MEN IN PRIVATE: WHAT TO DO WHEN IT WON’T WORK
There has never been a better time to have erectile dysfunction. The past 10 years have seen a revolution in the treatment of faltering erections. These days something can be done for almost everyone. As the new century opens, there is more in the medicine chest for male sexual problems than ever before. The subject of impotence, once barely whispered about, is now discussed freely in the media and in society. Not that men rush forward to admit they have it; but talking about it is no longer taboo.
At some stage of their lives, about 10 per cent of all men experience impotence. This may be characterised by a lack of desire, performance anxiety or ejaculatory problems.
It is now accepted that the causes of impotence – technically referred to as erectile dysfunction – fall fairly evenly into psychological and medical categories. Frequently a combination of both psychological and medical factors is responsible for the condition. The probability of a man experiencing episodes of erectile difficulty at the age of 40 is 40 per cent, with the odds increasing by 10 per cent every subsequent decade.
Over the years impotence has been defined in various ways. Today the term is used to refer to a failure to achieve an erection sufficient for the satisfaction of both partners.
Depression is one of the major psychological causes of impotence. Another factor is performance anxiety associated with fear of failure. Performance anxiety is often a result of relationship problems or low self-esteem.
Medically speaking, four basic things can go wrong with the mechanics of erections. First, there can be a wiring problem: nerve damage can prevent impulses from the brain reaching the penis. Second, there can be too little blood flowing into the penis to keep it erect. Third, blood can flow in well but drain so fast that the erection cannot be maintained. Fourth, the man can be on medication that sabotages sex. About 90 per cent of cases of physical erectile dysfunction are caused by circulatory problems. The remaining 10 per cent are due to factors such as a hormone imbalance, diabetes or trauma.
The proliferation of publicity about erectile dysfunction in the past decade may have created the impression that impotence has suddenly become a big problem. It has not. All that has happened is that new methods of treatment have been developed and aggressively marketed. In the process the whole issue of problematic erections has been dragged out of the shadows and into the limelight.
Thirty years ago, an impotent male patient would have been sent for counselling. That was pretty much all there was. The first real breakthrough in treatment came in the seventies with implantable prostheses. The second was the development of penile injections in the eighties. In the nineties came Viagra and now there are more developments in the pipeline. Few men cannot now find help.
In their heyday, injections changed the whole perception of impotence. Suddenly experts were claiming that 80 per cent of erectile difficulties were physical. Impotence was medicalised, was seen as a disease and treated as a purely mechanical difficulty. Other important factors were stripped away.
Emotional influences were discounted, and the state of a man’s relationships, his knowledge of sexual techniques and his comfort with bodily expression were given little consideration. Rather than addressing any of these softer issues, doctors prescribed injection therapy to override them instantly.
Medicalisation was attractive because it took away the confusion of impotence and stopped men feeling responsible for it. They were told it wasn’t all in their heads – that it was a physical difficulty that could be corrected. While this was an appropriate diagnosis for some, it was way out of line for others, and the underlying causes of these men’s problem were never investigated.
This attitude did not last. By the late nineties, the importance of psychological factors had been re-established and the treatment of the problem had begun to be the province of family practitioners again.
Family practitioners are the best people to provide initial treatment for impotence. They know their patients best: they know their history and social situation, and can see them as complex, whole beings. They are in a good position to understand the nature of the impotence and, if necessary, institute an appropriate therapy. Instead of just whacking in an injection or prescribing a pill, they can deal with underlying causes. They are more likely, for example, to detect circulatory problems, diabetes or depression. If family practitioners have a difficult or complicated case, they can refer the patient to a multidisciplinary centre, which will have access to all the appropriate facilities.
One of the advantages of Viagra is that it places the management of erectile dysfunction squarely in the hands of family practitioners.
*12\105\2*
Random Posts
Leave a Reply
You must be logged in to post a comment.