George, a 50 year old man comes to the clinic with his new partner because he is experiencing erection difficulties.  He has heard of a pill that he can take to make it better.  I suggest that before he starts popping pills we check other causes.  Erectile dysfunction can be a symptom of other problems and popping a pill might give George an erection but we would only be working on the symptom rather than the problem causing the erection difficulty.

First of all, one needs to know that all man will experience erection difficulties at least once in their lifetime.  10% of all men suffer from erectile dysfunction for a prolonged period of time.  Recent research also shows that half of men over 40 suffer from some extent of ED.  Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. ED is also known as impotence.  This is a problem which causes for men to suffer in silence because most men would perceive it as a lack of masculinity and virility.  This leads them to accept it as their new reality and live with it in secret.  One also needs to understand that the older a man gets the softer and less erect the penis gets during an erection.  I always tell me clients about the 5 finger rule.  If you look at a hand with open fingers the thumb, when fully open represents what an erection of a 20 year old should look like, the index finger represents an erection of a 30 year old, which is still erect but slightly lower.  The middle finger shows the angle at which an erection of a 40 year old should look like, ring finger an erection of a 50 year old and pinky an erection at 60.

There are different causes for ED and most probably if these are tackled, men suffering from this dysfunction can gain their erection back.  The causes can be categorised into three different groups: psychological; medical and physical:

Physically, one needs to understand that an erection happens because when the man gets excited the penile tissue is filled up with blood.  This is what makes the penis grow bigger and harder.  In order for this to happen blood needs to flow from the rest of the body into the veins and tissue in the penis and stay there until the penis ejaculates.  This is why any physical condition that effects blood flowing through the veins, such as high cholesterol levels, cardiovascular problems, and hormone deficiency will effect erections.  As a matter of fact, doctors have identified erectile dysfunction as a ‘marker’ or ‘early warning sign’ of possible cardiovascular diseases. Therefore if you are expiencing erectile dysfunction it is important that you discuss it with your doctor. The doctor will be able to carry out checks for cardiovascular disease which might also treat the erectile dysfunction.

In this case I would suggest that George stops smoking, if he does, cuts down on the alcohol and inhealthy foods, and starts exercising.  This would help him feel better about himself and gets his body in shape again.  A more specific exercise for his penis is the vacuum pump which he can use three times a week to help the circulation in his penis.  It is important that the vacuum pump is bought from a trustworthy seller and used responsibly as it can also cause problems if not used properly.

Surgery to treat many diseases e.g. prostate cancer may cause physical trauma due to damage of the nerves and vascular supply. Damage to the nerves can mean that there might be less sensation in the penis and less signalling to it from the brain (referred to as neuropathy). This in turn makes it more difficult to get and maintain an erection.  If you have had pelvic surgery and are experiencing erectile dysfunction, or are concerned about sexual intercourse, it is important that you ask your doctor for help.

Another important suggestion would be that George tells his GP or therapist what medication he is currently taking as erection dysfunction could be side effects of some medication.  Medication that is notorious to effect erection and sexual drive are anti-depressants and anti-hypertension tablets.

George has a new partner so it could be that he has performance anxiety when being intimate with her.  Therefore relaxation techniques and communication exercises might help him feel more at ease in this department.  Other relationship issues are also known to effect men’s erection.  Opposite to general belief men are affected by relationship issues and if they are not happy in a relationship it might cause for their body to reject the idea to have sex with their partner.  Other relational causes known to effect erections are fear of fatherhood, when th man consciously, or unconsciously is scared of parenthood and therefore his body reacts by not “letting him have sex”.

Other psychological factors that might cause erection problems are stress, both at home and otherwise.  It is a basic human function which helps keep our species as strong as possible.   If we are not happy or worried about our life situation we do not feel like having sex.  This happens so that we do not procreate unless we are in a stable enough environment to take care of our offspring.  Therefore if we feel depressed, unhappy or anxious we tend to not feel like having sex.

As was explained erection problems can be caused by several bigger problems.  Take your time to explore other treatments and work on the causes before popping the pill.  If George is suffering from a medical or physical problem it would be wiser to repair the damage causing the problem with his erection rather than getting an erection and leave the causing problem getting worse.  If the problem is of a psychological nature once George stops taking the pill he will revert back to suffering from erection difficulties once he stops taking it.  This is why it is very important to consult a therapist or doctor when you experience erectile dysfunction.

Penis pump can be bought from: http://www.pleasuremalta.com/sex-shop/malta-others/handsome-up-pump-with-3-sleeves/

First published on Health & Fitness magazine with Malta Today