Written by MOTUNRAYO JOEL - Nigeria
When a man finds it hard to get or keep an erection that is firm enough for sex, he is suffering from a medical condition known as erectile dysfunction.
Otherwise referred to as ED, studies have it that it affects as many as 30 million men and the condition has become highly visible in recent years.
On the causes of ED, many medical experts, who also referred to it as impotence, listed the most common as reduced blood flow to the penis due to chronic health challenges such as high blood pressure, high cholesterol, and hardening of the arteries.
Also psychological challenges such as depression, anxiety, and relationship issues are also possible causes of ED. Multiple sclerosis, spinal cord injuries, chronic back pain, and other neurological conditions, can trigger ED too.
A consultant urologist, Dr. Gabriel Ogah, opined that about one half of men between the ages of 40 and 70 experience ED.
On the severity, Ogah explained that, this also varies. According to him, some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still, others can sustain only brief erections.
"The variations in the severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors due to embarrassment, and thus the condition is under-diagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 18-30 million men in the United States," he said.
Another consultant urologist, National Hospital, Abuja, Dr Atim Teraka, said sufferers of ED, who are middle aged risk cardiac arrest if care is not taken.
Stating that the same cholesterol plaques that can build up in the arteries surrounding the heart can also affect arteries that go through penile tissue, he said, "Once doctors rule psychological causes, they need to do a cardiac workup to make sure that the man is not on the verge of getting a heart attack.
"Since sexual arousal is a complex process involving hormones, emotions, nerves, muscles, blood vessels and the brain, a malfunction in any of these can lead to ED."
Tereka noted that anxiety over maintaining an erection can actually make it harder to attain. "Any condition that inhibits blood flow to the penis can lead to ED."
Ogah, still on the blood flow to the penis, maintained that, "When you are not sexually aroused, the penis is soft and limp. But with a sexual arousal, nerve messages release chemicals that increase blood flow into the penis. The blood flows into two erectile chambers made of spongy tissue in the penis. The 'smooth muscle' in the erection chambers relaxes, which allows blood to enter and stay in the chambers. The pressure of the blood in the chambers makes the penis firm, giving one an erection. After orgasm, the blood flows out of the chambers and the penis goes limp again."
With ageing as one of the factors listed for ED, Tereka listed other causes as, diabetes, obesity, low testosterone, peyronie's disease (scar tissue inside the penis), certain prescription drugs, such as antidepressants and high blood pressure medication, smoking, alcoholism or drug addiction and many others.
But Tereka noted that low libido, which is a low interest in having sex, should not be confused with ED. He said, "Various mental health conditions may cause one to develop ED. They include stress, which could be due to a difficult work or home situation, anxiety, relationship difficulties and depression."
Ogah said ED develops quite suddenly if it is a symptom of a mental health problem but that it may resolve when one's mental state improves.
"However, some people become even more anxious or depressed when they develop ED. They do not realise it is a reaction to their mental health problem. This can make matters worse and lead to a vicious circle of worsening anxiety and persisting ED."
He said a psychological cause for the ED is more likely than a physical cause if there are times when one can get a good erection, even though most of the time one cannot.
Explaining further on the diagnosis of this dysfunction, a consultant urologist, Dr. Isiaka Lawal, said several tests can lead to an ED diagnosis.
He said diagnosis of the dysfunction is conducted on men who have repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least three months.
However, he noted that candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause.
Other tests done during diagnosis include blood tests to check cholesterol, testosterone and glucose levels; urinalysis to look for signs of diabetes; ultrasound to check blood flow to the penis; and overnight erection test to monitor erections during sleep.
Lawal said physical causes of ED can be ruled out if the patient has an involuntary erection while sleeping (a normal occurrence), breaking a special tape wrapped around his penis.
"A variety of drugs and treatments are available for ED, from simple pills to complex surgeries. The cause and severity of ED will determine which treatment is recommended. Some treatments can have significant side effects. Psychotherapy is an option to treat anxiety-related ED."
He added that the patient's partner could help in the process of developing intimacy and stimulation.
Oral medications could also treat ED in men. However, these medications should not be taken by men who take blood thinners.
"The combination of ED pills with these other prescription medications can cause a sudden, dangerous drop in blood pressure," he said.
The prevention of ED, according to Lawal, depends on a variety of lifestyle choices which can affect the ability to achieve and maintain an erection. He advised men to discuss chronic health problems with their doctors and to exercise regularly. They should also avoid smoking, taking excess alcohol and get help for anxiety or depression.
"ED can happen when health challenges limit blood flow or damage nerves in the penis and can be an early warning of a more serious illness. Finding and treating the cause(s) of ED can help the overall health and well-being."
Lawal said there are a lot of benefits to healthy sexual function. Whether it boosts the immune system or whether it is good for releasing stress. "One doesn't need to give up on it just because one is getting older. I must stress that no matter the cause of one's ED, open, honest communication is crucial for treatment and prevention."
He acknowledged that ED could undoubtedly affect one's sex life and relationships, and create a significant amount of stress. However, failing to manage stress can actually exacerbate ED.
Also, talking to one's partner about what one is experiencing can help alleviate stress and may also help both partners find other forms of intimacy while seeking treatment for ED.
While ED can be an uncomfortable or potentially embarrassing subject, having a frank discussion about one's symptoms with one's doctor is the first step towards finding treatment, Lawal stated.