I was driving upcountry a few months ago when I received a call from my longtime friend Hilary. Without a greeting, he went, “Doc, I have a problem”. Given the recent economic times, I could have been sure it was financial.
I quickly answered, “What is it my friend, this one that makes you lose your manners mpaka you can’t greet me?” Knowing the strong man Hilary has always been, hearing him in this vulnerable state was very frightening.
In a shaky voice, “Musawo, I can no longer erect, I have tried over 15 times in the past 6 months with my wife and failed” he said. “It is very
embarrassing and I am now very afraid to try again. I have tried to rest
and work less so that I have no complaints about fatigue but it has failed. I need your help, please tell me I have not lost my manhood.”
Hilary had what is called Erectile Dysfunction (commonly referred to as ED) also known as impotence. ED is the repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least three months. This should not be confused with loss of libido or sexual urge. ED varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and others can achieve the erection but sustain it only briefly. Many men are reluctant to discuss ED with their doctors due to embarrassment, and thus the condition is under diagnosed.
So, what causes ED? ED shares similar risk factors with heart disease.
These include; cigarette smoking, alcoholism, unhealthy eating and lack of physical exercises. Cigarette smoking leads to a condition known as
atherosclerosis which is the narrowing of blood vessels that transport
blood to the penis. Men with less education are also more likely to
experience impotence, perhaps because they tend to have less healthy
lifestyles, eat a less healthy diet, drink more and exercise less. While
the risk of ED increases with increased weight gain (overweight and
obesity), physical exercise tends to lessen the risk of impotence. Substance abuse like use of Marijuana heroin, cocaine, and alcohol abuse contribute to ED. In addition to causing nerve damage, alcoholism, can lead to atrophy (shrinking) of the testicles and lower testosterone. In addition, psychological factors may be responsible for ED. These factors
include stress, anxiety, guilt, depression, widower syndrome, low
self-esteem, posttraumatic stress disorder (a disorder that develops after a traumatic experience like death of a loved one, accident, etc) and fear of sexual failure (performance anxiety). It is also worth noting that many medications used for treatment of depression and other psychiatric disorders may cause ED. Hilary had now developed performance anxiety on top of ED. The risk of impotence increases with age. While ED can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced ED at least some of the time in their life. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Other studies have noted that approximately 35% of men 40-70 years of age suffer from moderate to severe ED, and an additional 15% may have milder forms.
Chronic diseases like heart diseases, hypertension (high blood pressure)
and diabetes are also major causes of ED. ED tends to develop 10-15 years
earlier in diabetic men than among non-diabetic men. In a study of men with type I diabetes ED was reported by 55% of men 50-60 years of age. Nerve damage due to disease, trauma from accidents, or surgical procedures and radiation for cancers in the pelvis like prostate cancer can also cause ED. Many common medicines produce ED as a side effect. Medicines that can cause ED include many used to treat high blood pressure, antihistamines, antidepressants, tranquilizers, and appetite suppressants. Therefore, watch out when your girlfriend brings you drugs to help your weight loss. Discuss your treatment with your doctor.
I am sure by now, you are wondering if ED can be treated. Yes, ED can be
treated. However, you need to be as honest as you can with your doctor and seek advice as soon as you start noticing a problem.
Psychotherapy and counseling in psychological ED has been seen to work. Honesty with your partner will also prevent anxiety and acceleration to more severe forms. Start with lifestyle modification. Quitting smoking, exercising regularly, losing excess weight, curtailing excessive alcohol consumption, controlling hypertension, and optimizing blood glucose levels in patients with diabetes are not only important for maintaining good health but also may improve or even prevent erectile function. Some studies suggest that men who have made lifestyle improvements experience increased rates of success with oral medications.
Medications that are used to treat ED include; (Viagra), vardenafil (Levitra) or tadalafil (Cialis). Do not self-medicate because these medicines can also be harmful to you and have side effects. Work with your doctors to select medications that do not impair erectile function in case of chronic diseases. In some instances, inserting medications into the urethra (intraurethral suppositories), injecting medications into the penile muscles and use of vacuum constrictive devices for the penis have been done. If all fails, penile prostheses are also available. Hilary had many psychological factors contributing to his ED. After a series of counseling sessions and working together on his lifestyle changes, he now boasts of a return to normalcy and feels like a man once again.
Dr. Phionah Atuhebwecan be reached on: [email protected]