Sexual Dysfunction: Male Erectile Disorder - Term Paper Example

Sexual arousal involves activation of physiological systems that coordinate sexual functions in both sexes and which includes central arousal, non-genital and genital arousal. In men genital arousal leads to erection and disorders are identified and known as erectile disorders. Erectile dysfunction (ED) amounts to impotence and has been defined as “the persistent or repeated inability for at least 3 months to attain, and/or maintain an erection sufficient for satisfactory sexual performance’’ (Graziottin, 2004). Deviation from the normal sexual response cycle constitutes a ‘sexual dysfunction’ (Potts et al., 2004). It is the ability to attain or maintain penile erection sufficient for sexual performance. The term ‘sexual performance’ is ambiguous and could vary across people. This paper will discuss the erectile dysfunction older males and how counseling could help them overcome the dysfunction. In order to obtain an erection three systems interact – firstly the bran receives tactile, visual or other stimuli that interact with various psychological factors to influence sexual desire (Simpson & Hickox, 2000). Then the neuronal system has to be in tact through the spinal cord and peripheral nerves to mediate the corpus cavernosal relaxation. Finally there should be adequate blood supply to fill the cavernosal trabeculae. Man’s ability to maintain erection can affect his confidence and result in other failures. Erection occurs when the imagination or one or more senses are stimulated and the person becomes aroused. Poore (2006) suggests four requirements for normal erection – a properly functioning nervous system that sends proper signals to the penis, an intact blood flow system so that blood flows in and out of penis correctly, muscles in the penis should be able to relax fully so that it can fill with blood and enlarge, and the ability to trap the blood in the penis so that t remains hard. Normal erectile function requires the coordination of psychological, hormonal, neurological, vascular, and cavernosal factors (Wagner & Tejada, 1998). Any alterations in any of these factors can lead to ED. It has been observed that more than one factor causes ED. ED can occur due to various psychological factors like performance anxiety, distraction by negative context-dependent factors or even biological of vascular factors (Graziottin, 2004). Neural problems that affect the brain and the spinal cord are known to cause ED. Surgical procedures to parts of the erectile system like the penis or the pelvic nerves, or cancer in the penis can directly lead to ED. Diseases like hypertension, heart disease, atherosclerosis and diabetes can severely impact the ED. Apart from these hormonal factors can lead to ED. In older men there is loss of testosterone which renders the process less subjectively perceptible. Research suggests that most men with ED have mixed functional impairment and structural damage on a multi-factorial basis. Emotional factors also have an impact on genital arousal. Apart from these, there is a strong relationship between depressive mood and ED. A person under antidepressant treatment is life to have sexual side-effects although it is often difficult to differentiate between the side effects of antidepressants and the illness itself (Hartmann, 2007). Depression leads to lack of sexual interest and sexual arousal. Among men depression and anger are highly correlated with ED. Research suggests mood disorders cause and maintain sexual dysfunction. Depressed men report diminished frequency of sexual thoughts and fantasies, decreased sexual activity, diminished pleasure from sexual activity and satisfaction level also reduces. Loss of sexual interest is related to loss of sexual satisfaction. ED affects approximately 30% of men in US and the prevalence increases with age (Shabsigh, 2003). Another longitudinal study revealed that there is increase in incidence of erectile dysfunction with aging. In the age group of 60-69 years nearly every 22nd man without previous erection problems developed ED (Jung & Schill, 2004). Research also suggests that risk of ED was higher in men with low education level apart from the physical diseases as stated above, that cause ED to occur. Some men assume that ED is a part of the aging process and tolerate it but most men today have a different approach towards ED as most have the confidence that they can return to successful intercourse. In the older men it occurs due to deterioration in the blood vessels that carry blood to the penis (Delvin, 2007). Further research suggests that there could also be deterioration in the arteries of the brain or the heart. The older men need to protect themselves against strokes and heat attacks by maintaining their blood pressure and cholesterol levels. ED can be treated through safe, non-surgical