A consultant endocrinologist and diabetologist at the Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Dr. Michael Olamoyegun, discusses erectile dysfunction, causes and treatments with DOLAPO AKITOYE
What is erectile dysfunction?
Erectile dysfunction is described as the inability to achieve and to maintain erection strong enough for sexual intercourse. For sexual intercourse to take place between a man and a woman, a man must have an erection for penetration. In those who have erectile dysfunction, it’s either they do not have erection at all or have it but it is not strong enough and if it is not strong enough, penetration cannot take place.
What causes erectile dysfunction?
There are many things that can cause erectile dysfunction. The causes of erectile dysfunction can be physical, psychological or both. For physical, it means that it can be due to diseases. For example, those who have hypertension can have erectile dysfunction. Those who have diabetes can have it as well and diabetes happens to be the commonest cause of erectile dysfunction. It could be due to some hormonal disorders or deficiencies. For example, the hormone called testosterone is needed for erection to take place and if there is a deficiency of that, a man can have erectile dysfunction. Then, some medications, like some of the drugs that are used in the treatment of diabetes or some other conditions, can also cause erectile dysfunction. Other causes include surgery, especially around the groin – if the nerves that help erection or supply the penis are affected during surgery, this can lead to problems with erection.
Those who have suffered major trauma in the back, especially the lower back, can also have problems with erection. Stress, depression and anxiety can also cause erectile dysfunction; any stressful conditions can cause it. For example, problems in interpersonal relationships can as well lead to erectile dysfunction. Other things like smoking, excessive alcohol intake and some herbal preparations can cause erectile dysfunction.
Can vasectomy cause erectile dysfunction?
No, vasectomy does not cause it. It is just a form of male contraception and it does not affect erection.
What are its symptoms?
The symptom of erectile dysfunction is that a man will not be able to have an erection or the erection will not be strong enough. Other symptoms of erectile dysfunction will be symptoms of the underlying cause. For example, if it is due to diabetes, the person will have other symptoms of diabetes. However, erectile dysfunction on its own only presents as the inability to have an erection or a strong erection.
Can too much sex lead to erectile dysfunction?
No! Too much sex cannot lead to erectile dysfunction.
Can masturbation worsen it?
No! There is really no connection between masturbation and erectile dysfunction.
How is it diagnosed?
The diagnosis of erectile dysfunction is as follows: The person will come to you and tell you that he has problems with having an erection. Some of them will tell you that they have an erection but it is not as strong as it used to be and when you probe further, they will mention that they find it difficult to penetrate. In the milder cases, some of them will say that they are able to penetrate but they lose it before they complete sexual intercourse. These are the things that patients will tell you. Some other things that they will tell you depend on what they think is responsible for it.
So, for example, if it is due to diabetes or hypertension, they will mention it and also show the drugs that they have been using. So, from that, you will be able to have an idea if the drugs are the causes of the problem or if it is a complication of the underlying condition. You will also be able to have an idea if the size of the patient is the cause, because obesity can cause erectile dysfunction. They could also tell you that they find it difficult to satisfy their wives and this might be causing friction in their relationships
What are its psychological implications?
Erectile dysfunction tends to puncture men’s egos; so, it is very difficult for men to tell their wives that they are having problems. What some of them tend to do is to stay away or give one excuse or the other as to why they cannot have sex and this could lead their wives suspecting that they might be having extra-marital affairs. Apart from that, it could also affect the man’s self-esteem and it can cause depression. In fact, as erectile dysfunction can be as a result of depression, it can also lead to depression.
Some men may begin to feel like if they cannot satisfy their wives for a certain period of time, then, is life worth living?
Can it be cured?
Whether it can be cured or not depends on the cause. For instance, if it is due to medication and you remove the offending medication, then the patient is expected to recover completely from erectile dysfunction. However, if it is due to conditions like diabetes, it may improve with weight loss, low blood sugar control or low blood pressure control. However, occasionally, the patient might need to be put on medication to help manage it. Also, when surgery is done in the groin area, if the nerves surrounding the penis are already affected, then it is not curable. If it is due to major trauma on the back or spinal cord injury, it is not curable. So, it depends on what the cause is, but even in situations where it is not curable, it can be managed to a large extent.
Can it signify that there is something worse going on in the body?
It can signify that there is something worse going on in the body. For example, erectile dysfunction can be the presenting complaint to patients who have diabetes. For someone who never knew that he had diabetes and is presenting erectile dysfunction, the doctor might suggest that his blood sugar be checked and then, it will show that the patient has diabetes. Then, for those who are aware that they have diabetes but have never had erectile dysfunction, the outset of it might suggest that they have a cardiovascular problem. In fact, diabetic patients, who have erectile dysfunction, are likely to die faster than those who do not have erectile dysfunction.
