction needs to address the most common causes. An excellent way to start will be alcohol abuse and medications.
Your doctor will try to get a complete list of drugs that you’re taking to see if one of them contributes to your problem. Taking the medication out may require gradual lowering the dose or replacing the drug with another chemical.
After ruling out medications and alcohol as a cause, doctors start evaluating for psychogenic ED. Stress, anxiety, relational issues, and fatigue are all psychogenic causes. Their triggers are mainly psychological factors or situational elements.
However, as noted above, we often have in the same patient both organic and psychogenic causes of ED. So, your doctor will still perform a medical history and physical examination. In doing so, he’s trying to rule out an organic problem acting as an underlying cause. As a part of the evaluation, you might need to test nocturnal penile tumescence. That is sleep-related erections. If your problem is temporary, they are most likely preserved.
To diagnose psychogenic ED, there should be no organic cause. Otherwise, mixed psychogenic-organic erectile dysfunction is diagnosed instead. In these cases, a mixed ED treatment is initiated considering the organic causes, too. The diagnosis is independent of the use of sildenafil (Viagra). This medication is a PDE5 inhibitor and works for organic causes by inhibiting an enzyme. But it also works for psychogenic causes by enhancing your body’s response to sexual stimuli.
So, the fact that Viagra works to improve your problem is not very useful to differentiate psychogenic causes. Instead, doctors need to know the situational cause. What happens around you when you can’t get an erection or lose momentum.
Psychometry instruments can be used to diagnose temporary erectile dysfunction. They are also useful to find out what is the best way to treat the problem. This evaluation features different scales and tests. They are usually grouped into three categories (2,5):
- Personality tests: Different personality tests contribute to the diagnosis of psychogenic erectile dysfunction. One of the most important is the Minnesota Multiphasic Personality Inventory. It is widely used in scientific studies and reliable to evaluate mental health, stress, and other aspects of ED.
- Depression inventories: We can highlight the Beck Depression Inventory as one of the most commonly used in these cases. It is a recognized questionnaire to assess depressive symptoms in any patient. In ED patients, it rules out depression as the leading cause of the symptoms. Note that you can have major depression symptoms without actually feeling sad. So, do not automatically rule out this possibility and take the test if your doctor recommends doing so.
- Sexual function and relationship questionaries: In this group, one of the most useful tools is known as the International Index of Erectile Function. This tool can measure sexual desire, orgasmic function, and sexual satisfaction. It is taken by the patient and can be self-administered. Other scales can also measure how the patient feels about his current relationship. They are relationship satisfaction tests that may also bring about sexual function items.
Tools and questionnaires are useful, but they should not replace actually talking to the patient. The doctor might need a comprehensive analysis of what is happening. This assessment includes a medical history with interpersonal, psychological, or sexual issues. The medical interview can be done with the partner or without the partner present.
In most cases, doctors would prefer to ask some personal questions without the partner and then interviewing both simultaneously.
During a couple of interviews, you might need to share your goals and coping strategies as a couple. So, be open with your doctor and remember that you want to provide accurate information. Otherwise, the whole purpose of the visit and the diagnosis might not work as intended.
Temporary erectile dysfunction treatment should follow the cause of the problem. Drug-induced ED is treated by replacing the drug that causes the problem. Alcohol-induced ED is treated by controlling your intake of alcohol. The same goes for substance abuse.
But treatment is a bit more difficult if we’re talking about psychogenic causes. In these cases, we need psychoeducational interventions, couple therapy, and other interventions to reduce performance anxiety. Most cases include one of these therapies or a combination (2,3,5):
- Cognitive therapy: ED often comes from distorted beliefs about sexual behavior. Cognitive therapy can be useful to modify the expectations of patients about their own sexual performance. Their perceptions of penis size and the ability to please their partner can be unrealistic. In these cases, cognitive therapy is beneficial to treat ED. The couple may also need information about their own genitals, sexual fantasies, masturbation, and stimulation.
- Behavioral therapy: There are different methods to achieve behavioral therapy. One of them is getting the couple to improve their sexual communication skills. This is achieved through a process that starts with no intercourse. Instead of penetrative sex, the couple is encouraged to engage in other nongenital activities. These activities should be pleasurable but non-demanding. Then, intercourse is introduced gradually and according to the couple’s advances.
- Script modification: Sometimes, what happens between couples is that they have too few sexual elements in their repertoire. Having no alternatives to intercourse can impair a couple’s sexual life after a while. So, script modification is a process of getting acquainted with other options of foreplay and other types of sexual stimulation.
- Couple therapy: If the main problem behind erectile dysfunction is relationship problems, couple therapy can help with the situation. It is aimed at improving communication between them and solve problems with assertiveness. After couples reach an understanding and more intimacy, they often improve their sexual function.
- Sildenafil and other erectile dysfunction medications: As noted above, sildenafil works for organic causes and psychogenic causes, too. It is even more useful when used along with other treatments listed in this article. Medications for ED can be used in the first phase of the treatment as the primary cause is addressed. However, doctors and patients should try to avoid the mistake of medicalizing sexuality. Many cases of ED indeed have an organic component. But sildenafil is often used in temporary erectile dysfunction without treating the real cause.
Talking to your doctor
In this article, we’re talking about diagnosis, a medical history, and therapy. But it would be incomplete if we do not address an important issue. It is not always easy to talk about erection problems with your doctor.
This is what you can do if you want to bring the topic to your doctor’s attention:
- With the information in this article, try to figure out what is probably happening. Is there any cause or trigger that rings a bell with you?
- Write down your questions and take your time to gather enough information about yourself
- Try rehearsing the initial words to boost your confidence. Something like “how can I tell if I have erectile dysfunction?” may help.
- Remember that you want to be truthful and provide accurate information.
Premature ejaculation and erectile dysfunction are both common problems in men of all ages. But it is sometimes due to transient and psychological causes. Different risk factors may contribute to temporary erectile dysfunction.
For example, having a stressful job, performance anxiety, depression, and drinking too much alcohol. You could even have problems putting on a condom and experience a sudden deflation of the penis. But all of these are temporary problems.
After diagnosing temporary erectile dysfunction, your doctor will evaluate your treatment options. They are usually lifestyle changes, couple therapy, and behavioral therapy. Sometimes you might need oral medication for ED during the initial phase of the treatment. However, the goal is to achieve spontaneous erections without any external aid.