How to cope with erectile problems

For some men, the problem isn’t that their erections aren’t what they used to be; it’s that they find it difficult to get or maintain an erection at all. Until recently, many doctors considered erectile dysfunction to be more in the mind than in the body. But now doctors know that physical problems cause 85 per cent of erectile difficulties. Common culprits include arteriosclerosis (hardening of arteries, which restricts blood flow to the penis), diabetes (which can damage blood vessels and nerves involved in erections) and high blood pressure, or the drugs that are used to treat these problems. Spinal cord injuries, strokes, surgery or injury to the pelvic area, and groin injuries that damage the penis or testicles can also interfere with erectile response.

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Emotional factors can complicate the situation. It’s natural to feel distressed when you want to perform and your body refuses. Unfortunately, stress just makes it worse. So try to relax and, most importantly, keep the lines of communication open between you and your partner.

The Viagra factor

When these little blue pills hit the market in 1998, millions couldn’t wait to try them—doctors wrote more than 16 million prescriptions for them in their first two years on the market.

For once, the hype was accurate. Sildenafil citrate, better known by its brand name, Viagra, improves erectile function for 80 per cent of the men who use it. It works by suppressing an enzyme produced in the penis that breaks down nitric oxide, which is needed for an erection. Viagra requires 30–60 minutes to take effect and physical stimulation is still required to get an erection, which can last 45 minutes to an hour.

But, Viagra, like any drug, has side effects, which can include headaches, diarrhoea, flushing and tinted vision. Men who take heart medication that contains nitrates cannot take Viagra. This drug combination can cause a sudden and dangerous, even fatal, drop in blood pressure. Viagra has not been shown to improve erections in men who are not impotent.

Another drug, apomorphine (Apomine), is currently only available as an injection for the treatment of Parkinson’s disease, but may soon be approved for the treatment of impotence. It works by increasing the levels of the brain chemical dopamine in an area of the brain thought to be important to erections. Since its mechanism is different from that of Viagra, this drug may prove to be beneficial for men who have found Viagra ineffective. And, unlike Viagra, it’s safe for men who take nitrate drugs. But this drug also has side effects. They include nausea, vomiting and dangerously low blood pressure that can lead to fainting.

Other treatments for erectile problems

One of the newest and most promising treatments for erectile dysfunction is a drug called alprostadil (brand name Caverject, for injection; and Muse, as an intraurethral pellet). It’s a synthetic form of prostaglandin E1, a hormone that causes the smooth muscle tissue in the penis to relax, allowing for the increased blood flow that causes an erection. You can inject alprostadil directly into the muscles of the penis with a very fine needle or use a disposable applicator to insert it, like a suppository, into the urethral opening. Erections occur within 15 minutes. Alprostadil should not be used more than three times a week. Other options you can take a look at are suction devices, implanted pumps and even surgery to repair damaged vessels that impair blood flow.

Natural approaches

There are also several nondrug options that are worth a try:

• Go for ginkgo biloba. It may offer a natural remedy for men with mild erectile difficulties. The herb appears to improve circulation by relaxing blood vessels, helping more blood reach the penis. If you are taking aspirin or prescription blood thinners (such as Coumadin), be aware that ginkgo can increase their effects, so check with your doctor before taking it.

• Get enough zinc. Adequate intake of this mineral is important to the production of testosterone. Foods rich in zinc include yoghurt, nuts and seeds, fortified cereals, wheatgerm, shellfish and poultry.

• Try losing weight. According to a recent study, men with a 107 cm waistline were nearly twice as likely to have erectile dysfunction as those with a 80 cm waist.

• Give up cigarettes. Smoking damages blood vessels, including the tiny capillaries in your penis. This can make it difficult to achieve and maintain an erection.