Erectile dysfunction - what is it?

Dealing with impotence…

If men were truly honest, they would all have to admit to not always being up to performance when it comes to sex. For many Irish men, this can be put down to the effects of alcohol and the so-called 'brewer's droop'. For the more mature amongst us, it is an unwelcome sporadic side-effect of the process of ageing.

However, for some men, regular difficulty in 'getting it up' is getting them down. They are suffering from erectile dysfunction - the inability of the penis to become firm enough to enter the vagina.

While not life-threatening, erectile dysfunction can be devastating for any man to experience. It also has an upsetting effect on partners. Together with the loss of a satisfying sex life is the concomitant loss of self-esteem.

Anxiety and stress

Impotence may be the result of a medical condition, such as diabetes, or can be an unwelcome side-effect of some types of surgery. But surprisingly, it is anxiety and stress that are most commonly to blame for a man's inability to sustain an erection.

There are a number of medical causes of impotence, but most cases are psychological in origin.

Dr Tom Kelly, the medical director of the Everyman Centre in Dublin's Lower Mount Street, has been a psychosexual therapist for over 20 years. He sees hundreds of men each year seeking help with their erection difficulties. A medical practitioner, he believes that some of his clients are so embarrassed by their erectile difficulties that they will not even speak to their own GP about the issue.

"I see men who say that erectile dysfunction pervades every aspect of their lives", he says. "They feel low in confidence and undermined in all areas of their life. All too often, men see getting an erection as a statement of how masculine they are. This is a phenomenon in all cultures. Perhaps it is genetic. Men may see each other primarily as sexual rivals and hence will not admit to problems like erectile dysfunction as it is tantamount to admitting sexual weakness".

Recognising the problem

It is well documented that men discuss their health much less often than women. They are also less likely to attend the doctor when they are ill and more likely to ignore serious health problems in the hope that they will go away. This reticence contributes to the difficulty of erectile dysfunction, because very often the source of the problem is psychological. Many men do not understand that other men are experiencing the same difficulties.

New drug treatments have helped the treatment of impotence, but often the source of the problem is psychological, not physical.

"People are extremely embarrassed by this problem", explains Dr Kelly. "Men are shy when talking about erectile dysfunction. They are not comfortable about talking to their doctor about it. Men do not discuss the issue of sex among themselves. If they did they would be aware of how common this problem is. Men often believe that they are unique in having this problem, when in fact it is quite common".

Unfortunately, there are no accurate figures on how common the problem of erectile dysfunction actually is in Ireland. Indeed, very few studies have been conducted anywhere into the incidence of erectile dysfunction. In 1992, the National Institute of Health in the USA assessed that between 10 million and 20 million Americans could be suffering from erectile dysfunction. Another study found that 5% of all 40 year olds were having such difficulties.

Several causes

Since there are so many men having trouble with getting an erection, it is clear that no single cause is to blame. Anxiety and stress are often implicated in erectile dysfunction and abusing drugs or alcohol can be a source of the problem. Many cases of erectile dysfunction are medical in origin, an unwelcome side-effect of a medical condition, of an operation or even of medication. As there can be a number of reasons why each case of erectile dysfunction is occurring, it is very important to get an accurate diagnosis from a doctor or sexual therapist.

"In younger men, the most common reason for erectile dysfunction is anxiety and fear", says Dr King. "Erectile dysfunction is quite common among young men, many of whom may have had a problem dating back to their first sexual experience. I often wonder whether it might even be one of the reasons behind our very high suicide rate among young men. If a young man is quite shy and introverted and suddenly finds himself in a sexual situation for the first time, a problem might easily develop".

He says that in older age groups there are often organic problems inhibiting the working of blood vessels or nerves. "Diabetes, for example, can cause peripheral neuropathy, where nerves in the penis and elsewhere become desensitised. Other older men often present with high blood pressure, high cholesterol, or as heavy smokers, all of which can contribute to erectile difficulties. Whether the cause of erectile dysfunction is organic or not, it can still lead to a range of psychological difficulties, though".

Addressing the underlying psychological issues is just as important as confronting the physical symptoms. Often this involves speaking with the man's sexual partner also. In many cases, it transpires that there is no organic reason preventing an erection from occurring.

