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“Ground Control to Major Tom, Your Circuit’s Dead, There’s Something Wrong..”

| By: Dr Robert Stevens

When you break it down, humans have some primordial needs that all need attention and satisfaction – food, water, shelter & SEX.  Here at the Men’s Health Clinic we will help you with the last one!

You need to forget all the nonsense of materialistic gains and ultimately pointless endeavours that this modern ‘civilised’ world has surreptitiously placed upon our shoulders.  We only NEED food, water, shelter and sex; the rest is pure and utter BS.  It always vexes me that with our supposed superior intellect, insight and reasoning powers, we are the only species on the planet that feels the need to pay to be here.  It’s too late for us now, that’s the way it is, but you can still alter your priorities.  You can’t remove the need for hard earned cash, but you can lower it on your list.  Many of us earn our position in life through feeding what is inherently rotten, money.

I’m always reminded of the old ‘Cherokee Tale Of Two Wolves’

One evening an old Cherokee Indian told his grandson about a battle that goes on inside people. He said, ‘My son, the battle is between two ‘wolves’ inside us all. One is Evil. It is anger, envy, jealousy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.The other is Good. It is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion and faith.’The grandson thought about it for a minute and then asked his grandfather: ‘Which wolf wins?’The old Cherokee simply replied, ‘The one you feed.’

That’s not to say I don’t like nice things, if I buy something, it usually has to be the best, if I can’t afford the best I simply won’t buy it.  I think it’s a man thing.  If I was to buy a Porsche, I would only ever buy a 911 turbo or GT3R, anything else would seem a waste.  It’s not because there is anything wrong with the Boxster, I’m sure it’s a great car, it’s just not the best.  I’m a kind of all or nothing kind of guy, some people may say obsessive.  I’m aware it’s a character trait that needs some attention.  I’ve been feeding the wrong wolf.

I’m always banging on about balance.  I know I sometimes sound like a broken record, it’s intentional… being naughty is fun, taking risks is fun.  Where would we be without the drive and ambition to succeed?  Wouldn’t life be terribly boring without it?  So it’s worth reiterating the need for balance when it comes to health.  Balance is king.  So my point is (there is a point to my ramblings hopefully!), when it all gets broken down and stripped away, when the fundamental needs of food, water, shelter and sex are not met, disharmony and unhappiness are sure to follow.

So this blog is all about erectile dysfunction, a topic us men really really don’t want to talk about.  For good reason, we are men – strong, confident, successful men.  We are the masters of our own destinies.  Well, what happens if you can’t perform in bed?  You might feel like curling up into a ball and wishing it all away, or you might want to stand up and take action!  May I suggest the latter.

What is Erectile Dysfunction?

Erectile dysfunction has been defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance. It can be very troubling, not only for you but also for your partner. The inability to perform sexually can have a profound effect on your self-confidence and self-esteem, it can cause relationship issues that wouldn’t otherwise be there. Achieving an erection is a complex neurovascular mechanism that is also under hormonal control, the fact we ever get it up should be celebrated. Don’t celebrate too soon, if you do, please read the upcoming blog on ‘Premature Ejaculation’!

How Common is Erectile Dysfunction?

A UK study of men aged 18-75 showed a rate of 39% for lifetime erectile dysfunction with a current prevalence of 26%.  However, it is estimated up to 50% of men will suffer with the condition at some point in their lives.

How is Erectile Dysfunction Diagnosed?

Here at The Men’s Health Clinic we screen our patients using the International Index of Erectile Function (IIEF-5) Questionnaire.  It is a useful diagnostic tool.  It important to identify a cause however, in order to effectively manage the condition, simply reaching for the little blue pills may isn’t always the right thing to do.  There may also be a more sinister underlying cause so don’t ignore the problem and just bury it away, something us men are prone to do all too often.

Over the past 6 months:-
1)  How do you rate your confidence that you could get and keep an erection? 
Very low1
Very high5
2)  When you had erections with sexual stimulation, how often were your erections hard enough for penetration? 
Almost never or never1
A few times (much less than half the time)2
Sometimes (about half the time)3
Most times (much more than half the time)4
Almost always or always5
3)  During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner? 
Almost never1
A few times (much less than half the time)2
Sometimes (about half the time)3
Most times (much more than half the time)4
Almost always or always5
4)  During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? 
Extremely difficult1
Very difficult2
Slightly difficult4
Not difficult5
5)  When you attempted sexual intercourse, how often was it satisfactory for you? 
Almost never or never1
A few times (much less than half the time)2
Sometimes (about half the time)3
Most times (much more than half the time)4
Almost always or always


Tot up your scores, how did you do?

1 – 7 suggests severe erectile dysfunction, 8-11 moderate, 12-16, mild to moderate, 17-21 mild, 22-25 suggests you have nothing to worry about.

Please note, the occasional blip on the scorecard is not a problem, a bad day is a bad day, it doesn’t have to ruin your season.

Causes of Erectile Dysfunction

Despite sexual intercourse being a basic human need, obtaining an erection long enough for ejaculation is a complex neurovascular process that is under hormonal control.

There are numerous physical and psychological factors that can influence it:-

  • Cardiovascular Disease – Atherosclerosis, High Blood Pressure, Diabetes
  • Neurological Disease – Multiple Sclerosis, Parkinson’s disease, Cerebrovascular disease
  • Hormonal Problems – Low Testosterone, Overactive or Underactive Thyroid, Cushing’s disease
  • Physical Abnormalities – Peyronie’s Disease
  • Certain Medications – Including some antihypertensives, antipsychotics, antidepressants, antihistamines, anti-androgens, corticosteroids, indigestion remedies, cytotoxics and others including opiates & benzodiazepines
  • Psychological Factors – Including acute & chronic stress and/or performance anxiety

The reality is that a lot of these factors are inter-related, cause and effect are sometimes not crystal clear.  Too often men simply reach for the little blue pill as a quick fix and are troubled if it doesn’t immediately work. What then ensues is panic and despondence, the last thing you need before a night of passion.  Sex should be fun, it should be one of the most enjoyable things you do!

“An intellectual is a person who has discovered something more interesting than sex.” – Aldous Huxley

I’m making no assumptions, but I’d hazard a guess doggy style and reverse cowgirl were not in his arsenal!

The little blue pills simply cause vasodilation allowing the penis to engorge with blood so that you can obtain an erection.  It does not improve your libido apart from perhaps giving you more confidence through its physical effects on the body, but there is nothing wrong with the occasional placebo to help your performance if it works.  Failure to address the underlying cause may have serious consequences on your overall health, not just your sexual health.  The psychological aspect behind erectile dysfunction cannot be under-estimated.  We are fragile creatures, I don’t care what anyone says, ignoring the machismo of the locker room, this complex function isn’t to be taken for granted and professional help should be sought if needed.  Erectile dysfunction does not make you any less of a man.  Having confidence in your erections gives you confidence in life.

Why Does it Matter?

Asides from the biological need to procreate and the fact that sex is fun, erectile dysfunction is an independent risk factor for cardiovascular disease, equivalent to that of smoking!  Low libido and erectile dysfunction are major symptoms of low testosterone, which is a treatable medical condition called Testosterone Deficiency Syndrome.  Ignore it at your peril.

The Men’s Health Clinic is here to help…

Dr Robert D Stevens MBChB MRCGP Dip.FIPT