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The Psychology of Erection Problems

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The Psychology of Erection Problems Introduction EPs are complex and can affect men at any age. Sildenafil They often have both psychological and physical components. Careful questioning will help to ensure that the advice is tailored to each patient. Giving men the opportunity to discuss any medical THE PSYCHOLOGY concerns and issues may highlight opportunities for signposting to other services to improve their overall health. OF ERECTION Men are often reticent to speak to healthcare professionals about their health. Every consultation for EPs gives an opportunity to discuss lifestyle PROBLEMS changes, medication use, health monitoring, mental wellbeing and general health concerns, and support male patients to improve their overall wellbeing. This training is for pharmacy professionals to support them to advise men affected by erection problems (EPs) and recognise opportunities for Remember that you can record any learning and engaging with men about their general health. how you use this information in your consultations as part of your revalidation. Objectives: l Understand the potential psychological causes of EPs l Appreciate how both younger and older men may be affected by EPs l Understand the wider physical and mental health aspects of EPs REFLECTION: Are you confident to signpost men to other services when having conversations about EPs? Do you know what other services are available in your area to support men’s health? Pharmacist Tom Advising on EPs Depression Having difficulty getting or Depression can affect how sustaining an erection hard men feel about themselves enough for sex (called erectile and others, and sufferers are less likely to seek help.1 dysfunction, or erection EPs may either contribute problems) is common and to, or result from, can be treated in many cases. depression. Although it’s not unusual, some men may feel uncomfortable admitting to the issue or discussing it. As there are many factors that can contribute to EPs, your health discussions with male patients might open up opportunities for further health intervention – whether that relates to physical or Relationships mental health. Relationship issues can affect a man’s ability to Stress have an erection but, A complex issue equally, erection difficulties Stress can result from can impact on Lifestyle factors such as diet, many areas, including relationships smoking, lack of sleep or excess lack of sleep and worries weight may have a role within about work, money or relationships EPs. In addition, EPs could either be a contributing factor to psychological issues, or be a result of psychological issues. As you read through this booklet, you should gain a deeper understanding of Anxiety some of the issues that might be impacting on a patient’s Anxiety can be specifically Self-esteem related to performance or erection and how this can be more generalised improve your consultations. Self-esteem issues can cause EPs, or conversely can happen as a result of EPs and may be a sign of depression UNDERSTANDING Psychological causes ERECTIONS There are three different types of erections – psychogenic, reflexogenic and nocturnal. Some of the factors that contribute to EPs may be assumed to be short-lived, such as Psychogenic erection is a result of audiovisual performance anxiety; however, many psychological causes can affect men on a long-term basis, stimuli or fantasy. Reflexogenic erection is and some men may find themselves in a cycle where worry about EPs compounds the problem.5 produced by tactile stimuli to the genital organs. Lifestyle factors can also have an impact on EPs, and these may again be compounded by Nocturnal erection occurs mostly during rapid- psychological issues, such as smoking or drinking when stressed. eye-movement (REM) sleep.2 For an erection to happen, sexual stimulation triggers neurotransmitter release from the cavernous nerve terminal, causing relaxation of the smooth muscle and changes to blood flow in the penis. The process of an erection involves Anxiety psychological, neurological and vascular Stress/money pathways.3 Any changes to these pathways can Life stresses such as work pressures, worry about Anxiety is a feeling of unease, such as worry result in EPs. money or job security (areas that men have or fear, that can be mild or severe.8 General traditionally been seen as responsible for) can anxiety and medicines used to treat anxiety EPs can have psychological causes and an result in EPs. These can affect men of any age. can contribute to EPs. Generalized anxiety effect on a man’s psychosocial wellbeing. EPs Signs of stress include: headaches, dizziness, heart disorder (GAD) is a long-term condition, and can also be due to physical causes, which can palpitations, difficulty concentrating or making those affected feel anxious about a wide affect the blood flow (vasculogenic), the nerve decisions, feeling overwhelmed, changes to range of issues and events. GAD can cause impulses (neurogenic), hormones or anatomy appetite/sleep and irritability.6 When stressed, the both psychological (mental) and physical (the structure of the