Soft defeat

Published December 12, 2020, 11:23 PM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“But blunt and flaccid is my pen.” — Walter Savage Landor (1775-1864), English poet, “Time to Be Wise”(1795)

Erectile dysfunction is “the inability to achieve and sustain an erection suitable for sexual intercourse.” Failure to achieve an erection in 50% of the time is cause for alarm. Less than 20% of the time? That can be ignored. Then again, erectile dysfunction is NOT a part of normal aging. It’s a myth older men can’t get it up.

A Normal Erection. A penis is an engineering marvel. With arousal, blood flow is directed to the two main erectile cylinders of the penis called the corpora cavernosa. A third cylinder, the corpus spongiosum, also has erectile tissue and contains the urethra from where urine and semen exit. High pressure traps the blood and thus an erection is sustained. It is reversed when the penis contracts, blood inflow stops and outflow channels are opened.

Causes of ED. About 10 to 20% of factors are psychological. There is stress, mostly work-related, money-related, or wife-related. “Performance anxiety” happens when the fear of a repeat strikes and it becomes a prophecy fulfilled. A depressed man won’t be any good in bed. He has much more to think about and sex is farthest from his mind. As for physical causes, there are many. Some studies report up to 50% of men with diabetes experience ED. So too are men with kidney disease, vascular diseases related to the hardening of the arteries (atherosclerosis), hypertension, and high cholesterol. Men who suffered stroke(s), have Alzheimer’s or Parkinson’s disease may not get erections. Tobacco and alcohol, props of the macho-macho man, restrict blood flow to the penis. Finally, there are about 200 prescription drugs that include erectile dysfunction as a possible side effect. So read the fine print.

Screening and Diagnosis. The specialist to see is the urologist. A complete history and physical examination is the standard. The bulbocavernosus reflex is an indication of nerve quality in the penis. The doctor puts one finger in the anus and tugs on the head of the penis. If the anus does not contract immediately or not at all, there may be a nerve abnormality. A duplex ultrasound is done with the penis erect and flaccid. It determines signs of venous leak, atherosclerosis or scarring of the tissue.

Treatment. Lifestyle changes include quitting smoking and regular exercise. It helps to reduce stress. The doctor will check if you can take any of the three available approved drugs for erectile dysfunction. These are: sildenafil citrate, vardenafil hydrochloride, and tadalafil. The last one boasts of a 36-hour erection but before you get more than your hopes up, consider these. You may not take ED drugs if you have had a heart attack, stroke, irregular heart rhythm (arrhythmia) in the past six months. These drugs may also interact with medication a person is taking for high blood pressure, prostate problems, or chest pain (angina). So it is best that these ED drugs are prescribed and not surreptitiously procured from well-meaning friends. These aren’t pain or indigestion medicines.

Erectile dysfunction is treatable and preventable. Winning in this context will be “hard fought.”

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