Erectile dysfunction

Updated 19 June 2014

The hard facts about erectile dysfunction

If erectile dysfunction is ruining your sex life, don’t let it get you down. The following life-changing facts will help you keep the flag flying – at full mast


Does this sound familiar?

He’s good-looking, successful and an adventure racer and cyclist with a Two Oceans and a Cape Epic under his belt. Clearly, Steven Adams is the archetypal macho man.

But when this 38-year-old executive describes his struggle with erectile dysfunction (ED), the machismo and confidence begin to droop.

“I’d been married for three years but had ‘intimacy issues’ for more than half of that time,” he explains.

“Part of me realised there was a deeper problem but I couldn’t admit it to myself or my wife. It wasn’t that I didn’t feel attracted to her or my libido was waning. It was just impossible for me to maintain an erection...”

He began looking for excuses for his failure to launch. First he put it down to stress. Then he said he was run down. Finally he considered the possibility he was depressed.

“After about nine months my wife thought she was to blame,” he says. When she wanted answers, Steven still couldn’t face the problem. Instead he lied, saying she was putting too much pressure on him to perform.

“After that the distance between us just grew,” he explains. Unable to cope with the strain, the couple eventually got divorced and in the aftermath of his failed marriage Steven thought the problem had passed.

But, a few months into a new relationship, the bedroom bombshell returned. “That’s when I got help and was medically diagnosed with erectile dysfunction,” he says.

It became apparent that Steven’s particular problem was rooted in a history of childhood molestation. “Once the cause was identified, I was able to process by means of therapy what happened to me and put the problem to bed.”

And speaking of beds, Steven’s new wife has no complaints in that department.

Although this story ends happily, Steven’s struggle is more common than you’d imagine. According to Health24, 52% of men between 40 and 70 suffer from some form of erectile dysfunction. To make matters worse only 10% of sufferers seek professional help.

In most cases the condition is treatable, but the social stigma and emasculating misconceptions cause many men to suffer in silent denial. But it’s time to change this and face the get-it-up facts . . .

* Not his real name

1.  You may not have a problem

Erectile dysfunction is “the consistent or recurrent inability to attain, and in some cases, maintain a penile erection sufficient for sexual intercourse,” according to Dr Evangelos Apostoleris from Wits University’s Department of Urology.

This means ED is not just about getting it up, but also about keeping it up. It also means that falling flat once in a while is not necessarily cause for concern.

“It’s relatively normal if a man is occasionally unable to achieve an erection,” Apostoleris says. “It becomes a problem only when there’s frequent failure.”

So in order for a diagnosis of ED to be made, you need to suffer from a “consistent or recurrent” slump. The extent of the slump determines the severity of the condition.

How do you measure up?

  • Mild ED  You achieve a successful erection seven or eight times in every 10 attempts.
  • Moderate ED You achieve a successful erection four to six times in every 10 attempts
  • Severe ED You achieve a successful erection zero to three times in every 10 attempts.

 2. You’re not alone

“Many healthcare practitioners don’t enquire about their patients’ sexual health,” Apostoleris says.

“And patients aren’t always upfront about it so it’s difficult to establish the exact number of men suffering from ED.”

Nevertheless, it’s clear that ED is not uncommon. Statistics indicate more than 50% of men over 40 experience ED – and the problem can start at an even younger age.

In fact, the condition is far more common than most men would like to admit – some of your buddies around the braai are probably dealing with it too. So don’t feel singled out; rather face facts and get medical help.

3. As your age goes up . . .

It’s a fact: the likelihood of developing ED increases with age. According to the American Urological Association four in 10 men at age 40 suffer from ED, six in 10 men at age 65, and eight in 10 men at age 75.

With the passing of the years, a man may notice his erections take longer to develop or aren’t quite as rigid. But ED is not an inevitable consequence of the ageing process alone.

“Normally ED occurs in older men simply because they’re more likely to have another medical condition – such as high blood pressure – that may interfere with erectile function,” Apostoleris says.

 4. Is your behaviour to blame?

In up to one in five cases of ED, a simple lifestyle change can provide the necessary lift.

“Exercise, a proper diet, packing away those cigarettes, monitoring cholesterol and controlling chronic illnesses such as diabetes and hypertension could help the problem to take care of itself,” Apostoleris says.

This urologist’s top tips on lifestyle changes are:

  • Slash stress Exercise, see a shrink, get a life coach, take a trip, organise your life – or do whatever it takes to lower your stress levels.
  • Stop smoking Because smoking decreases blood flow, quitting can have a significant effect.
  • Don’t overindulge Alcohol and recreational drugs can not only cause ED, they may also be responsible for a decreased sex drive.
  • Lose the spare tyre Obesity is associated with a host of complications such as high blood pressure. This just adds to the fact that men who are overweight are more likely to develop ED.
  • Manage your meds If your ED is related to your chronic medication, your doctor should be able to find a combination that suits your sex life.

5. Take a chill pill

The good news is ED is treatable. Even if the condition doesn’t respond to psychological intervention or lifestyle improvements, countless men have found the pick-me-up they need in prescription pills.

There are numerous prescription drugs available, but the phosphodiesterase type 5 inhibitors – which include Viagra, Levitra and Cialis – constitute a significant breakthrough in treating ED.

