Dr Chireka: Let’s talk about erectile dysfunction (impotence)

by Dr Brighton Chireka

TODAY we are talking about erection difficulties and sadly many men feel ashamed to talk about them. We choose to suffer in silence and at times pretend that everything is fine.

In my practice I encounter a lot of men who come to see me about some real or made up affliction such as backache. When I think I have sorted their problem and it’s time for them to leave, they then say, ‘By the way doc, I am sorry I think I am impotent or they say I cannot get a hard on”.

It’s unfortunate that most men struggle to open up to their doctors. There is nothing to be ashamed of or to apologise about as erectile problems are fairly common. It is simpler and quicker to just tell the doctor at the outset of the consultation that one thinks he has erectile problem. I hope this article will make most men go and see their doctors to openly discuss this problem.

Erectile dysfunction (ED) is also known as impotence and is the inability to get erection, or one gets it but cannot maintain it. It’s much more common than people realise as most men experience it at some time in their life. It only becomes a problem when the man or his partner considers it a problem. In the United Kingdom it is estimated that in the 20-40 age group it affects around 7-8% of men, in the 40-50 age group it affects 11%. In the over-60s it affects 40%, and more than half of men over 70.

Causes of Erectile dysfunction (ED)

Let me explain a bit more about erection so that it becomes clearer what causes ED. When a man becomes sexually exited (aroused), his brain sends a signal to the nerves in his penis. The nerves increase the blood flow to the penis, causing it to expand and harden.

Anything that interferes with the nervous system or blood circulation could lead to erectile dysfunction.

Anything that affects the level of sexual desire (libido) can cause ED because a reduced sexual desire makes it more difficult for the brain to trigger an erection.

Psychological conditions such as depression, relational problems and stress, can reduce sexual desire.

Changes in hormone levels (chemicals produced by the body) can reduce sexual desire.

Surgery or injury to the pelvic area or spine can cause ED.

Medical conditions that cause erectile dysfunction

• Heart disease
• Diabetes
• Raised blood pressure
• Raised cholesterol: this can lead to clogging of arteries, including the arteries in the penis, which are very narrow (1-2mm in diameter compared with around 10mm in the heart artery).
• Low testosterone: testosterone levels fall as men get older, but not all men are affected by it. Those who are affected will have symptoms such as feeling tired and unfit, and loss of interest in (and inability to have) sex.

Drugs that cause erectile dysfunction

• Some prescription drugs: these can include medicines (such as beta-blockers) used to treat raised blood pressure and antidepressants, antipsychotic drugs and anticonvulsant drugs
• Alcohol
• Recreational drugs such as cannabis and cocaine
• Smoking: nicotine affects the blood supply to the areas of the penis that cause erections

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner. If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress-related). This, in some cases, may be due to guilty after cheating on a partner and one cannot get an erection when he tries to make love with usual partner.

In our Zimbabwean culture people think that they have been bewitched by the other woman. The interesting thing is that the solution is the same regardless of the belief. One needs to stop feeling guilty and open up to their partner. The apologising and forgiving of the cheating partner will make him feel less guilty and the erection will eventually return to normal. This may involve counselling or even seeing sexual therapists but in our culture involving the elders (vana Tete) will help the situation.

Sadly nowadays people are going public on social media which does not help the situation. Marriages have broken down due to this erectile dysfunction problem since, at times, the man is wrongly accused of cheating when in actual fact he may be innocent. I hope this article will raise awareness that erectile dysfunction can be caused by several problems and also it can be treated.

If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical (being caused by conditions mentioned above such as diabetes etc).

How is erectile dysfunction (ED) treated?

Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological. Lifestyle changes play an important role in the treatment of ED. Stopping smoking, drinking too much or using recreational drugs may solve the problem. This may take several months as there is no overnight cure.

If you’re prescribed blood pressure tablets or antidepressants, your doctor may be able to put you on a different kind.

The narrowing of the arteries called atherosclerosis is one of the most common causes of ED. If this is the cause then lifestyle changes will be needed to treat the ED, such as losing weight, to trying to reduce your risk of cardiovascular disease. Whilst doing that, one will also benefit as this will improve one’s general health.

Medication may be needed to treat atherosclerosis, such as cholesterol lowering drugs called statins and also drugs to reduce blood pressure. Care needs to be taken on selecting medication for blood pressure as some like beta blockers can cause or worsen ED.

A number of therapies have been successful in the treatment of erectile dysfunction. Medication, such as sildenafil (sold as Viagra), can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.

Psychological treatments include talking therapy called cognitive behavioural therapy (CBT) and sex therapy. CBT is another form of counselling that may be useful. It is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mind-set. It is not the situation itself that is making you unhappy, but how you think about it and react to it. It will help to address the guilt, stress and anxiety associated with having ED.

Overall, treatments for erectile dysfunction have improved significantly in recent years. There is light at the end of the tunnel as most men are eventually able to have sex again. What is only needed is for the affected men to open up and get the right treatment.

I hope this article has called these men to action and can now go to their doctor and say, ‘I read this article about ED and I think I have got it’. This can be the beginning in the journey to get your sexual life back and I wish you the best.

Using the Internet 

We are now living in the Internet age where we can find anything online. As ED can be an embarrassing problem, some men are tempted to look for treatment on their own.

It is possible to buy medication over the internet, but you should always exercise caution as there are many sites that offer counterfeit medicines. These medications are not regulated and the amount of active ingredients in them can vary. They could cause unpleasant side effects or they may not be suitable for you.

My advice is that always ensure that any online doctor service is registered with a proper registration body such as Care Quality Commission ( CQC) in UK, that all doctors are registered with a body such as the General Medical Council (GMC) and that any prescribed medicines come from a pharmacy which is registered in a particular country.

I urge you to at least share this article with someone as we want the message to be spread. You never know we may save some marriages and improve some people’s sexual life.

This article was compiled by Dr Brighton Chireka who is a GP in Folkestone Kent UK. You can contact him on info@docbeecee.co.uk or visit his website www.docbeecee.co.uk

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.