Persistent or recurrent inability to get or maintain sufficient erection until completion of the sexual act.

Erectile dysfunction is relatively common (10-20% of the male population regardless of age) problem especially in elderly men (75% to more than 80 years old men). But it is also largely underdiagnosed, since only 10% look for treatment.

• Persistent lack of sexual desire
• Lack of sexual fantasies
• Utter disinterest and avoidance of sexual contact with a partner

• Inhibition of ejaculation (orgasm never happens)
• Premature ejaculation (when ejaculation occurs before, during or shortly after penetration and before the man desires it to happen)

• Formation of hard, fibrous formation in the form of a plaque beneath the skin on one side of the penis.
• First appears as though inflammation leading to the formation of cured scar that causes sudden bending (angle) of the penis when erect.
• If hardening occurs on both sides, shortening of penis may result.
• The scar or hardening can make an erection painful and sexual intercourse difficult or impossible to happen.
• The bending and deformation of the penis can lead to emotional distress which in turn aggravates sexual difficulties.

Affects 1% of men aged 40-60.

• Pain during the sexual act.
• Underlying problems such as prostatitis or neuropathy.

• Persistent lack of sexual desire.
• Absence of sexual fantasies.
• Utter disinterest and avoidance of sexual contact with a partner.

• Absence of stimulation.
• The normal bodily responses-adjustments do not occur: the vagina is not lubricated, the clitoris is not magnified, the vaginal orifice is not widened.

• There is stimulation from sexual stimulus but an inability to achieve orgasm.

• Pain during the sexual act.
• Inadequate lubrication of the vagina.

Common causes of dyspareynias are:

Vaginismus: painful, involuntary contraction of the muscles surrounding the vaginal orifice to prevent the penetration.

Vaginitis: itchy painful inflammation of vagina and vulva with worsening symptoms after sex intercourse. Usual cause is infection with bacteria and fungi. There may be spillage of liquids and distinctive smell reminiscent of moldy cheese.

Causes

Many different factors may contribute to incomplete sexual gratification or dysfunction.

• Diabetes. Diabetes is one of the most common causes of erectile dysfunction. It can damage nerves, blood vessels and therefore the perfusion of the penis and vagina.
• Bodily injuries Injuries in the back and waist as well as stroke, surgery in the pelvis, arthritis and congenital physical malformations can affect sexual function
• Hormonal disorders Low estrogen levels in women and low testosterone levels in men and women. Low estrogen levels in women after menopause leads to thinning and reduction of vaginal elasticity. The dilation and the lubrication during arousal decrease. This can lead to painful intercourse making orgasm unattainable.
• Pregnancy and breastfeeding. Both situations can lead to a change in the hormonal balance.
• Medicines. Some medications, such as antihypertensives, can lead to decreased blood flow to the genitals. A side effect of some of the antidepressants may be the reduced lubrication or the reduction in interest for intercourse. Antihistamines and chemotherapeutic drugs can decrease the libido and the ability to achieve orgasm.
• Chronic diseases, such as renal or hepatic insufficiency.
• Alcoholism and drug abuse.
• Smoking.
• Cancer. Cancer can affect the production of hormones in organs such as the prostate, penis, the ovaries, the cervix and the vagina. Patients often feel symptoms such as fatigue and nausea.
• Surgical treatment for benign prostate hyperplasia
• Contraceptive creams and foams. It is likely to irritate the female vagina and cause dryness.
• Peyronie disease hard, fibrous formation in the form of a plaque beneath the skin on one side of the penis.
  It first appears as inflamed, leading to the formation of cured epoxy scar that causes sudden bending (angle) of the penis when erect.
• If hardening occurs on both sides, it can result in shortening of the penis.
• The scar or hardening can make an erection painfull and sexual intercourse difficult or impossible.The bending and deformation of the penis can lead to emotional distress which in turn aggravates sexual difficulties.

Affects 1% of men aged 40-60.

