Maybe a friend, in a rare moment of openness, has confided in you at some time that they are suffering from erectile problems, but if so then this is rather unusual. Despite these problems being more common than they seem, this is not a normal subject of conversation.
"Unlike women, who speak much more openly about their sexuality, men are more reserved. We feel ashamed to talk about our sexual problems and there is a certain taboo around the subject. These things don't happen to 'real men', so if they do happen to you it is like a blot on your masculinity. That's why many men prefer to keep quiet about it," says Eduardo García Cruz, an andrologist, urologist and an expert in sexual health with more than 15 years' experience in this field.
The reality is that no matter how much they try to hide it, 20 per cent of men over the age of 18 in Spain suffer from erectile dysfunction, and it rises to more than 50 per cent after the age of 50. The figures also show a rising trend, as it is calculated that by the year 2025 this condition will affect 322 million men in the world, mainly due to the progressive ageing of the population.
Erectile dysfunction is defined as the inability to have an erection which lasts long enough to have a satisfactory sexual relation, although Dr García says "the term 'satisfactory' is down to each person's perception". For it to be considered a real problem it should have lasted for approximately six months and it can be caused by psychological problems as much as by physical ones.
The most evident sign that impotence is psychological is that someone is physically fit but is unable to have an erection, or only has one unexpectedly and intermittently (upon waking up or going to bed, for example). It is related to an alteration to emotions, which may be caused by arguments with a partner, the break-up of a relationship, the loss of a loved one, stress at work, lack of self-esteem or anxiety. Poor nutrition, a lack of rest and certain medications can also have an effect.
"The brain is what stimulates the erection, so sexual desire does not come from the penis, as many people think, it is in the mind," explains Dr García. This means that if the brain is not healthy, it is unable to carry out its functions correctly.
The senses and imagination are what activate the cerebral neurotransmitters such as testosterone, serotonin and dopamine, which are needed to get the sexual organ working. If this process suffers interferences, the chemical reactions do not take place and the erection does not happen.
It should also be noted that excessive exposure to pornography can also have a negative effect on erections. "Seeing more than seven hours of porn a week causes a lot of problems with desire and a reduction in orgasm. The reason is that your brain gets used to a level of erotic load which is almost impossible to reach in real life and everything else seems inferior when compared with that stimulus," says Dr García.
Erectile dysfunction due to psychological causes is more common in men under the age of 50 and the solution in these cases can be to introduce changes in lifestyle in order to recover emotional balance.
Two years to consult a doctor
Dr García also says that "impotence which is due to a physical problem is more common in men over the age of 50 and it occurs when some part of our body stops the penis achieving sufficient rigidity".
There are five different factors within this group: vascular problems (not enough blood reaches the virile organ), common in smokers, diabetics and people with obesity, hypertension or high cholesterol; neurological problems (when the nerves which stimulate the penis do not function correctly), which is common in diabetics, people with multiple sclerosis and spinal cord injury; hormonal problems (the necessary hormones for an erection, such as testosterone, are not produced); traumas (fractures of the penis or pelvis); and the side effects of certain drugs.
"There are three main drugs which can cause impotence: those for high blood pressure, psychotropics (to treat psychiatric problems) and some medication to treat prostate illnesses," says Dr García.
Men with erectile dysfunction for organic reasons also have more risk of suffering from other illnesses. In fact, it has been scientifically proven that men with the most serious erection problems see their health deteriorate more rapidly and are more likely to develop serious pathologies within five years. "Even so, we know that around 80 per cent of individuals with erectile problems never go to the doctor, and the other 20 per cent normally take an average of two years before doing so," says the doctor.
He says one reason for this is a lack of education. "At home, in schools and in the media we should talk more about this so that people realise the condition is normal and men feel confident enough to ask for help," he says. He has also set an example: years ago he created Tengo Un Amigo Que (I have a friend who) on YouTube, to answer questions about male sexuality and try to break down the social taboos which exist about the subject. The account now has 104,000 subscribers. He hopes it will encourage some people to see a doctor, especially because these days there are many treatments available with a high success rate.
After diagnosis, the first step will be to modify treatable causes. For example, stop smoking, improve lifestyle (healthy diet, exercise...) or adjust the segregation of hormones, among others. If that isn't enough, there are four types of treatment that could be applied. One is low-intensity shock waves which give good results, have few adverse effects and are very useful when impotence is caused by vascular problems. Inhibitors of phosphodiesterase 5 can also be used. These are tablets which are very safe and highly effective. Another, more effective treatment involves an injection into the penis but not everyone wants to do that. If none of these work, then a penile prosthesis is possible. "This is successful in over 90 per cent of cases, but is not used as often as it could be because some men prefer not to undergo surgery," explains the specialist.