I do have problems getting or keeping an erection

"I'm 27yrs old and I been having a hard time getting and keeping an erection, I have this problem whenever I want to have fun with my wife. Please, what can I do?"

Being able to achieve and maintain an erection for satisfying sexual intercourse is something that most men take for granted in their 20s and 30s. However, especially in later years, some men are unable to sustain their erection or may be unable to get an erection at all.
Erection problems like this (erectile dysfunction) are common in older men and can be devastating to a healthy sex life.

Often such problems may be associated with feelings of anxiety or depression and low self-esteem. Occasionally, they may lead to tension between the man and his partner and cause friction in their
relationship.

There are many different causes of erectile dysfunction and most can be treated!

What is erectile dysfunction (ED)?

During sexual stimulation, through seeing, hearing, smelling, touching, or thinking about something that is sexually exciting, the brain sends signals through nerves to the blood vessels in the penis. These signals cause the walls of the blood vessels to widen, causing blood flow into the penis to increase. Because more blood is entering than leaving the penis, the penis becomes engorged with blood, causing it to elongate and stiffen, leading to an erection.

After sexual activity, the blood is allowed to flow out of the penis again and the penis returns to its usual flaccid (soft state). In erectile dysfunction, these events do not occur normally, which leads to difficulty in achieving or maintaining an erection adequate for satisfying sexual activity.

How common is erectile dysfunction?

Very common! It is estimated that in Africa there are more than 11 million men with erectile dysfunction. In a survey of men aged 50-70 years attending primary care clinics in the Western Cape, 7 out of every 10 said that they have some degree of erectile dysfunction.

The chance of having ED increases as a man grows older. A study in America estimated that the incidence of erectile dysfunction in men over 70 is almost double that in men over 40 and that approximately 1 in 20 aged 40 years and 1 in 7 aged 70 years will have complete inability to attain and/or sustain an erection.

It is important to note that erectile dysfunction is not an inevitable consequence of aging and many men do enjoy a satisfying sex life well into their 70s and 80s.

What causes erectile dysfunction?

It used to be thought that the most common cause of erectile dysfunction was psychological. However, anything that interferes with the events that leads to a normal erection – from the ability to become sexually excited, to the normal response of the brain and nerves and proper functioning of the structures in the penis – cause an erection problem. Consequently, we now understand that only a minority of men with ED has a purely psychological cause, and more often, a combination of factors is responsible for ED. Some common causes are listed below:

Possible causes	Examples
Arterial disease	·         Atherosclerosis ·         High blood pressure ·         Diabetes ·         Cigarette smoking ·         Abnormal cholesterol ·         Obesity
Overindulgence in alcohol
Conditions of the nervous system	·         Stroke ·         Alzheimer’s disease ·         Nerve damage due to diabetes ·         Spinal cord injury ·         Nerve injury
Chronic medical conditions	·         Chronic Kidney disease ·         Coronary heart disease
Surgery or radiotherapy to the pelvis	·         Treatment for colon, rectal or prostate cancer
Psychological	·         Stress ·         Strained relationships ·         Anxiety ·         Depression
Medications (prescriptions and over-the-counter	·         Some blood pressure lowering medications ·         Diuretics ·         Some antidepressants ·         Some types of cholesterol-lowering medications ·          Some anti-epileptics

Can erectile dysfunction be cured?

Addressing the underlying cause of the erectile dysfunction may successfully and permanently return sexual function to normal. In some men however, a permanent cure for erectile dysfunction is not possible. Regardless of whether a permanent cure is possible or not, in most men erectile dysfunction can be treated (with tablets or by other means, allowing normal sexual activity).

What treatments are available for erectile dysfunction?

There are various different types of treatments for erectile dysfunction. Some are available only from a doctor, while others are available without a prescription from health shops and pharmacies. You have probably seen many others advertised in newspapers, magazines and on the internet.

Oral Therapies

The newest treatments for erectile dysfunction are oral tablets that are very effective in restoring a normal erectile response. Taking the tablets itself does not cause an erection, but helps to improve blood flow to the penis. After taking the tablet, sexual stimulation is still required for an erection to occur and the erection will go down again later as normal. Oral tablets are useful for most types of erection problems and are convenient to take. They are usually well tolerated and potential side effects are generally mild and self-limiting.

While most of the tablets are effective within a short time after they ate taken (usually within thirty minutes), they do vary in length of time for which they are effective. Some tablets are effective for only a few hours after being taken, while others can be effective for as long as 36 hours after one tablet. This means that, with sexual stimulation, an erection may be achieved at any time during a 36 hour period after taking the tablet. Furthermore, there are tablets that may be taken on a daily basis, meaning that erectile function is restored for a whole day, every day.

Non-Oral Therapies

Other treatments for erectile dysfunction include medications that are injected into the penis. Although they can reliably lead to an erection, many men do not like the idea of injecting themselves with a needle. Side effects include pain and uncomfortable prolonged erections.

Vacuum devices are cylinders that are placed over the penis, which pump out air and allow the penis to fill with blood. A tight ring is placed around the base of the penis to maintain the erection.

With both injection and vacuum devices, erection can be achieved without sexual stimulation.

Surgical implants of semi-rigid rods or inflatable tubes are sometimes used in men for whom other treatments have not been successful.

With medications that restore normal erectile function for a shorter periods of time. Or non-oral treatments, being able to get an erection is dependent on using the treatment shortly before intercourse.

However, some men and their partners may feel that having to have sexual intercourse within a few hours after taking the treatment puts them under pressure, or makes them feel uncomfortable. Many other things also contribute to setting the mood for sexual intimacy and the time des not always feel right.

Tablets that restores the normal erectile response for longer periods (up to 36 hours or all day, every day), give a couple the freedom to choose the moment that is right for them for sexual intimacy. These types of treatments allow more time for intimacy and free the couple from the worry of having to plan intimacy.

However, it is very important that whatever method you choose, you must discuss with your doctor first!

There are 4 very important reasons for this:

• Erectile dysfunction can often be the symptom of another underlying problem (e.g. Diabetes, Cardiovascular disease or depression) that requires a completely different type of treatment. In this case, treating the underlying medical condition may treat the erectile dysfunction as well, in other words you need a proper diagnosis of what is actually wrong before embarking on a treatment.

• Some types of medications may cause erectile dysfunction as a side effect. You need to tell your doctor about all other medications (prescription and over-the-counter) that you have taken recently.

• Not everything that is advertised as a treatment for erection problems has been adequately clinically tested and proven to be effective and safe. Some so-called treatments at the best do nothing, while, at worst, they may have unpleasant side effects and actually cause damage to the body and penis.

• Not all men are the same and not all cases of erectile dysfunction are the same. Treatments need to be personalized to each individual. That can only be done with a full assessment by your doctor.

If you are not sure about a treatment, ask your doctor!

Risk of cardiovascular disease in men with erectile dysfunction

Arterial disease is a common cause of erectile dysfunction, and erectile dysfunction may be the first sign that a man already has significant arterial disease. Consequently, a man with erectile dysfunction may be at a greater risk of having a heart attack and a stroke (cardiovascular disease).

The same risk factors that increase the risk of cardiovascular disease also increase the risk of erectile dysfunction. These include smoking, obesity, abnormal cholesterol levels, high blood pressure and diabetes.

Controlling these risk factors (e.g. stopping smoking, exercising and maintaining a healthy diet) can not only reduce the risk of cardiovascular disease, but may also help to improve erectile function. Furthermore, it is important that if you have erectile dysfunction, you should see a healthcare professional who can determine whether you are at significant risk for cardiovascular disease.

For further information, you can speak to your doctor.