What to do if you have erectile dysfunction
In recent years, men have made huge strides in opening up about themselves. Work stress? Relationship problems? Deep dark anxieties that keep us up at night? All this messy stuff is now almost as common in male conversation as football or rugby. But there is one conversational taboo that remains pretty entrenched when blokes get together in the pub: our willies. Other than occasionally taking the mickey out of each other’s members, you are unlikely to hear one man tell another that he is worried about the quality of his erections. It feels overly intimate and embarrassing – and remains the one vulnerability that we are too ashamed to share. And that’s a problem.
Any bloke who fails to get it up could be forgiven for thinking he is alone while, in fact, over half of men between 40 and 70 experience erectile dysfunction, and some research has suggested that as many as one in 10 men of any age will experience it at some point in their life. Recent studies suggest that erectile dysfunction is becoming more common among younger age groups too: 30 per cent of men under 40 have experienced it.
“If we talked about it more, then perhaps we’d feel less ashamed when it happened to us,” says Hussain Alnajjar, a consultant urological surgeon and andrologist based in London. “Feelings of shame and failure often contribute to the problem getting worse, so communication is key.” Not that all erection problems are psychological. “An erection is a complex physiological phenomenon that relies on numerous factors, all of which have the potential to be disrupted,” says Alnajjar.
In fact, once you take all of the physical, mental and emotional factors at play, it’s a wonder that anyone ever manages to get an erection at all. The good news is that almost all men can – and there are solutions to even the most severe cases of erectile dysfunction.
“Anyone can have a one-off problem with getting an erection,” says Dr Jeff Foster, a men’s health specialist at H3 Health. “But if you persistently feel aroused and yet can’t achieve erection, it’s important to get a medical assessment to check for underlying factors.” In older men (over 40), difficulties in getting an erection are often the first sign of cardiovascular issues. Dr Foster explains: “The blood flow to the penis can be hindered by heart problems or a narrowing of the arteries. If you visit a GP or men’s health specialist, they will assess your lifestyle, take blood tests and possibly refer you for an angiogram to rule out heart and circulatory problems.”
If erectile dysfunction is found to be caused by circulatory problems, lifestyle changes are often enough to help. “We would prescribe alcohol reduction, stopping smoking, adhering to a Mediterranean diet and getting at least 30 minutes’ exercise per day,” says Alnajjar. “Losing weight will also help because your heart will be putting less effort into supporting the rest of your body and be able to pump blood to your penis more easily. It will also improve raised blood pressure and cholesterol, which can lead to erectile dysfunction. Diabetes is another potential cause, as it will impact on your nerve endings and blood vessels. Again, this is why you should always seek medical assessment if the problem is persistent.”
‘There is no patient we can’t help’
Stressful lifestyles, leading to anxiety and depression, are one of the most common causes, says Peter Saddington, a relationship therapist with Relate. “Stress can trigger the fight or flight response in your nervous system. This means the body is put on standby to run from a threat, not relax into sex.”
In younger men, the problem is usually linked to performance anxiety, says Foster. “Almost all patients I see under 30 have psychological issues linked to the use of social media and pornography. Porn has normalised the idea of men with unusually large penises who can keep going for very long periods. Ordinary guys see this, feel inadequate and often struggle to get an erection as a result.” Pornography has also warped sexual expectations of younger men, says Saddington. “They might only be able to achieve an erection when they are alone watching pornography. The reality of actual sex can seem underwhelming by comparison.”
This can trigger feelings of resentment in relationships, says Michelle Bassam, a psychosexual therapist at Harley Therapy. “It’s important to explain to your partner that it’s not about them or their attractiveness. And it’s equally important for the partner to be kind and understanding about it. If they compound the sense of shame or embarrassment, it will make the problem persist. My advice [to partners] is always to be kind then, after a day or two, ask them if they are okay and maybe encourage them to see the GP if the problem is persistent.”
Cognitive behavioural therapy (CBT) can help confront psychological issues. “We would look to identify the negative thought patterns and behaviour that impacts sexual performance,” says Bassam. “The common issue is men who have experienced erectile dysfunction in the past assuming they will always do so. That sort of negative thought is a vicious cycle that CBT would seek to challenge.”
If the problem is more physiological, there are a number of treatments available. “Viagra can help, but I still advise getting medically tested before just buying it over the counter,” says Foster. “If your arteries are narrowing, Viagra will increase your chances of getting an erection by improving blood flow, but it won’t make your arteries better. Alternatively, you might be suffering from low testosterone levels. These problems can be masked by using Viagra.”
Contrary to popular belief, Viagra is not the only option. “Alternatives to oral medications include intraurethral agents that can be inserted into the penis either as a suppository, a cream, or even an injection that can be done by the individual at home prior to sex,” says Alnajjar. “The medication helps to improve blood flow to the penis by relaxing the muscles and can be highly effective for a lot of men.”
In more extreme cases, where medications do not work or, for example, following pelvic surgery for prostate cancer, penile implants are available with very high satisfaction rates. “This could be either in the form of two bendy rods implanted into the penis, which means you are permanently erect,” says Alnajjar.
“However, you are able to fold the penis away to try and conceal it when not having sex. Alternatively, there is an inflatable-type implant. A small pump is inserted in the scrotum and used to inflate two cylinders placed within the penis, which mimics natural erections when necessary.”
All of which is very much news to me. But then why would any of us know about the prevalence of erectile dysfunction or the myriad treatments available when we are so coy about discussing the issue? Understanding how normal it is should be a step towards all men finding the solution to the erectile problems that most of us will experience at some point in our lives. “The biggest myth about erectile dysfunction is that there is no solution,” says Foster. “But we have never met a patient we haven’t been able to help. There is something out there for everyone.”
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