It's estimated that more than 100 million men worldwide are affected by erectile dysfunction (ED).

Are you one of them? Or is your sweetheart?

With ED significantly impacting men's social and psychological well-being for the worse, this epidemic affects eroticism in numerous ways.

A 2004 study in the International Journal of Impotence Research found significant differences in self-esteem, confidence and relationship dimensions among men with ED.

In 2005, research published in the Journal of Sex and Marital Therapy investigated the sexual and relationship characteristics of men in the U.S. with and without ED. (The research was sponsored by Eli Lilly, manufacturers of the ED drug Cialis.) The Internet-based sample, which involved 700 men ages of 40-70, found that, compared to men without ED, the 111 men with ED were:

— Significantly older;

— Dealing with more medical conditions, such as heart disease, hypertension or diabetes;

— Significantly worse off when it came to sexual, psychological and relationship functioning.

Those without ED scored higher on sexual functioning measures: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.

Not surprisingly, the mean number of successful intercourse attempts in the last month was also significant.

However, one glimmer of hope for the sex lives of men with ED was the fact that they were likelier to report sexual initiation. To a certain extent, it can be claimed that the ED wasn’t holding them back from trying to get busy.

The same can be said for their lovers. The partners of men with ED were reported as likelier to initiate sex than those whose partners didn’t have ED – 14.7 percent vs. 5.3 percent.

So how does a man with ED reclaim his sex life? He needs to take a holistic bio-psycho-social approach in tackling the dysfunction. This begins with an evaluation of his medical condition and medications, including cardiac drugs, to determine any vascular, neurological, or hormonal factors that could be at play.

Psychological factors, like depression, and relationship factors, including anger toward his partner that may be undermining his sexual functioning, should be delved into as well.

In any case, there are treatments that may help a man plagued with ED. Ways he can return to his sexual rock star status include:

Pro-erection medications – Drugs like Viagra, Cialis and Levitra can help him attain and maintain erection. They work by relaxing the corpus cavernosum smooth muscle of the penis.

Intracavernous drugs – This option involves administering an injection at the base of the penis. For those who find this inconvenient, the Medicated Urethral System for Erection (MUSE) is an alternative, whereby the user inserts a small alprostadil suppository into the penile urethra. Note: this can be painful or uncomfortable.

Vacuum constriction device – Available with a prescription, this device, made infamous by Austin Powers, draws blood into the penis for erection. It then traps the blood to maintain erection.

By doing this, a plastic tube is placed over the penis and a vacuum is created via use of a motor or manual pump. The tube is removed once he’s erect and a fitted rubber band is placed at the base of the penis to maintain erection for up to 30 minutes.

Penile base – The soft rubber brace of these nonsurgical prostheses hold the penis rigid. Available at drugstores (and without prescription), the tip of the penis is still exposed for pleasure. This gadget may, however, make sex uncomfortable for his partner.

Penile vascular surgery – Surgery may be in order when there is irreversible damage to the penile arteries and veins. Results are typically poor, however.

Surgical penile prostheses – These rigid or flexible rods are surgically implanted into the penis for erection. This option should be the last, since implants are irreversible

In some cases, it’s best to work with your physician in experimenting with a combination of treatments, such as an injection medication and oral agent. In every case, a man and his lover should work with a sex therapist not only on any issues lending themselves to ED, but issues the ED is causing in the relationship as well.

Under the direction of a sex therapist, lovers can acquire the psychosexual skills needed to get through this difficult time. These lie mainly in understanding that relaxation and sensuality are the foundation for sexual response, not necessarily his erectile functioning.

Dr. Yvonne K. Fulbright is a sex educator, relationship expert, columnist and founder of Sexuality Source Inc. She is the author of several books including, "Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots."

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