processes like counseling and use of drugs. Sexual counseling has been found to be important even when other therapies are used. It is a supplement to the long-duration treatments. Sexual interest is a psychological process and the extent to which loss of sexual desire leads to reduction in sexual activity with age is not clear. Nevertheless, ED is definitely linked to psychiatric and other inter-current illnesses. This requires psychosexual counseling because many men associate ED with loss of power. The psychological causes include guilt, exhaustion and depression. Delvin advises that instead of suffering in silence, they should have the confidence to approach a doctor or a counselor. Relationship counseling is very important. Psychosexual counseling has gained importance because it has been recognized that organic element is present in most patients (Wagner & Tejada). The health professional, counselor or the pharmacist should ensure during treatment of ED that they are not treating just an organ. ED may be treated with drug therapy but achieving an erection is not synonymous with intimacy (Berger, n.d.). Only a small percentage of the older men bring the problem to a health professional. The term “impotence” implies a weak and powerless position. The counselor himself or herself needs to be well composed and trained in imparting advice. Counseling is a short-term, theory-based, non-directive, non-judgmental process (Stressmgn, n.d.). During the process, the client or the individual who is facing adjustment, developmental or situational problems, is helped by the counselor to gain awareness of himself and make decisions with support. Hence, the process of counseling would involve befriending, listening, helping, and empowering. Since the older men may be hesitant in speaking up, body language helps. One who needs counseling is in need of understanding and needs to release emotions. Hence, the counselor must learn to read non-verbal behavior because the patient may be hesitant to speak up. According to Jossey-Bass (1982), making an eye contact is of utmost importance. Maintaining facial expression makes the client feel comfortable and less nervous. As a counselor, adopting an inviting and open body language by smiling more often, an affectionate touch, leaning towards the person or nodding to show interest, most often relax the patient and encourage him to release. They have to use intuition and senses to understand the client better. The counselor also needs to ensure psychological and auditory privacy in the case of older men during counseling. The patient needs to be assured that counseling is absolutely confidential. Even though the counselor is aware of the problems, it is essential to listen to the patient. While providing information, the counselor needs to encourage questions from the patient. Empathic listening is essential for right counseling to the older men (Berger). Counseling can also involve sex therapy where the counselor asks the patient to read books on sex and perform touching exercises that takes away the pressure to perform during sex. Sex therapy is useful even to receive medical or surgical treatment. A person with ED should be informed of all the alternatives in treatment available so that he is able to take an informed decision (Levy, Crowley & Gingell, 2000). The purpose of counseling itself is to facilitate potency at all levels. The patient has to be encouraged to discuss monotony of sexual intercourse with the same partner, psychic and sexual traumas, impaired communication, as these are the major causes of ED. Evidence suggests that psychological assessment of sexually dysfunctional patients and psychosexual counseling are useful in selected patients in clinical settings. Counseling is often compared to taking drugs like Sildenafil but more important in the case of ED are not the costs but the outcome without any side effects. Counseling requires that the counselor is able to convince the patient that ED can be overcome which would give him the confidence to go in for long-term treatment. All patients evaluated for ED should undergo comprehensive medical, sexual and psychosocial history evaluations (Shabsigh, 2003). ED can be overcome by alteration in lifestyle like giving up smoking or substance abuse. Psychosocial counseling and changes in medication also helps. Sildenafil, a v-inhibitor, is an easy and secure therapy option for ED which works irrespective of the underlying cause of the diseases but the patient has to be informed also of the side effects. Sildenafil can lead to co-morbidity due to cardiovascular disease. Research further suggests that Sildenafil alone is not enough to overcome the psychological problems (Simpson & Hickox, 2000). The use of sex therapy becomes important along with the use of Sildenafil. The use of Sildenafil has to be combined with a psychological approach to