The results speak for themselves and Viagra manufacturer Pfizer reckons 83% of men are able to enjoy sex again within a few weeks of taking the drug.

6. If at first you don’t succeed . . .

For severe cases of ED, more extreme treatment options are available. Vacuum devices, for example, create a partial vacuum that draws blood into the penis, causing expansion.

There are also three surgical procedures for more extreme cases: implanting a device that causes the penis to become erect; reconstructing the arteries to increase blood flow to the penis; or blocking off the veins that allow blood to flow quickly from the penis.

These procedures can be pricey (from R6 000 to R25 000), but the success rate is reported to be between 90 and 95%.

7. Don’t be duped

Because ED is at the root of a hefty human insecurity, potential solutions attract big bucks.

Perhaps that’s why an everexpanding range of over-thecounter remedies jostle for space and attention on pharmacy shelves. Silver Bullets. Super Powerful Man Pills. Erectify XL. 4Everon.

The names themselves promise size and satisfaction – instantly. But do they really work? “These remedies may have a psychological effect,” says pharmacologist Gareth Kennedy of Johannesburg. “That’s probably the biggest benefit they contain.”

But while most contain only herbs and vitamins, alternative remedies could be dangerous because they are not regulated or tested as stringently as their pharmaceutical counterparts.

The American Food and Drug Administration has voiced concerns that the ingredients are not indicated and the remedies could contain substances that are harmful when used in conjunction with prescription drugs or if a patient has a preexisting medical condition.

8. Get to the root of it

If you think the problems associated with ED are limited to the bedroom, think again. In truth, your member is a window to your general well-being.

Why? Because ED can be associated with bigger health issues such as cardiovascular disease, diabetes, prostate cancer and hypertension.

Instead of fixating on the symptom itself, ask your doctor to check for these concomitant health conditions before it’s too late. The big bonus: treating the underlying condition could eliminate your ED.

9. And now for the good news

Recent research has shown that regular sexual activity can actually help to prevent the development of ED.

A 2008 study published in The American Journal of Medicine investigated a group of 989 Finnish men between the ages of 55 and 75 and found the men who went a week or more without having sex had twice the risk of developing ED, compared with those who had sex once a week.

The even better news: engaging in sexual intercourse three times a week has been found to reduce the risk of cardiovascular disease by as much as 50%!

Who would’ve thought preventing ED could be such a pleasure?

Are you at risk of ED?

Anything that hinders any of the structures or elements (such as nerves, muscles, blood vessels or chemicals) involved in the erection process can contribute to erectile dysfunction or ED.

Answer the following questions and assess your level of risk.

Do you have heart disease, hypertension or high cholesterol? Do you smoke?
Disorders like these narrow arteries or decrease blood flow and contribute to 40% of ED cases. A vascular abnormality in the veins of the penis, for example, would cause blood to drain too quickly and you would not be able to maintain an erection.

Pfizer’s research has also shown that a pack-a-day smoker is 50% more likely to develop ED than a non-smoker of the same age.

Do you suffer from diabetes or any other endocrine disorder?
Diabetes or a testosterone deficiency plays a part in some 36% of cases. According to the World Health Organisation, 50% of men with diabetes develop ED, often within 10 years of diagnosis.

Have you suffered nerve damage due to injury, surgery or radiation therapy?
Damage to any nerves leading to or from the penis is a contributing factor in 24% of ED cases. Nerve injuries can also result from spinal diseases, multiple sclerosis or peripheral nerve disorders.

Do you suffer from anxiety or stress?
Often ED is caused by a combination of physical and emotional factors. Stress, guilt, anxiety, depression and low self-esteem have all been linked to ED and in about one in 10 cases, an emotional problem could be the single cause.

Do you take sleeping pills, antidepressants or medication for hypertension?
ED is a potential side-effect of many common medications.

Do you use recreational drugs, binge drink or consume more than three alcoholic drinks a day?
Drugs and alcohol are known to sap the sex drive and contribute to ED.

Are you overweight?
According to Pfizer every 9 kg of excess weight can lead to a 3% decline in erectile function.

If you answer yes to any of the above questions, you have an increased risk of developing erectile dysfunction. For more information on erectile dysfunction, visit the South African Sexual Health Association’s website,

How do you drive this thing?

“A normal erection essentially depends on the balance between arterial inflow and venous outflow in the penis, mediated by a complex interaction of the nervous system, chemical reactions and hormones,” ED specialist Dr Evangelos Apostoleris says.

The brain and nervous system send this message to the penis.

Muscles inside the organ relax and more blood flows into the penis, getting trapped inside spongy tissue.

More blood means more pressure; this causes the penis to lengthen and expand. And voilà! There’s your erection.

Read more:

The not-so-hard facts about erectile dysfunction
The benefits of great sex in later life


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Ask the Expert

Erectile Dysfunction Expert

Dr Kenny du Toit is a urologist practicing in Rondebosch, Cape Town. He is also consultant at Tygerberg hospital, where he is a senior lecturer at Stellenbosch University. He is a member of the South African Urological Association, Colleges of Medicine South Africa and Société Internationale d’Urologie. Board registered with both the HPCSA (Health professions council of South Africa) and GMC (General medical council UK). He has a keen interest in oncology, kidney stones and erectile dysfunction.

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