This is because what causes erection is blood flow to the vessels that supply the penis and the erectile muscle. So, if there is a blockage in the vessels, from maybe atherosclerosis, that could be the cause of the erectile dysfunction. Atherosclerosis is the narrowing of the blood vessels.
In vessel blockade, same process might occur in the brain, heart and other parts of the body such that the outset of the erectile dysfunction may indicate that there is a blockage in other parts of the body, which may lead to heart attack and other things. This is why, for diabetic patients, who have erectile dysfunction, it could actually signify a worse problem compared to other diabetic patients who do not have it because the same mechanism that causes erectile dysfunction may also occur in other parts of the body.
Even for those who never had diabetes or hypertension, it could be a pointer that there is something sinister going on in the body. In the past, when a person has erectile dysfunction, they could blame it on stress or tend to rationalise it. While stress can cause it, there could also be something else, which could be major cardiovascular problems.
What are the treatment options?
The treatment options are divided into medication, addressing the psychological issues behind it and also, addressing the cause. So, there are drugs that can be used in the treatment of erectile dysfunction like viagra. There are also other drugs that can be used that work for many men.
There are injections that can be used as well. The other thing is to address the underlying cause. For example, if it is due to hypertension, the blood pressure needs to be well controlled. With good blood pressure control, it can help erectile dysfunction. With diabetes, if the blood sugar is well controlled, it is going to improve erectile function. Also, there are drugs that are used in the treatment of some conditions that have side effects of erectile dysfunction. In that case, the doctor will need to look at those drugs and remove or replace the offending drugs with others that do not have the tendency to cause erectile dysfunction.
Smoking can also cause erectile dysfunction by narrowing the blood vessels and reducing the amount of blood to the penis. With excessive alcohol intake, the person will have to stop or reduce the amount of alcohol that they consume. With obesity or overweight, it has been shown that loss of weight can improve erectile function. Exercise has also been shown to improve erectile function because with exercise, some of those blocked vessels will open up and it will also help patients to lose weight. If it is due to psychological issues, the psychological problems will need to be removed. The patient will need to be counselled and all the stressors removed. So, these are some things that improve erectile dysfunction. For men, who have erectile dysfunction, they need the assistance of their wives because when a man is battling with it, that is not the time for the woman to be putting pressure on the man’s inability to satisfy her because it can worsen the situation. It can also cause performance anxiety, especially if the woman is the type that has already been insulting the man. The woman will have to understand the man and it would be good for her to accompany him when he is going to the clinic for the two of them to be counselled. These are some ways that erectile dysfunction can be treated.
What ages are prone to it?
It tends to affect older men. The older one becomes, the more one tends to have erectile dysfunction. For those who have diabetes, the longer the duration of the diabetes, the more they tend to have erectile dysfunction. For diabetic men, up to 60 per cent of them tend to have erectile dysfunction. It is one of the major complications for people who have diabetes. It tends to happen to older men and this is in contrast to premature ejaculation, which is another form of sexual dysfunction. Premature ejaculation is when a man ejaculates before penetration or before he is ready to ejaculate. This causes dissatisfaction to him and his partner. This tends to occur more in the younger age group but erectile dysfunction tends to occur as one gets older.
What are the myths of erectile dysfunction?
There are many myths. Some tend to think that the more sex you have, the more you tend to have it. Although, it doesn’t mean that one should be having sex every day, but erectile dysfunction has nothing to do having sex often. Some others say that if a man has sex with woman who is menopausal, it could cause erectile dysfunction. This is untrue.
Health facts: On erectile dysfunction
- ED is a highly prevalent and undertreated disease with a significant impact on total health.
- ED is not an over-treated condition, despite media representations. On the contrary, studies have revealed that 90 per cent of those suffering from ED never go for treatment.
- The expected increase in the number of men who suffer from ED is the direct result of aging populations, unhealthy eating habits, the earlier onset of diabetes and obesity and stress.
- In studies worldwide, the incidence of ED is never less than 10 per cent and often as high as 30 per cent, depending on who took part in the study.
- ED is a barometer of cardiovascular health.
- PDE 5 drugs can be used for men with spinal cord injuries. The higher up the spinal cord injury, the better the drug response, according to a health expert.
- In a US survey, it was found that 71 per cent of participants never raised the issue of ED with their doctors, because they thought they would dismiss sexual concerns. Sixty eight per cent feared the doctor would be embarrassed and 76 per cent thought there would be no medical treatment available.
- When on phosphodiesterase type 5 (PDE 5), men do not have a constant erection – they are merely responsive to sexual stimulus. These drugs have 80 per cent effectiveness in treating ED.
- PDE 5 drugs, when taken in conjunction with illegal drugs such as ‘poppers’ (nitro-glycerine or TNT tablets) or ecstasy tablets, can cause hypotension (low blood pressure), and possibly death.