When the flag flies half-mast

A problem with having or sustaining an erection is referred to as Erectile Dysfunction (ED). Men with ED are unable to have satisfactory penetrative sexual intercourse. Studies suggest about 40 percent of men over the age of 40 suffer from some form of ED. Remedial measures are readily available, and men should not shy away from seeking help.

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen ED. Sometimes a combination of physical and psychological issues causes ED. Many men experience transient ED, this is not usually a cause for concern unless it is sustained. But ED should not be confused with decreased libido, which is lack of sexual desire. Men with ED usually have normal libido.

In most cases, ED is caused by something physical. Common physical causes include heart disease, diabetes, obesity, low testosterone, injuries affecting the pelvic area or substance abuse (tobacco, alcohol, and illicit drugs). Psychological causes include depression, anxiety, stress, relationship problems or other mental illnesses. As men grow older, they take longer to achieve and sustain an erection. Sometimes this may be an effect of medications they may be on, for example blood pressure tablets.

Men experiencing ED should make attempts to see a doctor, either a general practitioner or a specialist. A detailed evaluation is done, and may include psychological assessment and review of any relationship issues. Blood tests and some imaging studies may be done to pinpoint the diagnosis.

Specific treatment for ED will depend on what the cause is. Optimal treatment of existing conditions may improve ED. Oral medications, such as Viagra, are appropriate and satisfactory treatments for many men with ED. Caution must be advised in men with specific conditions like heart disease, or those on other medications that may potentiate Viagra’s side effects. Other options include self-injections, urethral suppositories and testosterone replacement. Penile pumps and surgically inserted implants are also available, and some men may require blood vessel surgery. Herbal or internet purchased remedies must be used with caution, as they may contain potentially harmful components not usually listed in the label. Acupuncture has also been tried.

Psychosexual counselling is an important component of ED, regardless of whether the cause is physical or psychological. Women should support their partners whilst seeking remedies for ED, rather than berate them with unkind actions, which just erodes their self-confidence further.

Some causes of ED may not be preventable, but leading healthy lifestyles is a good starting point. Men with ED should quit smoking, reduce alcohol intake, optimise weight, exercise and work through relationship issues.