New treatments

For those men who are struggling with a medical issue that inhibits their ability to perform, new drug treatments offer new hope. Everyone is surely aware now of the existence of the drug sildenafil (Viagra), the first of a number of well-known anti-impotence medications to come on the market. But there are alternatives to drug treatments for people with erectile dysfunction.

"Injections and oral medications can be used to increase arterial supply to the penis", explains Dr King. "These can be taken a number of hours before sexual intercourse is expected to take place. Vacuum pump devices have also been available for many years and are effective. However, they can be uncomfortable and do not produce the same kind of erection as occurs naturally. For some people, however, they are the best option".

Pumps have been used successfully for decades, but can be a passion killer.

"Implants are considered as a last resort, as they involve relatively major surgery. Two kinds of implants can be inserted into the penis. One is inflatable, while the other is a flexible rod. Implants are generally only suggested when other options have failed to have any success".

All men deserve to enjoy a satisfying sex life and the development of recent treatment options makes it possible for the vast majority who experience problems. But most erectile difficulties have a psychological component and it can be more difficult to unravel the web of anxiety, stress and fear that contributes to an erectile dysfunction.

Only as more men conquer their embarrassment and come forward for diagnosis will erectile dysfunction cease to be a problem for so many couples. Men experiencing impotence problems should contact their GP for advice.


Anonymous - 31/10/2001 12:34

I just love the way nobody comes up with an answer, nothing very specific, often plenty of 'waffle' but getting nowhere.

Anonymous - 31/10/2001 21:13

Any comments/views on the issue of the relationship between 2 middle age partners losing the sexual appeal/chemistry of yesteryear?

eddie(kaedy) - 31/10/2001 23:35

I have this problom,I know that I drink to much as well as smoking too much, if I was to reduce my drinking and give up smoking,should I wait to see what effect this has on me before consulting my GP about this problem?

Anonymous - 01/11/2001 00:39

it must be the smokes???

Anonymous - 01/11/2001 12:47

"viagra" not an option when patient suffers from hypertension

eddie(kaedy) - 02/11/2001 04:01

ToAnon,& all anons, Perhaps this is the only way that I have been able to discuss my problom to the fore my male friend's realy don't want to know,I belive this is sad in fact very sad because had I been able to discuss like women DO our probloms maybe I would not have had to pose the ?,however there is another ? to be asked how serious do our GP's take us when we do ask the akward ? regarding OUR disfunctuion('s) normally with a smile (grin)and how are you ,hav'nt seen you for awhile how are you keeping? perhaps we males should start going to see our lady GP,s then just maybe we be will understand just how easy it is to be human,instead of being MACHO and suffer,it's a new world out there and I want to live to enjoy my life in this new world but if equality is the buzz word then let it be the same in medicine,treat us equaly,our probloms are just as topical,serious and as life treating as anyone else,but unless we all wakeup and be open up about our health as we are (bullshit) about how we do it, who we fancy and what we as men would like to do ,then we deserve to pay the higher premium,there are no breadwinner's anymore and if that be true then as men we should be as open as the next and speak to each other openly and DEMAND that we be listined to with the same compassion as those who fought to get where they are now,wake up boy's we are being left behind. Regards, Eddie.

Sandra(sandrastevesean) - 05/11/2001 01:00

Women also deserve to enjoy a satisfying sex life!! I wish there was such a huge worldwide interest in research, help, drugs etc to ensure women's ability to have and enjoy sex. "high suicide rate among young men due to erectile dysfunction"!!?? HUH.. If women were as fickle, we'd be extinct!!!

Anonymous - 06/11/2001 13:08

Sandra, if women want to improve their sex lives all they ned to do is to discuss their needs and desires with their partners. They do not experience any equivalent of erectile dysfunction. The closest is vaginismus, which is extremely rare. If women placed less focus on the need for men to 'perform' and more on being intimate and sharing mutual pleasure, it is possible that many men currently experiencing difficulties would soon find those problems resolved.

Anonymous - 17/11/2001 16:32

all they need is a little loving understanding from the wife. My husband was on viagra without little success but eventually everything is in working order with a little patience and understanding and trying not to make a big deal about it. We made very light of it even with some friends and now everything is just great.

Anonymous - 20/11/2001 00:36

can erectile dysfunction be related to need for circumcision?

Anonymous - 17/01/2002 21:05

can ginko tablets be bought in any health stores without perscription any more, could they be an alternative to viagra?

