Hard facts

Erec­tile dys­func­tion can af­fect 40%-55% of men over the age of 40. Don’t be shy about talk­ing to your GP about the prob­lem

Irish Examiner - Feelgood - - Parenting - DR PHIL KIERAN

ONE of the most suc­cess­ful drugs of all time is used to treat a prob­lem which most of us would rather ig­nore than dis­cuss with our doc­tor. De­spite the fact this prob­lem is so com­mon it has fea­tured as a sto­ry­line in al­most ev­ery TV sit­com, I rarely see peo­ple be­come as un­com­fort­able as they do just be­fore they bring up the is­sue of erec­tile dys­func­tion.

Erec­tile dys­func­tion (ED) is a com­mon prob­lem, which will af­fect 40%55% of men over the age of 40. It can be as short-lived as a few weeks or in some cases can be dif­fi­cult to rem­edy.

Sex­ual arousal is a com­plex process that we can all take for granted un­til there is a prob­lem, but be­fore we reach for the Vi­a­gra there’s a bit more de­tail to look into.

How does it hap­pen?

Sig­nals travel from your brain down to the pe­nis and cause blood ves­sels in the top of the pe­nis to en­large while at the same time con­strict­ing the out­flow tract at the base of the pe­nis. This in­creases pres­sure, caus­ing the pe­nis to elon­gate and be­come hard. For this to hap­pen the mind must be in the right place, the blood sup­ply must be func­tion­ing well, there needs to be enough testos­terone in the blood sup­ply, and the nerves need to trans­mit the sig­nals ef­fec­tively.

Is­sues can arise in the mind (psy­chogenic ED), in the nerve sup­ply (neu­ro­genic ED), or in the blood sup­ply (vas­cu­lar or hor­monal ED) and the treat­ment for each will dif­fer.

In younger men, a com­mon prob­lem is psy­chogenic ED (although this only ac­counts for 10% of the over­all num­bers). Fa­tigue be­cause our lives are too busy can leave a lot of us with­out the phys­i­cal or men­tal en­ergy needed. De­pres­sion and anx­i­ety will also cause sig­nif­i­cant prob­lems, ham­per­ing the li­bido and the phys­i­cal abil­ity to achieve and main­tain an erec­tion. This can of­ten be a self-re­in­forc­ing prob­lem as in­creas­ing the pres­sure we put on our­selves makes erec­tions even more dif­fi­cult to achieve. You could call it per­for­mance anx­i­ety.

I re­mem­ber a con­sul­ta­tion years ago where a young man told me his part­ner said she would leave him un­less the prob­lem was fixed quickly. I was only work­ing in that prac­tice for a short pe­riod so I don’t know how it worked out in the end but with that level of pres­sure, I’m not too op­ti­mistic.

Let it flow

Vas­cu­lar prob­lems are a com­mon cause as the small blood ves­sels that do the work down there are eas­ily dam­aged by un­treated high blood pres­sure, smok­ing, or con­di­tions which dam­age the blood ves­sels such as high choles­terol and di­a­betes. In fact, one of the first tests that will likely be done when you dis­cuss erec­tile dys­func­tion with your GP is a fast­ing blood sugar to screen for di­a­betes. Thank­fully, with ef­fec­tive treat­ment of ei­ther of these con­di­tions, ED can im­prove.

Neu­ro­genic ED can oc­cur as a con­se­quence of di­a­betes and in those cases can be dif­fi­cult to treat, which is an­other rea­son to try and keep di­a­betes well con­trolled if you have it.

Apart from di­a­betes, neu­ro­genic ED is mostly as a re­sult of spinal in­jury or de­gen­er­a­tive neu­ro­log­i­cal con­di­tions such as MS.

What about med­i­ca­tion?

Peo­ple al­ways think of med­i­ca­tion as a so­lu­tion to ED but it is much more im­por­tant from a med­i­cal point of view to try and treat the causes of ED rather than just throw­ing med­i­ca­tion at the pa­tient and miss­ing their di­a­betes un­til they have a stroke or heart at­tack.

From a lifestyle point of view, reg­u­lar ex­er­cise (although not too long on a bike), keep­ing weight at a healthy level, and stop­ping smok­ing can go a long way to fix­ing the prob­lem.

Med­i­ca­tion can be ef­fec­tive in ED treat­ment. It works by help­ing the blood ves­sels in the pe­nis ex­pand and, de­pend­ing on the med­i­ca­tion, there are dif­fer­ent tim­ings to take it. The most com­mon drug (silde­nafil) is taken 30-60 min­utes be­fore sex. Be­cause it works on the blood ves­sels them­selves, it has no ef­fect on your li­bido, so if that is the root prob­lem, no amount of med­i­ca­tion is go­ing to help. Coun­selling can be ef­fec­tive.

The most com­mon side-ef­fects of these drugs are runny nose, fa­cial flush­ing, and low blood pres­sure. This can cause headaches, feel­ing faint, and, if mixed with other drugs, can be dis­as­trous.

Silde­nafil is one of the most com­monly pur­chased drugs on­line and it is quite dan­ger­ous as you don’t know what dose or what qual­ity of med­i­ca­tion you are get­ting. For any­one with a heart con­di­tion who is on a ni­trate con­tain­ing med­i­ca­tion (Im­dur or ni­trate spray for angina), this type of med­i­ca­tion can be fa­tal. I per­son­ally think tak­ing un­pre­scribed med­i­ca­tion bought on­line with­out med­i­cal ad­vice is ask­ing for trou­ble.

For the vast ma­jor­ity of pa­tients, a sim­ple trial of med­i­ca­tion will sort out the prob­lem. Also, for most peo­ple, the need for med­i­ca­tion will also, thank­fully, be short­lived and they will re­gain unas­sisted erec­tions when the un­der­ly­ing med­i­cal cause is treated.

For some, how­ever, the prob­lem can be more re­sis­tant, not caused by any treat­able un­der­ly­ing med­i­cal con­di­tion and not re­spon­sive to med­i­ca­tion. For these peo­ple I will refer them to a urol­o­gist (a spe­cial­ist in the gen­ito-uri­nary sys­tem). There are other op­tions such as var­i­ous med­i­ca­tions, in­jec­tions di­rectly into the pe­nis (not as ter­ri­fy­ing as it sounds, I have been told), or even pros­thetic de­vices which can be pumped up to achieve an erec­tion.

For most peo­ple, although erec­tions prob­a­bly won’t come as eas­ily as they did in their late teens or early 20s, erec­tile dys­func­tion will not cause a prob­lem. For those who do suf­fer from it at some stage, there are a num­ber of treat­ments which can ef­fec­tively help the prob­lem and re­store full func­tion.

Most im­por­tantly talk to your GP. They have dis­cussed this with hun­dreds of pa­tients and there is no need to feel un­com­fort­able. It is com­mon and im­por­tant.

Pic­ture: iStock

STAND AND DE­LIVER: Men of­ten think of med­i­ca­tion as a so­lu­tion to ED but it is much more im­por­tant to treat the causes of erec­tile dys­func­tion.

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