About 10 percent of men report having had severe erectile difficulties in the past year. Up to 25 percent have milder difficulties. There are many possible causes of erection problems. Heart disease, diabetes, a low amount of HDL ( “good” cholesterol) , hypertension, and other medical conditions may be a factor. Medications for those condition and other physical disorder can also contribute to the problem. Stress or anxious preoccupations can distract a man from the sexual encounter and cause changes in arousal.

If a man has no history of arousal problems, any current difficulty in that area may be due to stress. Unresolved relationship issues could be lurking, but not necessarily. The parasympathetic nervous system – which is in charge of sexual arousal – shuts down when a person is stressed or anxious.

The initial cause for a man erectile sexual problem may not be what is maintaining the problem. Worries about sexual performance can make a man unable to relax during sex and therefore be unable to get an erection, even if the initial cause is no longer relevant.

Many men falsely believe that if they do not maintain their arousal for the duration of a sexual encounter, then a problem exists. In fact , men who are very comfortable with their partners, who participate in longer lovemaking sessions, and who take time to focus on sensual foreplay instead of intercourse may not stay arousal at all times. Intimate moments that are tender but not passionate may cause a normal fluctuation in arousal.

If the female partner has an enthusiastic attitude toward non-intercourse forms of sexual stimulation, a man with erectile sexual problems may feel less pressure to have an erection. His anxiety thus reduced, his ability to get and maintain an erection can improve.

Among older men, more active and direct stimulation of the penis by his partner may be necessary to improve arousal. While some changes in arousal occur in older men, erectile problems severe enough to be a “disorder” are not inevitable and are not considered to be a typical part of the aging process.

Couples with very good communication skills seem to have improved outcome in treatment of arousal problems compared with couples with poorer communication skills.

It is premature for any person to conclude that erectile difficulties must automatically be a sign of disinterest  in one’s partner.

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