erectile dysfunction. It serves as a catalyst during treatment which can be lengthy and frustrating for the patient. The acceptance and success of this therapy is much higher than auto injection pump or a vacuum pump. Testosterone gel preparation can be applied to the upper arms and the shoulders and has been found to be effective but testosterone patches requires shaving the scrotal skin which many resist to. Discontinuation of Sidenafil is prevalent as in most cases patients due to advanced age, diabetes and other health problems. This requires 6-8 doses and may be more in case of the older men, but patients get frustrated after 2 or 3 attempts and tend to drop out (Gruenwald et al., 2006). This too requires the right advice at the time of starting the treatment. Those having ED as a result of diabetes need an annual review of their diabetes. This would help to minimize the morbidity rates and ensure they are able to lead as normal a life as possible. This requires counseling on their quality of life issues, evaluation of their metabolic control, assessment of the presence or absence of microvascular and macrovascular complications and the risk factors connected to these. With diabetic people, direct questioning on ED is not usually done but it could for a part of the quality of life issues. Diabetic patients with ED should attend counseling preferably with their partner. To provide the right counseling, it is essential to get the right input and make correct assessments. Formal psychological treatment is not always possible or practical but it is essential for people with immediate psychological problems. Most patients with ED resort to medical treatment but psychosexual counseling helps. Alcohol and tobacco also impact the aetiology of erectile failure although alcohol affects only when it is consumed beyond specified limits (Alexander, 1999). Hence counseling would assess their consumption habits and advice accordingly. Cessation of smoking cannot restore erectile function and this should be communicated to the patient. Thus it is evident that ED in older men is not very uncommon but due to advanced age there may be other factors contributing to ED. While it can be restored through drugs and other therapies, patients tend to dropout due to lack of proper guidance at the initial stages. The counselor of pharmacist has an important role to play as the older men may be hesitant to speak about it initially. This requires great amount of understanding on the party of the counselor and the counselor needs to have an empathic attitude towards the patient. They need to have a comprehensive, proactive approach to treatment of ED which implies that thorough knowledge of how erection takes place and the possible reasons for ED. At the same time the patient should not be made to feel there is something wrong with him because this affects his confidence and morale. ED can be very sensitive for a patient to discuss but if the counselor is well trained and does not treat it as an organ, the job of the counselor and the patient is much easier. References: Alexander, W., (1999), Themanagement of erectile dysfunction associated with diabetes, Blackwell Science Ltd, Sexual Dysfunction 1, 113-118 Berger, B., (n.d.), Counseling the Patient with Erectile Dysfunction, 22 June 2007 Delvin, D., (2007), Erectile dysfunction (impotence), 21 June 2007 Graziottin, A., (2004), Sexual arousal: similarities and differences between men and women, JMHG, Vol. 1, Nos. 2–3, pp. 215–223, September 2004 Gruenwald et al., (2006), Positive Effect of Counseling and Dose Adjustment in Patients with Erectile Dysfunction who Failed Treatment with Sildenafil, European Urology 50 ( 2 0 0 6 ) 134–140 Hartmann, U., (2007), Depression and sexual dysfunction, JMHG, Vol. 4, No. 1, pp. 18– 25, March 2007 Jossey-Bass (1982), Carnegie Melon, RA Resource Room, 22 June 2007 Jung, A., & Schill, W., (2004), Male sexuality with advancing age, European Journal of Obstetrics & Gynecology and Reproductive Biology 113 (2004) 123–125 Levy, A., Crowley, T., & Gingell, C., (2000), Non-surgical management of erectile dysfunction, Clinical Endocrinology (2000) 52, 253-260 Poore, R., (2006), Erection Problems (Erectile Dysfunction), 21 June 2007 Potts et al., (2004), ‘‘Viagra stories’’: challenging ‘erectile dysfunction’ Social Science & Medicine 59 (2004) 489–499 Shabsigh, R., (2003), Hypogonadism and erectile dysfunction: the role for testosterone therapy, International Journal of Impotence Research (2003) 15, Suppl 4, pp. 9– 13 Simpson, C., & Hickox, A., (2000), Sildenafil as a psychological treatment, Blackwell Science Ltd, Sexual Dysfunction, 1, 143-146 Stressmgn (n.d.), Stress Management in Disasters, Ch 4, An introduction to Counseling and Crisis Intervention, 22 June 2007 Wagner, G., & Tejada, S., (1998), Update on male erectile dysfunction, BMJ 1998;316:678-682, 22 June 2007 Read More