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
By Robert Whitaker
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
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 per cent of men between 40 and
70 suffer from some form of erectile dysfunction.
To make matters worse only 10 per cent 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
- You may not have
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
“It’s relatively normal if
a man is occasionally unable
to achieve an erection,” Apostoleris
says. “It becomes a
problem only when there’s
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
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.
- You’re not alone
“Many healthcare practitioners
don’t enquire about
their patients’ sexual health,”
aren’t always upfront about it
so it’s difficult to establish the
exact number of men suffering
Nevertheless, it’s clear that
ED is not uncommon.
Statistics indicate more than
50 per cent of men over 40
experience ED – and the
problem can start at an even
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
- 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.
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.
- Is your behaviour
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,
and controlling chronic
illnesses such as diabetes and
hypertension could help the
problem to take care of itself,”
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
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
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.
- 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 per cent of men are able
to enjoy sex again within a few
weeks of taking the drug.
- 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 per cent.
- Don’t be duped
Because ED is at the root
of a hefty human insecurity,
potential solutions attract
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
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
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
drugs or if a patient has a preexisting
- 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.
- And now for the
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 per cent!
Who would’ve thought
preventing ED could be such
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.
- Are you older than 40?
According to pharmaceutical manufacturer Pfizer
erectile function declines by 12 per cent with every
10-year increase in age.
- 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 per cent 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 per cent more likely to develop ED than
a non-smoker of the same age.
- Do you suffer from diabetes or any other
Diabetes or a testosterone deficiency plays a part
in some 36 per cent of cases. According to the
World Health Organisation, 50 per cent of men with
diabetes develop ED, often within 10 years of diagnosis.
- Ha ve 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 per cent 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
- 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 per cent 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, www.sexualhealth.co.za.
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.
- Your senses
pick up a stimulating
the outside world.
- The brain and
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.
Medication for erectile dysfunction
Causes of erectile dysfunction