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Penile Erectile Dysfunction

Penile erectile dysfunction (ED) is a broad term used by the medical establishment to indicate the inability to get or maintain an erection, ejaculate, or orgasm. However, in popular media, ED usually refers only to impotence. Research suggests that over 50 percent of men between the age of 40 and 70 years experience some form of ED. Historically, ED has been resolved through psychotherapy, often involving relationship counseling. However, with the introduction of self-injection drugs and oral therapy, the medical establishment became the leading treatment provider for dealing with ED. To understand the social implications of ED, it is necessary to discuss the etiology and treatment of the disorder.

Etiology of Erectile Dysfunction

The cause of ED is the result of a combination of biological, psychological, and social factors, referred to as the biopsychosocial model of sexuality. Biologically, the hormonal and vascular systems as well as the existence of chronic illnesses impact sexual functioning. Chronic disorders such as cardiovascular disease, diabetes, arthritis, and cancer negatively impact sexual functioning. The extent of the impact is determined by the duration of the illness and the type of treatment involved. Psychologically, the attitudes and information a man has about sex contributes to how he functions sexually. The sexual patterning that is developed in childhood and adolescence through masturba-tory technique and frequency as well as attitudes about gender and appropriate sexual expression are transferred to adulthood, resulting in the inability of some men to produce an erection, ejaculate, or orgasm unless stimulated in particular ways. Socially, the availability of partners, quality of relationships, length of relationships, and a man's status and income impact upon his self-image and body image, which directly affect his ability to perform sexually.

Currently, finding a solution for ED predominantly involves physical intervention, as opposed to psychological or relational. Men often fail to connect ED with other life events, such as stress at work, problems with their spouses, or poor nutritional and exercise habits. Despite the fact that longitudinal research exists demonstrating that age is the most important element of sexual behavior and that functioning naturally decreases as one gets older, the medical model emphasizes physical treatments. These treatments include penile prostheses, self-injections, vacuum constriction, and oral therapy. Oral therapy is the most common intervention for ED and was popularized by the introduction of Viagra, which is a cognitive distraction bypasser and has been prescribed to over 20 million men worldwide. However, self-injection is the only treatment for ED that does not require sexual arousal in order to be effective. In this treatment, men inject a small dosage of medication directly into the penis and an erection is produced within a few minutes and often lasts for 1 hour or more. Due to media coverage of ED, many men have unrealistic expectations about the benefits and limits to medical intervention. These expectations result from a lack of education about sexuality and aging and are based upon socially constructed notions of how men should be able to perform sexually.

Social Construction of Masculinity

There are many myths surrounding male sexuality and aging. It is not generally understood that as men age, it will take longer to have an erection, the erection will be less full, the volume and force of ejaculate is decreased, and the male will require more stimulation, both mental and physical, from his partner to become erect. Moreover, as men age, they often realize that they do not feel like ejaculating and/or orgasming at each sexual encounter. This is contrary to what men have internalized through socialization about male sexuality. Men have learned that to be masculine means to want sex constantly and to be able to perform on command. The medical establishment is also not immune to such myths and identifies as dysfunctions any reduction in stereotypical male sexual performance.

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