Dr Dulcy Rakumakoe
Sexual health is essential to an individual’s general health, affecting quality of life and psychosocial and emotional wellbeing.
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 highly under-researched.
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.
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.
Erectile dysfunction is the 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. 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.
Testosterone replacement therapy might be recommended as the first step. You might need to work with your doctor to find the right medication and dosage for you.
If medications aren’t effective or appropriate in your case, your doctor might recommend surgery. For example:
Penile implants – This involves surgically placing devices into both sides of the penis which allow you to control when and how long you have an erection.
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 procedure, might be needed.
Smoking – 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.
Stop alcohol and illicit drugs – Drinking too much or taking certain illegal drugs can worsen erectile dysfunction.
Work through relationship issues – Consider counselling if you’re having trouble improving communication with your partner or working through problems.
Dr Dulcy Rakumakoe. Picture: Refilwe Modise
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