Dear Readers:

R.T. from Kingston 19 wrote concerning his experience with erectile dysfunction (ED). C.B. writes more recently with a similar experience. R.T. finds that sometimes he is unable to achieve an erection and there are other times when he looses his erection during sex. He says he has problems also with a poor circulation and wonders if this could be contributing to his ED.

Erectile dysfunction (ED) refers to the inability of a man to achieve and maintain a penile erection adequately to allow for satisfactory sexual intercourse. ED affects over 150 million men globally so it is a common, although often a hidden problem.

Some studies report the rate of sexual dysfunction to be about 43 per cent in the normal population.

The sexual response cycle experienced by normal, healthy individuals include:

1. DESIRE:

The wish, fantasy, feeling, to have sex.

2. EXCITEMENT:

A sense of sexual pleasure which is accompanied by physical changes in the male. In the female, vaginal lubrication occurs along with some genital swelling.

3. ORGASM:

This occurs with attaining the heights of sexual pleasures and is associated with release of sexual tension and with contractions of the pelvic muscles. This culminates in the male with ejaculation of semen.

4. RESOLUTION:

At the end of a successful sexual encounter there is a sense of well being and relaxation.

Problems associated with any of these four phases can be associated with erectile dysfunction in the male.

The causes leading to ED are many and complex and can be classified as organic, psychological, or mixed.

Organic causes can be neurological, endocrinological, vascular, drug induced (several antihypertensive drugs) or corporal. Risk factors for ED include diabetes, hypertension, hyper-lipidaemia, smoking, ageing, obesity and prostate cancer.

Psychological causes include depression, anxiety and post traumatic stress disorder. Performance anxiety is also common after men experience erectile failure and compounds the situation.

Mixed erectile disorder refers to ED occurring with contributions which are both organic and psychological. Treatment of ED should involve both the male and his sexual partners. Sex education and counselling can resolve some problems. Conflicts at home, at work and in relationships should be addressed.

The drug treatment of choice now lies with the phosphodiesterase inhibitors which include the popular Sildenafil (Viagra), Tadalafil (Cialis) and Verdenafil (Levitra). These drugs do not cause the man to experience an erection, they, however, potrntiate and facilitate the erection, building up on what is already present. They are actually very well tolerated by most men. These drugs are however, not for use in men with serious cardiac impairment or who take drugs called nitrates. Men should use these drugs with caution as their use can occasionally result in priapism (excessively prolonged erection). These tablets also work well in men with diabetes or hypertension and with those who suffer with some vascular im-pairment.

Treatment with the male hormone testosterone using injections or a transdermal patch are used in men with low male hormone level. Other less used methods for obtaining erections in the dysfunctional include the injection of prostagland into the urethra within the penis or into the Corpus Cavernosum in the penis.

Vacuum suction devices and surgical penile implants are also used at times to assist the male with achieving an erection. They are available but not often used.

Every man suffering with erctile dysfunction should be assessed and treated. Their partner should be involved in the management if possible. There is no reason for couples to suffer a lifetime of sexual unfulfilment and marital disharmony because of ED.

Write Lifeline

P.O. Box 1713

Kingston 8

A.J.M.