Unless you're George Hook - the first rule of the erectile dysfunction club is that you don't talk about erectile dysfunction. ED, formerly known as impotence can affect men of any age, but is mainly associated with getting older. About half of all men aged 40 to 70 suffer with it to some extent - rising to seven out of ten men aged 70 and older.
ED means you can't get and/or maintain an erection. Most men have it occasionally when they're tired, stressed or with excess alcohol use, but for some it's persistent and recurring. There are multiple causes of ED, which break down broadly into physical and psychological, but reduced blood flow to the penis is responsible for seven out of ten cases. Circulation to the penis is reduced by narrowing of the arteries, so it is associated with high BP, smoking, raised cholesterol and age. It often occurs, therefore, in men who also have heart disease and problems with circulation to their legs.
Diabetes - which effects both your nerves and circulation is another common cause. But there are many neurological or hormonal conditions that can cause it. Other less common causes include injury - including post-op injury - and cycling! So all you MAMILs (Middle-Aged Men In Lycra) beware. Certain medications like anti-depressants and beta blockers can also cause it. As, of course, can alcohol.
With physical causes, ED tends to occur slowly, over time. Psychological cases - which account for about 20pc - can develop quite suddenly. And stress, anxiety - particularly if related to sex - depression and relationship difficulties can all be factors.
One indicator that the cause may be psychological, is if you can get or maintain an erection at certain times, such as with masturbation or in the early morning.
As with most things, the cause should be identified and treated. As 70pc of cases are due to narrowing of the arteries, that's where we start. First thing is stop smoking. Smoking doubles your risk of ED. Get your BP checked yearly. Keep it normal with lifestyle - or medications if necessary.
Maintain a normal body weight. Keep your cholesterol down with a low fat diet or again medication if indicated. Moderate your alcohol intake.
If you do have diabetes, good blood sugar control can reduce the impact of diabetes on blood vessels and therefore on ED.
Its worth noting that men often develop ED years before they develop the related, similar condition of heart disease - if you have ED, it should be viewed as a possible warning sign and you should have a cardiovascular check-up.
Treatment options primarily involve tablets that increase blood flow to the penis - these can be taken orally before you plan to have sex. They don't give you an erection unless you are aroused.
These work well for most people. It's important to note they interact with certain other medications and should only be taken on advice, by prescription. But for those who don't respond to them there are other treatments like injections or urethral tablets (tabs inserted into the penis) and also vacuum devices and surgical rods that can be used - some of these may give you an erection even if you aren't sexually aroused.
If the cause is psychological, psycho-sexual counselling can help. This examines the issues surrounding your sexual difficulties and attempts to deal with them. One approach involves taking full sex out of the equation altogether while encouraging other physical intimacy such as kissing or massage - essentially everything except sex itself is allowed. This alleviates the pressure and can help overcome a psychological hurdle that may in fact mean paradoxically that sex occurs.
ED affects huge numbers of men, is not spoken about and causes difficulties physically, psychologically, and in relationships. There is treatment - you just need to open up and ask.
When it comes to problems of a sexual nature, Irish men are reluctant to voice their concerns. This is what Wicklow resident Martin Ryan (50) discovered when he faced a troubling problem concerning his own sexual health. At that time he could find no one else to share their experiences with him.
FOR men, it is the ultimate taboo – the dysfunction that dares not utter its name. "One in five men experience premature ejaculation. They don't want to talk about it. However, it is likely we all know someone who suffers from it," says Dr Wallace Dinsmore, a sexual health specialist and chair of the Irish Association of Sexual Medicine.