penis, such as Peyronie’s blood level of the hormone cortisol is increased. symptoms including feeling restless or worried, disease). These physical causes include potential Cortisol can affect the ability to have an erection, having difficulty concentrating, having trouble undiagnosed conditions such as CVD, diabetes, and long-term raised cortisol levels can affect sleeping and dizziness or heart palpitations.9 hypertension or hypercholesterolemia. testosterone production.7 Age is a contributing factor to EPs, and If your patient is showing signs of feeling incidence does increase with age; however, When discussing overwhelmed and very anxious then it may men under 40 are also affected, due to both medication for EPs, be appropriate to refer them to their GP for physical and psychological causes. Moreover, you may be in a a diagnosis. evidence indicates that incidence is increasing position to identify in this younger age group.3,4 Psychogenic what some of the causes tend to result in a sudden onset of underlying issues symptoms, whereas physical causes may lead may be and to a gradual onset of symptoms, with no effect whether referral on libido. If a man can achieve an erection for to other services masturbation, it is more likely that EPs within is appropriate. a relationship are psychogenic. Many EPs involve a combination of psychological and physical components.3 DID YOU KNOW? The prevalence of Pharmacy support EPs in younger men (aged under 40) may be as high as During discussions about EPs you may identify occasions where patients need 4 additional support. Some patients might need to be referred to their GP for 25% appropriate counselling, sex therapy or mental health support. Some advice you can give includes:13 • Offer suggestions of how they can take time out to relax and exercise • Suggest tips to encourage them to eat well, while limiting their Performance Depression Self-esteem Relationship use of alcohol, anxiety There is thought to be a link Men may issues cigarettes Performance anxiety between EPs and depression, associate their How a man feels or drugs may be an issue for and there may be changes to ability to have about his partner • Providing details some men, particularly libido or sexual function as a an erection with can impact on of mental health JENNY early in their sexual life result of taking anti-depressants.10 their masculinity. his ability to have charities that as they may be overly One of the biggest causes of Having EPs can an erection. If he can offer support focused on their depression in men is loss, such therefore impact feels pressure to may be erection. This can then as a job, a relationship or sense self-esteem.12 perform, or is no appropriate. impact on arousal of security. Men affected by Long-term low longer happy in and the quality of the depression may feel angry, self-esteem can, the relationship, erection. Men may also irritable and stressed. They may in turn, have or has a sense of be worried about their lose interest in what they used to an impact on guilt about his sexual performance or enjoy (including sex and normal mental health. ability to satisfy their body image. Any routines) and withdraw from his partner, he Signposting and further previous sexual failure those around them. They may might not be able reading can then affect future drink excessively or use drugs, to achieve an sexual confidence.10 and find their sleep and appetite erection.5 is affected.11 For a list of mental health charities visit: www.nhs.uk/conditions/stress-anxiety- Listening out for changes to depression/mental-health-helplines/ someone’s routine and what may have led to these changes To find out more about the sexual may help you to identify wellbeing of men, visit: someone potentially affected https://sexualadviceassociation.co.uk/ by depression. Disease and EPs Lifestyle and EPs There are many health conditions associated with EPs and you can help patients manage their condition or discuss with them further health checks that may be appropriate. l Cardiovascular A number of lifestyle factors can contribute to EPs. These include: The most common physical cause of EPs is atherosclerosis, which affects the supply of blood to the penis. Penile blood vessels are narrow, and EPs can be an early indicator of future heart problems, occurring around three to five years before a heart complaint (e.g. myocardial Diet and being overweight – obesity infarction).10,18 may cause damage to blood vessels, and a diet high in saturated fats may High blood pressure, diabetes and high cholesterol are also possible causes, as they too affect increase blood cholesterol levels, blood supply to the penis. In younger men, the role of EPs as a marker for cardiovascular risk contributing to EPs15 is an opportunity to identify subtle and subclinical conditions in apparently healthy men.10 l Lower urinary tract symptoms (LUTS) Alcohol consumption – alcohol can damage the nerves and affect The prostate gland increases in size from the age of 40, narrowing the urethra and causing hormone levels problems passing urine (straining to pass urine, an increased need to urinate and a feeling that the bladder doesn’t empty fully).
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