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Answering your questions about sexual performance problems

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Frustrated Couple, Conflict and Erectile Dysfunction CrisisI am often called upon to field questions that reach us via the “Ask the Pharmacist” feature on our website. When it comes to the subject of sexual performance problems, many people are too uncomfortable or embarrassed to raise their questions face-to-face with their doctor or pharmacist, who may be a friend or close acquaintance, or a family member. The ability to bring up a delicate subject like sexual performance at arm’s length with us, retaining some sense of anonymity, along with a degree of trust in the reliability of any answer that we will give, allows people to be relatively candid in providing details of their specific experience, and allows us the opportunity, more often than not, to help. 

In general, the most common questions we are asked regarding sexual health and performance fall into a few main areas. We are sharing some of the frequently asked questions below. Please understand that each person’s experience is different, so what is provided below is very general information. For more information about your specific situation, speak with an experienced healthcare provider you trust. 

Observation #1 – it’s mostly an issue for men

Without a doubt, the great majority of the questions that come to us regarding sexual performance come from men. 

While I’m neither a psychologist nor a sociologist, I can give my opinion on what may be a few general reasons for this. In the first place, women usually have much more intimate conversations with their doctors, dealing with subjects like their periods (or lack thereof), and due to the changes coming from hormonal cycles having far more pronounced effects in women than men ever experience. Women are also more subject to infections in their genital areas, such as UTIs and so on. This means that it’s easier both for doctors and for their patients to talk about any issues that relate to sexual functions openly. 

Secondly, sexual performance has been associated in culture, literature, and religion as a male issue. It’s only been in very recent years, since the “sexual revolution” in the mid-20th century, that sexuality has been seen as the domain of women just as much as it is of men. This means that men have a degree of expectation both in their own minds and in their relationships with others that places greater demands for sexual performance than there would be for women. 

Observation #2 – the road to sexual satisfaction can be blocked at many points

The questions we are asked generally start off at the same point, with people asking whether there is some simple way to overcome their lack of satisfying performance, but further questioning usually brings out that the failures can come from several different sources. This means that there is hardly ever a “one-size-fits-all” solution available.

It’s important to find out exactly what is going wrong and to address that as the first step. It’s also necessary to understand that cause and effect can be very closely interrelated. A failure to perform adequately at one point can trigger other failures later on. That makes treating sexual dysfunction a “big picture” item, and this is another reason why getting proper care from a trained physician is essential.

In the main, we have found that men experience two main forms of sexual dysfunction:

  • Erectile dysfunction (ED) used to be the more prevalent condition that people sought help for, but the revolution of the “little blue pill” at the end of the 1990s provided a very effective treatment and gave most men who were experiencing problems with achieving erections a simple treatment. Viagra (sildenafil) and the other drugs based on phosphodiesterase 5 (PDE-5) provide an effective mechanism to overcome most cases of erectile dysfunction as long as there is some degree of excitability in the penis. It was in fact such a great leap forward that for over twenty years, there were no releases of different drugs for erectile dysfunction based on anything other than PDE-5, which meant that the limitations and side effects of all these erectile dysfunction treatments remained unaddressed.

Happily, there is now a completely new approach to treating ED that bypasses the systemic pathway that all the PDE-5 drugs use. Instead of having to be ingested and reaching the penis through the bloodstream (which can involve several unwanted side effects and which also makes the reaction time somewhat slower than most people would like), the latest solution known as Eroxon Stimgel works from the outside in, since it works by stimulating the nerve-dense area at the tip of the penis (the glans) in a unique way that invokes an erection within ten minutes. Unlike the other ED medications, Eroxon Stimgel doesn’t have to be swallowed and plays no part in the body’s metabolism. It’s not a medication and does not require a doctor’s prescription (although, as we said before, persistent sexual performance problems should always be discussed with your doctor.)

  • Premature ejaculation (PE) can be experienced if a man achieves penetration during sex but can’t delay ejaculating. Usually, being unable to engage in sex before reaching orgasm for less than two to three minutes would be regarded as PE. While this can happen to anyone occasionally, persistent sexual performance problems of this type way can lead to a sense of sexual inadequacy, with the resultant psychological effects I will describe in the next section.

Until now, there haven’t been any medical treatments that target premature ejaculation specifically. The most frequently suggested options were psychological counseling, behavioral modification (mostly learning to change the way the act of sex is conducted), or trying some of the medications that can induce changes in neurological processes, such as antidepressants (selective serotonin reuptake inhibitors.) Now, there is a topical medication called Stud (lidocaine USP 9.6%) that works differently. Lidocaine acts as a desensitizer that can reduce the sensitivity of the nerves in the penis that control ejaculation. It doesn’t dull or numb the tip but reduces sensitivity enough to prolong intercourse and prevent premature ejaculation. It is FDA-approved and does not require a prescription.

Observation #3 – a feeling of failure in sexual performance can be a self-fulfilling prophecy

Quite frequently, men can experience periods of dissatisfaction with their own performance, which turns out to be a temporary blip in their lives. However, if the problem occurs frequently, it can create a form of a feedback loop in which it becomes increasingly challenging to achieve a satisfactory sex life. Once that starts, it can be difficult for a man to regain his balance. 

There can also be a reverse process that comes when a man frequently experiences the problem of premature ejaculation. This can, in turn, cause anxiety and stress that feeds back onto the feelings of desire and affect the ability of a man to conduct normal sex. In situations where premature ejaculation is starting to occur and is causing problems in achieving erection as well, it may be worthwhile to treat both conditions simultaneously rather than waiting to see if treating one on its own will help both. For example, we have suggested that combining Eroxon Stimgel and Stud could be a very effective way of achieving a good erection and sustaining the sex act for longer, which will produce a far more satisfactory conclusion than either one of these on their own.

Wrapping it up

As I said at the beginning, each person’s experience with sexual performance problems is different, and we are only able to offer some very general observations along with what potential solutions we believe could be appropriate. It’s just as important to be able to talk about your specific situation with a healthcare provider you trust. And of course in future, we are always happy to receive any questions from you along with well as feedback on our responses – we are here to serve.

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