Monday 23 October 2017

Dear Dr Nina: I'm too embarrassed to talk to my GP about my erectile dysfunction

Erectile dysfunction can affect up to 50% of men
Erectile dysfunction can affect up to 50% of men

Nina Byrne

I find this subject a bit embarrassing, so I'm writing to you instead of visiting my own GP. I'm a 65-year-old man who would consider himself to be fairly healthy - in that I don't smoke or drink much, maybe five pints over the weekend. My diet is also good thanks to my wife who always has a healthy dinner for me every evening. However, recently I've been unable to sustain an erection. I love my wife and we have always had a relatively good sex life. I can't pinpoint any physical reason as to why this is happening and I was wondering if you had any ideas. I have recently retired and this is casting a cloud over my enjoyment of this time. I have given up initiating sex with my wife in case it happens again.

Dr Nina replies: Erectile dysfunction (ED) is an extremely common condition and is thought to affect up to 50pc of men over 40 at some time. This statistic often surprises many men who think it is usually a problem of later years. ED occurs when an erection is not sustained long enough for sexual intercourse. This can occur from time to time for anyone but if it occurs regularly it can cause stress, embarrassment and poor self-esteem.

Male sexual arousal involves the emotions, the brain, hormones, blood vessels, nerves and muscles. If a man is aroused the brain sends a signal to the nerves of the penis. This sends a signal to blood vessels allowing blood to flow in the arteries causing it to swell and harden. When arousal is complete the blood flow in the artery reduces and the veins allow blood to flow back out. ED can occur due to any problem along this pathway.

Medical conditions that can affect the blood flow to the penis need to be ruled out. ED can be the first sign of cardiovascular disease. The penile artery is one of the smallest in the body so narrowing here may cause symptoms before they are obvious elsewhere. This is why it is important to attend your doctor to discuss this issue. You shouldn't be embarrassed, your doctor will have seen this before.

Other conditions such as diabetes, high blood pressure, high cholesterol and low testosterone levels should be ruled out. Medical conditions that disrupt the nerve supply to the penis such as multiple sclerosis, Parkinson's disease, or damage to the pelvis or spinal cord may also result in ED - it can also occur after treatment for prostate disease.

Poor lifestyle choices can also cause ED. It is associated with obesity, alcohol, smoking and the use of drugs such as marijuana, cocaine and heroin. Some prescription drugs such as those used for blood pressure or some psychiatric medication may reduce the chance of sustaining an erection.

A successful erection requires coordination between the brain and penile tissue. Psychological causes of ED are very common. Depression, anxiety, stress or relationship difficulties can have a huge impact and it is equally important to discuss any emotional upset with your doctor.

ED can occur in any male but it is most common in those over 50 and those who have heart disease, diabetes, high cholesterol, high blood pressure and in those who smoke. All of these conditions cause damage to arteries overtime, which eventually manifests as difficulty with erections.

Don't be shy about going to your doctor to discuss this problem. It can open the door to a better understanding of your health and it is a treatable condition.

Your doctor will ask some specific questions to try and ascertain whether your case of ED is related to a psychological or physical issue or in fact a combination of the two. You will require a general check-up and examination and blood tests to rule out diabetes and cardiovascular risks.

There are a number of treatments available for ED ranging from medication to surgery. So talk to your doctor abut the options. Help is readily available. Don't be afraid to ask.

My mother tells me to let my toddlers out for a small while — say 20 mins to half an hour —  without sunscreen for vitamin D when the sun is out. Is she right?

Dr Nina replies: Vitamin D is found in fish oils, eggs and meats, but even in these foods it is hard to absorb. Our main source of useful vitamin D comes in the form of UV exposure from sunlight. For those living in northern latitudes (such as ourselves), covering their skin for medical or religious reasons, or with darker complexions, it may be impossible to keep levels up. Studies throughout the world have consistently shown vitamin D deficiency among large percentages of the population. We know that many babies are deficient in vitamin D and it is recommended that all babies aged 0 to 12 months take a daily vitamin D supplement. It is also a good idea for pregnant and breast-feeding mothers.

A lack of sun exposure from October through April means that without supplementation our levels are at their lowest in early March which may help explain the peak in fatigue and low mood in the late winter months. Previous generations spent much time outdoors and as such maximised their ability to absorb and synthesise vitamin D in their skin. Today we spend more time indoors and due to a fear of skin cancers most of us (correctly) apply high factor sun protection when we do venture into the sun.

How then can we ensure adequate levels of vitamin D? Fortified milk, yoghurt and cereal can be one solution. Also, as suggested by your mother, small amounts of sun exposure without sunscreen during summer months.This exposure should occur outside the peak hours of 10am to 4pm and it needs to be controlled based on the type of skin. About 15 minutes on 25pc of the skin will give a decent boost. However if your child has extremely fair skin less time may be appropriate. Finally, a small daily capsule or drops may also bring some sunshine inside.

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