Why Irish couples shouldn't be afraid to talk about Erectile Dysfunction
Dr Nina Barnes addresses your health and relationship issues.
Question: I have started a new relationship recently. I am very attracted to my partner but I'm worried about spending time in the bedroom as I have had difficulty with erections in the past. I'm embarrassed to ask my doctor about it. I know there are pills available but how do I know if medication will work?
Dr Nina's reply: Erectile dysfunction (ED) is a common condition and is thought to affect up to 50pc of men over 40 at some time. This statistic often surprises 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 occasionally 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 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.
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 see your doctor to discuss this issue. You shouldn't be embarrassed: your doctor will have seen this before.
Other conditions, such as high cholesterol, diabetes, high blood pressure 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 is linked to 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.
Psychological causes are also common. Depression, anxiety, stress or relationship difficulties can have a huge impact. If you can sustain erections alone or you still experience an erection on waking in the morning, then it is more likely that there is a psychological element. You will require a general check-up, an exam and blood tests to rule out diabetes and cardiovascular risks.
There are a number of treatments available. Since the arrival of the little blue pill in the 90s, medication has become the main treatment. They all work by enabling the flow of blood into the penis by enhancing the effects of nitric oxide which is a chemical in the blood that relaxes blood vessels. You may not be able to take the medication if you are already taking other medication with nitric oxide, are taking certain medication for the prostate or some other heart medication. Those with active heart disease, or those who have had a stroke or uncontrolled diabetes, may also need to avoid these.
Another option is penile alprostadil. This can be given by injecting it into the side or base of the penis or inserting a small suppository into the penis. Side effects of this treatment can include a prolonged erection.
An external pump device may be an option for those who cannot use medical treatments.
Lastly, when all of the above fail, or are unsuitable, penile surgery is an option. This is usually used for those who have ED due to surgery for prostate or bladder cancer, or have severe diabetes.
It may be tempting to avoid the doctor and buy some products online, but an old-fashioned visit to the doctors is best. A satisfying sex life is an important part of a relationship so don't delay at home. Onwards and upwards as the saying goes!
Health & Living