Dr Dulcy Rakumakoe
5 minute read
8 Jul 2019
10:48 am

What you need to know about erectile dysfunction

Dr Dulcy Rakumakoe

There are many bogus 'treatments' on the market and in newspapers - try and avoid those.

Picture: iStock

Sexual health is essential to an individual’s general health, affecting quality of life and psychosocial and emotional well-being.

However, sexual problems are estimated to affect 20-30% of men, with the prevalence increasing as individuals grow older.

Erectile dysfunction is the inability to get or keep an erection firm enough to have sexual intercourse. It is also sometimes also referred to as impotence.

Many guys experience it during times of stress. If it is frequent, it can be a sign of health problems that need treatment.

It can also be a sign of emotional or relationship difficulties that may require the couple to go for counselling with a psychotherapist. It can also manifest as premature ejaculation, delayed or absent ejaculation and even lack of interest in sex.

Diabetes mellitus, cardiovascular disease, genitourinary disease, psychiatric or psychological disorders and poor general health have been identified as common conditions associated with sexual dysfunction. There is also high comorbidity with HIV infection but that area is underresearched.

Declining sexual capability is a devastating problem for aging men. The importance of being able to function normally from a sexual point of view is a major issue in men’s lives and the decline in potency represents a clear indication of a man’s mortality.

The subsequent psychological manifestations of the problem, like depression and anxiety, represent a further complication of the underlying physical disease process. The impact of this syndrome on marriages, family and social relationships, is considerable.

Picture: iStock

How does a man get an erection?

An erection is the result of increased blood flow into the penis. Blood flow is usually stimulated by either sexual thoughts or direct contact with the penis.

When a man becomes sexually excited, muscles in the penis relax. This relaxation allows for increased blood flow through the penile arteries. This blood fills two chambers inside the penis called the corpora cavernosa. As the chambers fill with blood, the penis grows rigid.

Erection ends when the muscles contract and the accumulated blood can flow out through the penile veins. Erectile dysfunction can occur because of problems at any stage of the erection process. For example, the penile arteries may be too damaged to open properly and allow blood in.

Causes of erectile dysfunction

• Lifestyle related: obesity, drug use, alcohol use, smoking.

• Mental problems: stress, anxiety, sleep disorders, depression or relationship problems.

Medical: cardiovascular (heart) disease, kidney disease, cholesterol problems, hormonal and neurological problems, diabetes, hypertension.

• Damage: direct trauma or from cancer or surgery.

• Medication: It can happen as a side effect of the medication one is taking, for example hypertension medication, depression medication, antihistamines, some pain medication.

• Some sport: Prolonged bicycling, which can compress nerves and affect blood flow to the penis, may lead to temporary or permanent erectile dysfunction.

Picture: iStock

Symptoms of erectile dysfunction (ED)

ED is defined by an inability to get or sustain an erection firm enough for sexual intercourse. It has no other symptoms.


It is a treatable condition. It is important that you do not first self-prescribe. There are many bogus “treatments” on the market and in newspapers. Try and avoid those.

The type of treatment generally depends on the underlying cause of the erectile dysfunction. It can start with counselling and lifestyle changes. It is important that you consult a doctor to first find out the exact cause. Treatment can also be medication or surgery to improve the blood flow.

Treatments for erectile dysfunction have advanced to such an extent that it is now possible to return up to 90% of men with erectile dysfunction to normal sexually active lives, even well into the eighth and ninth decades of life.

Common medications include: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra, Staxyn), Avanafil (Stendra) and Testosterone replacement.

The first four medications enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation. Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves.

These medications amplify that signal, allowing men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side-effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not fix your erectile dysfunction immediately.

Picture: iStock


If medications aren’t effective or appropriate in your case, your doctor might recommend surgery. For example:

• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.

• Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or semirigid rods. Inflatable devices allow you to control when and how long you have an erection. The semirigid rods keep your penis firm but bendable.

• Blood vessel surgery. Rarely, leaking or obstructed blood vessels can cause erectile dysfunction. In this case, surgical repair, such as vascular stenting or a bypass, might be needed.

Lifestyle remedies

If you smoke, quit. If you have trouble quitting, get help.

Lose excess pounds. Being overweight can cause or worsen erectile dysfunction.

Exercise. It can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.

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