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Men's Sexual Dysfunction

by Kelly Casperson, MD

Erectile dysfunction (ED) and premature ejaculation (PE) are two common dysfunctions of the penis. An important thing to remember is that these are health problems just like high blood pressure, and should not be taken personally by partners. If you learn nothing else about men’s (people with penises) sexual health and function, I want you to remember to not take any of it personally. It rarely means anything about you, your attractiveness, or your capability as a lover.

Let’s back up and learn about these two conditions first.

The penis is an amazing organ and actually has three functions.

  1. Pass urine from the bladder to the outside world

  2. Pass sperm from the testicles/epididymis to the outside world, specifically the top of a vagina is the necessary location for fertilization.

  3. Organ of pleasure/orgasm for men

So just like any organ with a job to do, it can have some issues.

Prior to 1998, nearly all erection problems were considered to be “psychogenic” or in a man’s head. So what happened in the late 1990’s? Viagra (Sildenafil) was approved by the FDA to treat erectile dysfunction (defined as erection not firm enough for penetration). It works by improving blood flow in the penis via relaxing muscles and arteries. An interesting aside, it was actually being studied as a blood pressure medication. It didn’t work for that so they asked for the study drug back. Turns out the men didn’t want to give it back because they noticed better erections. Talk about a blockbuster side effect.

We now know that ED can be a harbinger (canary in the coal mine) of heart disease. Why? Because arteries and blood flow that don’t work well enough to produce an erection can be a sign that other arteries are also unhealthy in the body. In addition, things that increase your risk of heart disease (smoking, alcohol, being overweight, physical inactivity, diabetes, increased cholesterol) also increase a man’s risk of ED. The good news: any lifestyle change that improves heart health improves penis health, too. All the more reason to get moving with your partner and help each other’s heart!

So what about the brain’s role in ED? The brain is the biggest sex organ after all. Turns out, performance anxiety is a real thing. The more anxious, stressed, criticized or “performance based” a man feels, the worse erectile issues can get. The penis needs a relaxed individual to perform, and a stressed out body sends signals that sexy time is not going to happen.

Psychogenic impotence is where an erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical pathology. Treatment options for psychogenic ED include anxiety reduction and desensitization techniques, cognitive-behavioral interventions, guided sexual stimulation techniques, and couples' or relationship counseling. Just taking the pressure off the need for the penis to perform can be very helpful. Sometimes a bit of Viagra helps by increasing blood flow and giving a little “boost” to the organ. You can help your partner out by talking about ways to get pleasure that don’t include the penis. Sometimes the “heterosexual paradigm” of penis in vagina as the only option is very limiting for couples. Think outside the box (pun intended) to take the pressure off the penis performance.

On to premature ejaculation. This is defined as when a man ejaculates (comes) sooner than preferred. This is often defined as less than one minute (they had to pick a time frame to do research on it). Causes can be biological or psychological just like ED. Treatment options include medications, counseling and sexual techniques that delay ejaculation, or a combo of these. Again, here we see that the heterosexual paradigm limits creative options. We know that a female (vagina owner) can take 20 or more minutes to orgasm with penetration with a male partner. We know a man on average takes 3-5 minutes after penetration to orgasm. So often, just adjusting expectations and considering not penetrating until after the female has an orgasm obtained by other ways can be very satisfying and much less stressful when we are dealing with “orgasmic timing mismatch”.

So back to the first thing (most important thing). Women – don’t take these conditions personally. There is no need to make a penis issue about you. It rarely is because of the female. Not certain? Talk it out. An open, relaxed and loving conversation actually builds intimacy, and opens the doorway to expand outside the heterosexual paradigm that is so narrow that it restricts pleasure (usually for the female but certainly for the man too) once ED or PE enter the picture.

And remember, you are not broken. And neither is he.

Dr. Casperson can be found on her podcast at “You Are Not Broken” and on IG at

Dr. Kelly Casperson is a urology specialist with extensive expertise in comprehensive urology care and her commitment to patient-centered health care. She specializes in urogynecology which addresses urological conditions specific to female patients, such as stress urinary incontinence, pelvic organ prolapse, and vaginal atrophy due to menopause and sexual health. She is dedicated to making her patients feel comfortable with her warm personality and medical expertise.