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29 Apr 2003

erectile dysfunction?
Hi

My boyfriend approaches me, but about after 10 minutes, he can't get a climax, it is as if he loses interest? He says it has nothing to do with me, he just physically can't keep the erection. Anything we can do to help him?
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Expert
Sexologist
sexy

01 Jan 0001

Maybe you've just answered your own question "he loses interest", he might be distracted because of heavy work pressure, financial worries, illness, affairs, etc, etc.
But it can also be a medical condition. So here is the usual fact sheet for erectile dysfunction:

Erectile dysfunction (ED) is defined as the consistent inability (75% of the time) to attain or maintain an erection sufficient for satisfactory sexual intercourse. Historically, this condition has been known as impotence. The term erectile dysfunction is more medically accurate because it refers specifically to the clinical problem of gaining and keeping an erection. However, sufferers use the words erection problems to describe their condition.Men with erectile dysfunction often retain other related sexual functions such as sexual desire and the ability to have orgasms and ejaculate: some do not.

Prevalence and association with age:
After the condition of premature ejaculation, ED is the most common male sexual problem, affecting an estimated 2,6 million South African men and more than 100 million men worldwide. ED is suspected to be dramatically under-reported, as the majority of men do not seek diagnosis or treatment for this condition.

ED usually begins around age 40 and becomes progressively more prevalent as men get older. A recent study (Massachusetts male aging study) found that among men aged 40 to 70, approximately half (52%) had a problem achieving and maintaining an erection. While the incidence of complete ED is about 5% at the age 40, it increases to 15 – 25% of men aged 65 and older.

Although the rate of ED increases with age, aging itself does not appear to be the cause. Rather, age related illnesses such as vascular diseases and diabetes, the effects of certain medications taken to treat those illnesses (for example – beta-blockers and diuretics for raised blood pressure) and the toll of years of smoking and alcohol use are reasons why ED is more prevalent and severe as men age. Whilst ED should not be considered a natural or acceptable part of the ageing process, it does, however take elderly men longer to develop erections and force of their ejaculations is generally diminished.


Diagnosis of ED:
Although ED is a serious condition, a recent study found that of those suffering from ED, only 7% considered their problem abnormal for their age and only 5% intended to seek treatment. Many assume nothing can or should be done. Moreover, men do not know what to expect if they seek treatment and may be embarrassed to discuss their problem with anyone, including their doctor. The availability of new treatment options may help alleviate these apprehensions.

The nature of a patient’s ED can be diagnosed by combining clinical history, a physical examination, laboratory tests (such as serum testosterone level and penile arterial pulse wave analysis) and / or filling out a simple questionnaire.

If a man has a normal erection with foreplay but loses it upon entering the vagina (intromission); has a normal erection with some partners but not others; or has a normal erection with masturbation but loses it with a partner, chances are the source of the ED is psychogenic.

ED’s effect on partners:
ED can have a profound effect on feelings of self-worth and self-confidence and may impair the quality of life of affected men and their partners.

The condition may damage personal relationships and lead to frustration, anger, depression and anxiety that pervade all aspects of life. There is a psychological element in virtually all cases of ED. Frequently partners feel rejected or undesirable because of the perceived “inability” to arouse their partners and because of the lack of communication or misunderstanding about the condition.

Risk factors of ED:
Psychological causes account for the majority of ED complaints, yet there is growing recognition that the origin of a lot of ED is organic (physical), often with a contributing psychogenic component. In fact, ED may be the first sign of an underlying medical condition. Dietary factors, largely ignored by conventional medicine, also fuel the problem. Following are the risk factors that are associated with ED.
· Clogged arteries (arteriosclerosis) is a risk factor in approximately 50% of men over 50 years of age and 70% of men over 60 years of age in the United States
· Diabetes, which can affect both vascular and neurological systems, is a common concomitant condition associated with ED. About half of men with diabetes are affected with ED, which occurs 10 – 15 years earlier in men with diabetes than in the general population.
· Raised cholesterol a recent study showed a distinct relationship between serum cholesterol levels and increase in ED. For every mmol/litre of cholesterol increase above the normal range (3.63 – 5.18 mmol/litre) the risk of ED increases. Researchers concluded that high levels of cholesterol and low levels of “good” lipoproteins (HDL – high density lipoproteins) were important risk factors for developing ED.
· Kidney disease is often associated with ED. Nearly half of the male patients with uraemia (urea in the blood) and 75% of dialysis dependant men experience ED.
· Hormone abnormalities such as low bodily androgen (testosterone) levels and thyroid problems (in rare cases), can be responsible for ED.
· Dietary factors Men with diets high in caffeine, sugar and alcohol experience more ED, as do men who smoke and use recreational drugs. Diets poor in vitamins (such as vitamins C and E), minerals (such as zinc), essential fatty acids and antioxidants (such as found in fresh fruit and vegetables) conspire against vascular integrity and sufficient blood flow to the penis’s erectile tissue (Corpus Cavernosum)
· Injuries that may bring associated ED include spinal cord (neurologic), pelvic or urologic such as prostatectomy (excision of the prostate gland). One third of men in the US with pelvic fracture with associated arterial injury are affected. And in some cases, ED is associated with nerve damage or impairment of penile blood flow after pelvic surgery. In men undergoing radical prostatectomy, at least 40% will experience ED, as will 50% of men with spinal cord injury resulting from lumbar (lower back) injury.
· Psychogenic factors, tiredness and stress account for about 10 – 20% of cases of ED in men over 50 and a much greater prevalence in young men.

