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The problems of hormone imbalance


In our ongoing series for November, Dr Christos Michael look at erection and ejaculation problems

What is a ‘healthy erection’ and how do erections work?

A healthy erection is one which happens when the man needs it, which is hard enough for penetration, which stays hard enough for as long as is necessary to satisfy himself and his partner and which achieves orgasm at the desired time. Strong erections need a good hormone profile, healthy arteries and blood flow to the penis, a normal structure of the penis and normal nerve function. All the above can be affected by disease, the majority are preventable.

What is erectile dysfunction? What is premature ejaculation and anorgasmia?

Erectile dysfunction (ED) is when a man’s penis can’t get hard when he wants it. This could mean he can’t get hard at all, can’t stay hard for the duration of sex, or can’t get hard enough for penetration.

Premature ejaculation is when the man climaxes too soon to satisfy himself and his partner, in the majority of cases in less than three minutes from penetration. The opposite can apply with delayed orgasm.

Anorgasmia is when the man can’t orgasm at all, no matter how long he is having sex for.

What causes erectile dysfunction and orgasm problems?

Erection problems can be caused by hormonal problems such as low testosterone or high prolactin, diseased blood vessels caused by smoking, high cholesterol, high blood pressure and diabetes, medications used for the heart such as beta blockers and medications used for depression, anxiety, bipolar disease and schizophrenia. Nerve damage can happen as a result of surgery or cancer, for example in prostate cancer. It can also happen as a result of an accident. Psychology can also affect sexual function, such as depression or performance anxiety.

What should I do if I have erection or orgasm problems?

Please see your doctor. The causes mentioned above and others must be tested for. Testosterone, Prolactin, Cholesterol and Blood Sugar levels should be tested. Blood pressure and the heart should be checked. The causes for blood flow problems to the penis are the same as the ones which cause heart attacks and strokes so if you have erection problems it’s important to mention this to your doctor as they may also need to assess your risk of having heart attacks in the future.

Your medication will need to be looked at for potential side effects. Medications affecting sexual function can be switched or doses changed. Any potential prostate problems should be investigated.

Stopping smoking, losing excess weight, healthy eating, regular cardiovascular exercise, controlling diabetes and high blood pressure are all important to help prevent and treat erection problems.

Psychological issues should be managed by a psychologist or sexologist experienced with managing psychosexual problems. Creams, condoms and medications can be used for premature and delayed ejaculation.

As always, prevention is better than cure so developing healthy lifestyle habits will help prevent erection problems in the future.

What treatments are there?

Many treatments are available depending on the individual case and patient preference. This can range from pills, creams, penis pumps or even injections. These options can be discussed in the first instance with your GP or if necessary by a Urologist.


Dr Christos Michael is a London trained GP and Clinical Assistant Professor at the University of Nicosia Medical School. He currently works at the University of Nicosia Medical Centre and provides general practice services to the public on GESY


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