What’s causing your erectile dysfunction?
We may live in a society where being sexually explicit is the norm, but erectile dysfunction is a hidden issue that causes many men deep shame.
Erectile dysfunction is common. One in 10 men in Australia is unable to have an erection and one in five men over the age of 40 experiences erectile dysfunction (ED), according to Andrology Australia, the centre for male reproductive health.
Erectile dysfunction is defined as the inability to achieve and/or maintain an erection that is suitable for penetration. There was a time when this was called impotence, but that’s not politically correct these days, according to sexual health researchers who say it is associated with powerlessness.
For many guys, there is no cure for ED, says Andrology Australia. However, for some men there may be a reversible underlying cause. What causes erectile dysfunction is usually broken down into two camps: psychosocial problems such as performance anxiety, relationship problems, depression or financial concerns. The second camp is physical problems and this can range from urological issues to endocrine problems such as Thyroid disease.
According to Dr Michael Lowy, from Sydney’s Men’s Health, the issue among younger men is more likely to be psychological than physical. As men near 40, this can change due to lifestyle factors or health concerns such as being overweight, type two diabetes, sleep apnoea, hypertension or heart disease. Other factors such as heavy drinking, recreational drug use, smoking or high cholesterol can also have a detrimental impact.
“I have a lot of men who come to see me with ED, it’s my biggest source of referral,” says Dr Lowy. “But there are probably a lot more men out there with this problem than we don’t know about. It’s still considered shameful.
“Younger men come to me with sexual performance issues, generally from their 20s onwards, and there is a lot of anxiety associated with that; but there are younger men who exacerbate the problem with binge drinking or taking steroids.
“As men get older, it’s likely that the issues are more physiological. They tend to feel ashamed and their attitude is that they don’t want to bother anyone with it. I think that’s sad.”
However, Dr Lowy says phosophodiesterase-5 (PDE5) inhibitors such as Viagra, which came on the market here in the late ’90s, have changed the landscape for men when it comes to erection problems, and he says that’s been extremely helpful to many men.
However, Rik Schnabel, a NSW-based life coach who works with men with ED, is more cautious in his appraisal of drug-taking. “I see many men who really need help with sorting out the underlying emotional causes of their ED,” he says. “And I see too many men who are masking feelings of guilt and shame, in relation to things like a long-term relationship ending or cheating on their partners, and so taking medication just masks what’s really going on for them.
“I worry that some of these men become too reliant on a pill to sort out their sex lives, when what they really need is to sort things out on a far deeper emotional level. It takes a very brave man to come to see me with ED. For every man who comes to see me, many don’t see anyone.”
Meanwhile, Dr Lowy says there is also a group of young men who bypass seeing their GP, and buy Viagra and the like online to enhance their sexual performance.
“Younger men who take these sorts of drugs by buying counterfeit medication online are doing themselves a disservice. They’re potentially putting themselves at risk because you don’t know what you’re buying, it could be poison, and I would never encourage it. But, young men are often risk-takers.
“However, I wouldn’t want anyone to become psychologically dependent on these types of drugs. What they often need is simple reassurance or counselling, or they need to rule out that they do in fact have a physical issue associated with their ED.”
While ED is common, it’s not the number-one sexual problem among Australian men. Juliet Richters, professor in Sexual Health at the School of Public Health and Community Medicine at the University of New South Wales, says another issue is more prevalent. “Everyone talks about ED as if it were the most common sexual problem out there, it’s not,” she says. “In major surveys in the US, Britain and in Australia, the top of the list is actually a lack of interest in sex.”
She says there’s often a cause couples don’t want to address. “Sometimes in sex counselling, the issue isn’t ED,” she says. “It’s that the man no longer wants to have sex with his partner. You can’t fix that with a drug.”
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