Anonymous - 04/03/2002 13:29

E.D. HAS a female equivilent:- particularly around the time of menopause - low to non-exisitent libido. This is heartbreaking when you have a healthy loving partner who is also a very virile person! Its hell having no interest. I would take whatever pill I could to be aroused even for the moment! I am healthy, attractive, imaginative and have a great talking realationship with my partner. HELP! The funny thing is that I have a great friend with whom I am easily aroused with when we are together!!!! But I would prefer this to be with my partner. AM I cracked up?

Anonymous - 06/04/2002 23:10

I don't want this to develop into a forum for women's problems given the topic in hand, but maybe Sandra was talking about the fact that it is much more difficult for a woman to achieve orgasm than for a man under normal circumstances, and often it is not enough for a man to just "perform". With the pressures of family life and work, it's often not possible to put the time into talking through needs, or cuddling, massage, foreplay, etc, and the whole affair ends in orgasm for the male partner, and frustration for the female partner. Or is that just me....?

Anonymous - 09/04/2002 13:25

can a diabtic take Viagra

Maureen.(lucky123) - 09/04/2002 13:48

Sometimes men find it easier to perform with a younger woman.

Anonymous - 20/04/2002 22:32

My GP recently precribed me Uprima, a new ED tablet. He said it was far safer given my heart condition. I find it far more effective than Viagra. Anybody else tried it ?

mary(maryspierinn) - 24/04/2002 13:58

hypnotherapy can sucessfully help in some cases of sexual dysfunction to find a therapist

Anonymous - 01/05/2002 20:39

Mary, hypnotheraphy may well work, however I can recommend aromotheraphy. Having suffered from a rather limp erection for several months, possibly caused by back pain during intercourse, I was cured by my aromotherapist recently. On a recent visit I explained how back pain, particularly when I started to climax, was putting me off sex and in my opinion was causing my inadequate erection.

Tracey(traceylee) - 11/07/2002 22:07

I started taking a health product for heart health a few months ago, which has now enabled me to get off blood pressure medication! Now, one of the many, welcome side-effects of this remedy is a remarkable increase in circulation, and guess what...yep, increase in libido and overall sexual dynamics-I\'m talking DRAMATIC improvement. Okay, I\'m a woman, but the fundamental circulation issue makes some sense to either sex. Co enzyme Q10 is available from most health food stores. Please post a follow-up if it works for you.

Anonymous - 21/08/2002 09:44

I don't think Uprima is 'up' to much - give me the Viagra ANY day!

Anonymous - 30/09/2002 15:48

Dont have trouble haveing an erection but i do have trouble comeing to the ejaculation stage of sex with a partner

Anonymous - 04/11/2002 14:59

i have suffered ed 10 yrs have just got currage to go to a clinic they perscribed VIAGRA in losenger form which u let disolve in mouth has anyone had any success ??? please reply /

Anonymous - 14/03/2003 18:42

anytime i get close to my girlfriend i ejaculate small amounts of semen every few minutes. this happens even when i don't have an erection. any help????

Anonymous - 02/06/2003 18:48

My penis is becoming weaker latly. I am 54 and and my penis is looking more like an empty intestine. Even at errection it is losing sensitivity, weaker errection, no feeling at ejaculation. Without errection I feel my penis as " dead flesh piece". any comment ?

harlem - 23/07/2003 22:57

I need help!! I love my girlfriend deeply and we are both virgins.But when we was about to begin to have sex i lost my erection, but i usually have them when she arouses me . Whats wrong???

Anonymous - 07/08/2003 08:17

My partner has recently started to suffer with DE. It has had a dramatic affect on my self-confidence, let alone his! Has anybody any tips on what to do?

Anonymous - 30/10/2003 08:20

My problem is I can get an erection, but it's not very strong and never was. See, I'll have it for about a minute and I'll feel like i have to pee and i lose the eretion completely until I urinate, this happens about 2 or 3 times before I can ejaculate, and I'm only 19

Anonymous - 12/01/2004 02:07

I'm 25 years old, at first when I have sex with my partner it ends quickly after the first one. After that i sometimes get an erection but can't maintain it to have intercourse. I'm thinking about Viagra just to experiment, any answer thanks.

