There is hardly a penis that has not refused to straighten up at the desired time. Perhaps because there was too much red wine in the evening, or because stress at work has diminished the desire.
Not so bad, man thinks, and rightly so. But if the problems occur more and more frequently and "the inability to get or maintain an erection sufficient for sexual intercourse" is the rule rather than the exception, the matter should no longer be taken lightly. Not only the penis suffers from erectile dysfunction, but also the psyche and partnership. And sometimes there is another serious illness behind erectile dysfunction (ED), which should be treated urgently. A visit to the doctor brings certainty here - and usually also help.
How frequent impotence is in Europe was demonstrated by a study carried out a few years ago, in which the erectile capacity of 2,869 men was tested with special questionnaires within the framework of the health examination: 32.2 percent of the men involved fought with erectile dysfunction.
Extrapolated to the population as a whole, about one million Europeans would be affected - 700,000 by a mild form of ED, 300,000 by a moderate to severe form.
Potency problems become more frequent with age. Between the ages of 51 and 60, ten percent complain of moderate to severe problems during sex; between the ages of 71 and 80, the figure is already 50 percent. All forms of erectile dysfunction together, 37 percent of men in the 50s and 71.2 percent of men in the 70s are affected.
In the years before, erectile dysfunction is more or less evenly distributed in the age groups: Around 20 percent of Twens report having "failed" several times, as do men between 40 and 50. "In these young men, erectile dysfunction was usually mild, but the pressure of suffering was all the greater because of the high pressure of expectations."
"Of course, not all these men are in need of treatment," we point out. "That depends strongly on the personal feeling. Impotence not only threatens sexual function, but is often experienced as a general loss of status and a weakening of male identity. If men cannot get an erection for a longer period of time, they do not feel sexually any more than men. Depression can be the result.
"The partners of those affected and the partnership often also suffer massively as a result," says Prof. Siegfried Meryn, Chairman of the Society for Men's Health and Gender. "Open dialogue with women is the first step towards solving problems. Otherwise, the spiral of silence and withdrawal will continue."
The next path should lead to the doctor. Especially in older men, erectile dysfunction can be a sensitive sign of functional disorders of the inner wall of the vessel, the first stage of atherosclerosis. Erectile dysfunction is also an early sign of diabetes. "No one should shy away from openly addressing sexual problems," advises Prof. Meryn. "Because sexual health is a high good and the doctor is the specialist with whom one can talk about it - and who can help.
Since the introduction of the class of PDE-5 inhibitors, impotence has become a more frequent topic in medical practices. Previously, there were hardly any drugs that could help with an erection so reliably.
As long as only injections into the penis or vacuum pumps promised improvement, many men preferred to accept the problems. With modern medication, it is now possible to achieve a sufficient erection in about eight out of ten men simply by taking one tablet. Of course, the success of therapy depends on the underlying disease, but even with nerve damage resulting from prostate surgery, spinal cord injuries or severe vascular changes, PDE-5 inhibitors can still improve the situation.
For some of the men - the size of the proportion is controversial - psychological problems are the cause of impotence. Disgruntlement, nervousness or fear of failure spoil pleasure. The woman's reactions also have an effect, of course. What role do the problems play in the partnership? In some cases the honest answer to this question - worked out together - can already solve the problem.
"The partner should be involved in the treatment as early as possible," advises Prof. Meryn. In couple therapy or sexual therapy, difficulties are tackled that even the hardest erection cannot overcome. After all, it's all about "sexual health" and not just penis circulation. Don't worry: couples' consultations are today a time-limited, goal-oriented measure, which has nothing in common with a year-long analysis according to Freud's model. In ten to 15 sessions all relevant things should be discussed.
In the case of mild erection problems, a change in lifestyle is often sufficient for a significant improvement. The usual suspects have been proven to be associated with impotence: Smoking, overweight and lack of exercise. Slimming a few kilos seems to be particularly effective: In a study conducted by the University of Naples on 110 overweight men with potency problems between the ages of 30 and 35, one third of the participants were cured by diet and exercise alone (weight reduction of around ten percent).
For a sexuality to be experienced as satisfying, several factors must come together: Physical health and sufficient fitness, the ability to have an erection, a functioning partnership, emotional readiness in both men and women.
Accordingly, a one-dimensional treatment in the form of a pill is sometimes not enough to achieve sexual health. Just as a couples counselor cannot ignore physical problems. However, if the different areas of sexuality are considered together, and corrected if necessary, sexual satisfaction is achievable for the vast majority of people.
Written by Mark Riegel, MD
Here’s what we've been up to recently.