Sexual health means enjoying the sexual activity you want without causing yourself or anyone else suffering, physical or mental harm. Sexual health is not just about using contraception or avoiding infections. Making positive choices about sexual health is important not just for your physical health, but also for your general well-being.

An important aspect of being sexually healthy is having an understanding of what is happening to the body during sexual activity. For the male, the ability to get and maintain an erection is an important part of being sexually healthy. This section will deal with providing a greater understanding of the erection and how to overcome any difficulties which may occur.

Physiology of Erection

The penis has two main parts, a head and a shaft. The head of the penis is much more sensitive than the shaft. Normally a man’s penis is soft and hangs down, except when he is sexually excited and he gets an erection. When a man has an erection his penis becomes stiff, grows longer and wider and it sticks outwards and upwards from the body. An erection is the result of an interaction between the blood circulation system, the nervous system, the hormonal balance and a number of psychological factors. In simple terms, during an erection the penis is filled with blood, the foreskin stretches and the head of the penis is completely exposed.

Many men experience erectile difficulty at some stage in their sexual lives. Erectile difficulty or erectile dysfunction is also know as ‘impotence’ and it can be defined as ‘the inability to achieve or sustain an erection that is hard enough or lasts long enough to complete sexual intercourse or another chosen sexual activity’. In order to diagnose the potential problems that lead to this condition, it is useful to describe what conditions must be present for erection to take place. The first component you need to achieve an erection is a normal, intact male sexual organ.

Secondly, a normal amount of circulating hormones is necessary. Third, a man must have an intact nerve supply and blood flow to the male sex organ. Finally, normal erections require a healthy psychological response to the arousing stimuli, coupled with a relaxed state of mind.

Causes of Erectile Difficulty
In many cases erectile difficulty is related to physical causes, such as an injury or drug side-effects. However, there may also be psychological reasons, such as depression and anxiety. The majority of men with erectile dysfunction experience a combination of psychological and physical causes. Men whose impotence is due to a physical cause often experience gradual onset of erectile failure which tends to happen with all sexual activities. These physical causes may include;

• diabetes
• hardening of the arteries - this can lead to high blood pressure, angina or poor circulation
• kidney disorders
• multiple Sclerosis
• high cholesterol
• side effects of prescribed drugs
• heavy smoking
• alcoholism and drug abuse
• neurological diseases
• pelvic surgery.

If you experience a sudden onset of impotence but can still achieve erections under some circumstances but not others, it would suggest that the cause is psychological and may include;

• stress and anxiety from work or home
• problems within your relationship
• worry about poor sexual satisfaction
• depression
• sexual boredom
• performance anxiety
• unresolved sexual orientation

Sometimes the triggering factor can be easily identified such as an argument or major disagreement with your partner. Other factors can be; being interrupted while making-love or excessive worry about work, family life or finances, etc.

Available Treatments

Erectile Difficulty or Impotence is almost always treatable with the majority of patients responding to one of the available treatments. However there are a number of steps you can take first before seeking additional medical help. An important first step is to discuss the problem with your partner if at all possible.

Your partner may unintentionally put pressure on you to "perform". If you have erection difficulties this pressure could cause impotence. Discussing the problem with your partner may relieve this pressure and restore normal erectile function.

Secondly it is important to look at your own lifestyle. Are you a heavy smoker? Do you drink a lot of alcohol? Do you suffer from stress and anxiety? If this is the case it would be wise to cut down on alcohol intake and try to quit or cut down smoking. Also, try to reduce stress and anxiety by finding ways to relax.

If these changes do not solve the problem then you should seek medical advice. If you feel you need medical treatment visit your own GP. Your doctor should be able to do the relevant tests and offer you a suitable treatment. Treatment options for erectile difficulty will depend on the cause. For example, if the cause is psychological, you may be referred to a psychotherapist to get to the root of the problem. Such treatment is successful in the majority of cases, even where the impotence has been present for some time.

If it is suspected that impotence is a side-effect of a medication, switching to a different class of drug may solve the problem.

Otherwise, you may receive some sort of drug therapy. In recent years, significant developments have been made in the availability of drugs to treat men with the problem of impotence. It is important to speak to a medical professional and have a detailed consultation to gain a full understanding of the problem and to identify the most relevant treatment.

You should never take impotence medication prescribed for another person – these drugs are not suitable for everyone and can cause serious problems to some patients.

Other medical options include injections into the penis to bring about an erection.

Penile implants are sometimes used, particularly for men who are permanently impotent. Some implants are inflatable by squeezing a small bulb placed in the scrotum to achieve an erection. If you find that your doctor is unable to do this then asked to be referred to a clinic that deals with sexual dysfunction.