Male Erectile Dysfunction – part III

I have spent a great deal of time discussing impotence in people under 50 even though the problem affects the over 50s disproportionately more. Besides, the increase is continuous and exponential with age. In other words, the problem starts from before age 50 but becomes more prevalent after, rising to dramatic levels in the 60s and 70s.{{more}} The result is that most men in these age groups have “given up” sex and “shut up shop” as they would have been suffering from this problem for years without any help. Most attribute it to the “normal” process of aging and with the aging of their partners both have decided to resign from sex and live a quiet usually “godly” life. This is when most of my female patients would say, “Doc, I have left the world”. This is a nice way of saying I have stopped having sexual relations with my boyfriend or husband. This is usually because the partner, because of age, has also stopped “asking” for it.

This attitude of western society towards sex in the mature and older years, is why, when medications such as Viagra came on the scene over 10 years ago, many men abused it inappropriately with some suffering fatal consequences. This abuse only occurred because men in the above mentioned age groups are still interested in sex. Many will try different methods to achieve and maintain erections. I have heard men in these groupings say that they would prefer to die than to stop having sex. It is the main reason why HIV is still so rampant, because men still value sex as one of the main priorities of their lives, and can be risky in “getting it up” but not “putting it on” or wearing a “cap”. Even when men have lost the ability and desire for sex in their 70s and 80s they still fantasize about it and secretly hope to one day be able to “rise again”. When I treat men in their 60s and 70s for prostate cancer, a significant amount of these men will object to the treatment because of the risk of loss of erections or the possibility of not regaining it even when they have already lost it.

At the risk of sounding redundant I will briefly review the main causes of impotence in the over 50s. These include the usual culprits of diabetes, hypertension, obesity, high cholesterol, alcoholism, heart disease, aging, psychiatric illnesses, smoking both tobacco and marijuana, enlarged prostate, kidney diseases, medications and cancers to name a few. In short, any chronic illness that a man suffers may cause erection problems. Some are as a direct effect and others indirectly as it affects how he views himself and his sexuality. For example, diabetes, hypertension, high cholesterol and circulation problems affect erections directly because they affect how much blood the heart pumps or how much blood flows through the blood vessels that go to the penis. Diabetes affects the function of the nerves to the penis and, along with hypertension and high cholesterol, cause narrowing and eventually clogging of the small blood vessels carrying blood to the penis. Because the penile blood vessels are fairly small they tend to get blocked up quicker and earlier than the vessels to the kidneys, lower limbs and heart. Hence, when impotence occurs, start looking for other circulation problems like heart disease, as these can follow fairly soon after.

Other diseases like cancers and depression and abusive drugs tend to affect erections indirectly by affecting desire. Imagine being diagnosed with cancer, sex is not the first thing on the mind! Likewise people who abuse alcohol and marijuana can cause testicular damage (the “balls” will shrink with excessive use of these substances), which will in turn affect testosterone levels and hence affect desire and performance. We will continue with our discussion on ED next week.

For comments or question contact:

Dr. Rohan de Shong

Tel: (784) 456-2785

email: deshong@vincysurf.com