ERECTILE DYSFUNCTION
Erectile dysfunction, otherwise known as impotence, is the inability to sustain an erection to perform sexual intercourse and ejaculation. This medical problem affects at least 30 million men in America and the figure may be much higher. The introduction of Viagra in 1998, the first truly effective oral medication for impotence, brought many men to their doctors for treatment of this condition.
The physical causes of impotence can include medication side effects (especially high blood pressure and antidepressant drugs), alcohol, diabetes, vascular disease, low testosterone levels, low zinc levels, multiple sclerosis, Parkinson’s disease, low thyroid function and low pituitary function. A significant percentage of cases are due to emotional causes, especially performance anxiety. Failure to perform sexually, even once, can be a blow to the self-esteem of many men. Subsequent anxiety about whether they can perform can lead to impotence and a downward spiral of anxiety and poor performance. Other emotional causes include depression, guilt, fear of intimacy and shame. The ability to perform sexually has great symbolic meaning for most men and lose of this ability equates with lose of power or potency.
If a man suffers from this problem, he should see a physician and have a thorough history and physical exam done. If this does not reveal an obvious cause, a battery of blood tests can be done to see if an organic physical problem is the cause. Once a diagnosis is established, treatment options can be explored. Viagra works well for impotence of psychological cause but is less effective if disease has damaged the nerves or blood vessels of the penis. This drug is deadly when taken with nitroglycerin and can cause flushing, headache, diarrhea and stuffy nose. Other options for impotence of physical cause include injections of vasoconstricting drugs into the penis, vacuum assist devices, surgical implants and vascular surgery.
Older age is not a direct cause of impotence and a normal healthy male should be able to have satisfactory sex into advanced old age. Failure to have sex for many years may lead to impotence in old age since all body systems work best when used regularly.
Holistic treatments may be very effective. Exploration of emotions and the quality of the relationship of the couple are very important. Couples therapy or therapy with a sex therapist may be useful. Acknowledgement and discussion of the problem with the partner can be very helpful in alleviating shame and anxiety, which may improve performance.
Low zinc can be a major factor in low testosterone levels. A trial of zinc supplementation at 30-60 mg daily is warranted. Eating a healthy whole foods diet is essential for proper function of all body systems and this includes the male gonads.
The hormone DHEA is a precursor of testosterone and is frequently low in older males. A trial of 25-50 mg daily may be undertaken under the supervision of a physician. DHEA may contribute to prostate cancer so men at high risk should avoid it.
The herb, yohimbine, has a long history of being used as an aphrodisiac. It increases blood flow to the penis by increasing production of the adrenal hormone norepinephrine. This herb may cause high blood pressure, headaches, anxiety and flushing and should be used cautiously by men with heart disease. The herb Tribulus has been studied and is helpful in increasing fertility and in improving sexual performance.
Daniel Blodgett MD