Anonymous - 12/03/2004 10:08

As a woman, I find that the brain is our biggest sex organ and in the past I've found that when a man has an inability to get or sustain an erection, the things that go on in his mind are what keeps the problem there. When the woman he's with doesn't know how to boost his self esteem apart from their sex life, then she complicates his problem and makes him think about it even more, thus perpetuating the dysfunction. So many things can cause it, drink, smoking too much (and not cigarettes!), but these can be corrected fairly easily. It's fear and the mind that is a man's biggest enemy. Get around that one, and I have found that things get back into order.

Anonymous - 13/03/2004 01:11

There is a wealth of information on the internet regarding the causes of erectile dysfunction (mainly physical, and NOT PSYCHOLOGICAL, I might add). Diabetes is a main cause, of course. Certain types of medication are also a cause i.e. medication for blood pressure. It is a matter best approached with the doctor or urologist, who will determine the exact cause. If the problem is psychosexual in nature, then of course, a visit to the appropriate specialist would be in order.

Anonymous - 19/10/2004 15:45

Having read all of the above posts, I am none the wiser. I am 37 and have had this problem for years without ever really doing anything about it, and now I don't really know where to start. Should I go to a doctor or a sex therapist? Will I be prescribed medicine or advised to take up yoga? Is my problem mainly mental or physical? I don't really know where to turn... Martin

john(AFY24008) - 06/02/2005 00:54

my problem occurs when my partner gets back from work.He is always in the mood for sex but because of past trauma of association with work I do not rise to the occasion.In my case it is mental because I have tried viagra which works physically but the mental block remains

E(KZS24794) - 22/02/2005 07:48

If you are suffering from ED try these things: Per Day; 1. Take 60 mg elemental zinc suplements with some copper [e.g., 60 mg of zinc sulphate monhydrate has 20 mg of elemental zinc]. Take zinc with empty stomach. Don,t eat or drink anything[except water]2 hrs before and after taking zinc. 2. Eat 20 gms of garlic 3. eat 50 gms of raw onion. 4. Cut and eat 250 mg of tomatoes [with or without sugar] Try this for two months. If some positive sings are there, bring zinc intake down to 30mg per day and continue for another 4 months. Wish You Good Luck. Jawahar Try these for 2 months and see.

Anonymous - 06/03/2005 03:58

I went to my GP three times and then to an urologist. That was nearly a year ago, and I'm still no wiser. I feel like I haven't been taken seriously at all because I'm openly gay. In fact, my GP (a woman GP!) was hinting that I may not be gay. Ludicrous! I don't know what to do now.

Anonymous - 25/07/2005 21:57

I'm 26, not a virgin, but experiencing the same problem as harlem above. No problem getting aroused, but lose the erection just before sex. Could I be distracted by having to stop to put on a condom? Having read the comments above, it seems psychological factors may be at play, need to keep the mind on the job! Any other theories???

Anonymous - 25/09/2005 00:41

ED was a problem during the last few months of my relationship which has just ended. My confidence is so low as a result. I am not sure if it was me or him who caused the problem... Maybe he just lost interest.... but I am going over things in my mind and i think he may have been having a real problem on and off throughout our relationship. I know its not really my business now, but I would like to understand what happened. I thought we loved eachother. Any comments would be welcome...........

Anonymous - 25/09/2005 00:43

...... to add to my post above, i don't even know for sure if my ex actually had ED, we didn't discuss it really.... just had several awkward moments, and several semi-apologies from him.

E(KZS24794) - 26/09/2005 17:02

If you are suffering from ED try these things: Per Day; 1. Take 60 mg elemental zinc suplements with some copper [e.g., 60 mg of zinc sulphate monhydrate has 20 mg of elemental zinc]. Cut and eat two tomatoes [with or without sugar] everyday. Try this for 3 months. If some positive sings are there, continue for another 4 months. Bring down the elemental zinc content to 30 mg per day as soon as you feel normal and continue for another 3 months. Wish You Good Luck. Jawahar

Anonymous - 21/10/2005 04:48

I am young only 18. I have experienced problems maintaining an erection. I become aroused. But when me and my girlfriend are about to have sex I totally lose it. It is totally making me depressed. I thought this only happend to men that were old. Whats wrong can you help me?

Anonymous - 11/12/2005 16:00

Myself and my wife are experiencing infertility problems. My wife is now on medication to help ovulate but the pressure on me to perform is causing me to loose my erection during intercourse... further exacerbating the infertility problem. Any suggestions/help gladly accepted.