ED treatment options:
The ultimate goal of therapy for ED has been described as being a treatment with the following ideal characteristics: simple to use, non-invasive, painless, highly effective, well tolerated and affordable. The introduction of agents with all of these characteristics should encourage more ED sufferers to seek remedy for their problems.
ED treatment options include the following:

Surgery:

Penile prosthesis implants:
A penile prosthesis is surgically implanted into the penis, an irreversible process. This is regarded as last resort due to the invasive nature of this treatment option

Venous / Arterial surgery
Option restricted to surgeons only and very few patients opt for it.

Vacuum pump devices
Vacuum constriction devices (VCD’s) consist of a closed plastic cylinder that is placed over the penis in order to create a vacuum effect that increases blood flow into the penis. Generally only recommended by specialists but high cost of importation limits its usage.

Intra-cavernosal injections
Intra-cavernosal injections (given directly into the penis), currently first line ED therapy for Urologists, but this situation may change with the advent of oral therapies. They are effective but because of the invasive nature of the administration, not deemed ideal by either sufferers or healthcare workers.
Intra-urethral pellet
A pellet of alprostadil is introduced into the penis (urethra) to evoke a local reaction, which results in an erection.

Oral treatments:

This therapeutic category is characterised by “off label” (unlicensed) use of a variety of scheduled products that have effects ranging from curing lethargy to increasing libido and as such are only marginally effective in treating ED and most have been evaluated in clinical trials in ED patients with the exception of sildenafil citrate (Sildenafil).

· Sildenafil citrate (Viagra): Launched in South Africa in March 1999, Sildenafil is effective in about 70% of ED patients. Sildenafil helps restore penile blood flow and erection in response to sexual stimulation

· Oral androgens: Oral androgens (testosterones), where low bodily testosterone is thought to be the cause of ED, are being used as first line therapy by GP’s and by Urologists.

· Psycho stimulants: Psycho stimulants are used by GP’s to cure lethargy associated with sexual dysfunction.

· Antidepressants: Antidepressants are used equally by Urologists and GP’s to break the vicious depression and ED cycle. Antidepressants are also used where the patient is suffering from depression.


Natural remedies:

Traditional healers (Sangomas and Nyangas) have, for centuries, made use of varying herbal remedies to treat what is traditionally known as loss of libido. Herbal medicines, most often registered as food supplements, offer many of the same therapeutic benefits as drug therapies, with a better risk/benefit ratio.

Coryanthe yohimbe:

Coryanthe yohimbe is reputed to increase libido and shorten the latency period between ejaculations. However, because of its possible effects in overdosing (anxiety, aggressive behaviour and raised blood pressure), this herbal medicine should only be taken under careful instruction.

Siberian / Korean / Panax Ginseng:

Ginseng is well known for its aphrodisiac properties. Called adaptogens, they seem to target any bodily system that needs nutritional support – resulting in higher energy production and improved function. A man is consequently better able to achieve and maintain an erection. Ginseng Panax quiquefolius is considered safer for long-term use.

Ginkgo biloba:

In several studies, Ginkgo caused increased peripheral blood flow both in normal healthy subjects and those with arteriosclerosis (hardening of the arteries). For instance, 60mg per day of Ginkgo extract increased penile arterial flow in a group of patients who had not responded to intra – caversonal injections.

Professional counselling:
Psychotherapy and or behavioural therapy alone may be helpful for some patients in whom no organic cause of ED is detected.

Dr Elna Mc Intosh
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
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