Emotional factors affecting sex include psychological problems of the involved partners as well as interpersonal issues:

• Incurable depression and chronic stress.
• Anxiety disorder. After a traumatic event such as a heart or stroke, the person may be afraid of the sexual act which may trigger another episode of anxiety.
• A history of sexual abuse. Emotions derived from earlier sexual traumas in life can spare satisfaction from sexual experience.
• Issues of culture and religion. Guilt to sexual enjoyment and fear of intimacy.
• Relationship problem. Lack of confidence, inability to communicate preferences and wish to mate, boredom and unhappiness in the relationship or performance anxiety in relation to sexual act.
• Self image. Hair loss, weight gain, skin diseases, surgical removal of the breast or testicles due to cancer, all can affect sexual identity and consequently the functioning of an individual.

Viagra® (sildenafil) approved by the national medicines agency, USA in 1998. Its administartion 1 hour prior to the sexual intercourse causes dilation of blood vessels and increase of blood flow to the penis. It works by assuming that there is sexual stimulation. But it is not a panacea. Men with heart problems who take medications vasodilators are not good candidates because the combination can lower the level of blood pressure dangerously. The 2003 approved Levitra® (bardenafili) for the treatment of erectile dysfunction. The mode of action is similar to sildenafil. The Cialis® (tadalafil) is the first medicine that is taken orally and has a duration of action 36 hours. Some men with hormonal problems can be helped with testosterone injections or skin patches.

CAUTION: the 2005 pharmaceutical formulations cialis, levitra, viagra added marking possible sudden vision loss due to non-arterial ischemic optic neuropathy. There is a recommendation to patients taking these medications should they experience sudden eye sight loss in one or both eyes, stop and go to a doctor. If there is a history of sudden vision loss they should inform their physician.

This involves putting plastic tube into penis and pumping the air outside of the pipe allowing the inflow of blood into the penis and erections to happen.

Drug is injected directly into the side of the penis, which causes dilation of blood vessels and erection.

Ένα μαλακό σφαιρίδιο με φάρμακο ενίεται στην ουρήθρα. Η απορρόφησή του προκαλεί στύση.

It can refer to three procedures: implantation prefix which can cause erection of the penis, the reconstruction of arteries to increase the blood flow to the penis and the repair of veins in the penis which are insufficient to contain adequate amount of blood for proper erection.

Counseling psychotherapy can help, unless there is a physical problem that causes sexual dysfunction. Treatment with estrogen and testosterone hormones may help some women. Other medications that increase blood flow to the genitals, such as gel called prostaglandin E-1 and even the sildenafil – both approved for use in men – studied in women.

A doctor should investigate the underlying cause of dyspareynias before the proposed treatment. For women who are in menopause, the estrogen replacement therapy could help. A water-soluble lubricant before contact could alleviate the pain.

It can be treated with consultative psychotherapeutic sessions. The usual practice is the gradual vaginal dilation which helps to reduce the intensity of muscle spasm. Here vaginal dilators can be used with progressively larger diameter until the contact is possible without any pain.

Cured with drugs mainly of class of antibiotics.

Some people feel guilty with the sex. Others fear an unwanted pregnancy or sexually transmitted diseases. Sometimes an past nasty sexual experience as a rape may be the cause. Psychotherapy still can help in the case of an underlying depressive disorder. Marriage counseling can help in reinstalling communication and the strengthening of ties in a couple.

Taking antidepressant therapy can restore your interest in sex with improving self-esteem and relieve the depressing feeling. Nevertheless, some antidepressants ( SSRIs) can cause sexual problems. In some cases, premature ejaculation can be improved by taking low doses of SSRIs.

A properly trained to sex therapy therapist can help the couple to gain more intimacy.

Exercise does wonders to your self-esteem, contact and familiarize yourself with the bodily functions and increase your energy levels. Try to exercise at least 30 minutes most days of the week.

These are some practical ways to help you overcome your sexual issues:

• Talk to your partner. Discuss ways you can give pleasure to each other. Discussing the changes in sexual response, erectile dysfunction and loss of sex drive can help you in handling the problem.
• Give time to yourself and your partner. Some may need more manual stimulation or foreplay.
• Find a doctor that you trust and feel comfortable with him.
• Arrange romantic encounters with your partner.
• Don’t forget what originally attracted you to your partner and got into this relationship.
• Stay in shape, work out and have a balanced diet. Taking care of yourself is an important step in order to gain a positive self image and self confidence. In addition, the exercise helps reduce stress.
• Don’t let the stress get you down. If it persists being in high levels and you don’t seem beind able to get rid of it, then contact specialist.