Matthew - 23/05/2006 00:16

I have Epilepsy which is controlled by a series of Anticonvulsants also used as Mood Stabilizers for people with Depression (Tegretol, Lamictal, Phenobarbitol). They work at calming down your inner system to keep seizures or mood swings stable, but they also wreck my sex life. My girlfriend and i are all set to have sex when suddenly my middle leg turns into Mr. Softee. I try putting a condom on, and it looks like I'm pushing my penis inside my body as it just collapses. I tried Viagra, but it's no match to all the drugs I'm on, and I can't stop them or I'll have seizures. I'm wondering about the implant now. Haven't asked my doctor yet, as it's too embarrassing for a grown man to talk about. Has anyone here ever had it done?

Anonymous - 16/10/2006 15:31

I am 18 and never had sex. I am getting an erection but not sustaining it at all, for no longer than a minute or two. And it is usually not strong enough anyway. Why cant I sustain it, is it psychological i wonder. It is really stressful. Any help?

Hank - 11/01/2007 13:39

I to am having some ED problems, have any off you guys out there found any solutions???? My problem is Stress, I don't cope well with it, I want to preform we are planning to have kids . All solutions , however odd you may think they are will be helpful

Just 4 You - 15/06/2007 13:39

I have Epilepsy with my first of many seizures at age 7 (1969) and was diagnosed at age 8 (1970). I was never able to achieve an erection longer than a few seconds, and women hated that. It made them think they weren't turning me on. The hardest part for me was never being able to put on a condom to have sex. By the time I got it unwrapped and on the head of the penis, I'd end up pushing my penis inside myself like the old radio antennas. Being on medications for epilepsy I was told that controlling my seizures was more important than having sex. I'm now 44 and although I've been naked with women, I've never been inside one, except with my fingers. Now doctors are saying that's normal for a guy my age, as a way of pushing me away again. I'm looking at the penis implants, just to see if I can have sex with someone. Every woman I've ever tried to have a relationship with, dumped me after the bedroom scene. We both wanted something that I couldn't give her!

Anonymous - 09/10/2007 10:00

My husband has had (Ed) for past 3 years. He has tried all the tablets and injections and nothing seems to work. At this stage he won't talk about it and it's getting both of us down. He has diabetes and is 32 years old. I love him to bits.

curtis(DGO74319) - 26/08/2008 01:27

4th time it has happened now, when it comes to the sex, i cant get hard enough! help

Just 4 You - 26/08/2008 10:34

I went to a Urologist and he tried Viagra, Cialis, and other erection meds, none of which manged to give me an erection firm enough to put a condom on. So I was slated for a Penis Implant and got a 3 cell device that enables me to just push a plastic box inside my scrotum and fluid from a plastic sack (about the size of a breast implant) that's in my belly, drains into two long chambers in my penis. Each is the size of a hotdog when it's filled and the pump in my scrotum doesn't allow the fluid to drain out until I push it again. It either pumps the fluid in to create a full sized rigid penis, or pumps the fluid out, but not both. My girlfriend loves it! I can keep it firm for hours! Sometimes, she likes to flip the switch like I'm a walking talking sex toy! Everybody should ask their Urologist about this! Why try med's that don't work, or be told it's all psychological when you and I both know it's your penis, not your brain that's not working properly!

john(MUV75207) - 15/09/2008 03:26

They say that too much coffee can cause ED, something about EXCESSIVE caffeine that can cause ED, like soda, choc and coffee. But for the most part, its psycholigical or being stressed in my opinion.

Alan Whistler432 - 06/07/2014 20:48

I have been buying herbal erectile capsules from UK. I can honestly say they have changed my life again. Luckily I do not suffer from any heart disease or diabetes. It is in my family so I am checked on regular basis. Nearly 40 now and suffered erectile dysfunction since early 30's. GP costs then getting prescription filled was costing a fortune in Dublin. 

dorothyhyggin - 21/10/2014 10:11

The five oral medications available to treat erectile dysfunction -- Cialis, Levitra, Staxyn, Stendra, and Viagra -- have been used successfully in people with diabetes. In general, however, the success rate of these medications is less than the reported success rates in people without diabetes. These medications may help 50% to 60% of men with diabetes.

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