Wednesday, December 11, 2002 - 1:14:23 AM MST
Dear Dr. Douma:
I really need help. I'm a 56-year-old man and I'm afraid that I'm becoming impotent. It is getting harder and harder to sustain an erection with my wife, whom I love dearly. I'm getting very anxious with the holidays coming up, since it's a time we've always found sex to be particularly enjoyable. I don't have a medical problem that I know of and don't know where to turn. I don't have a regular doctor to talk with. Please help.
-- H.C., Houston
There are many, many reasons why you might think you're less sexually potent. Let me talk about some of them and suggest directions you can take.
But before I do, I strongly suggest that you have a heart-to-heart conversation with your wife. Your sexuality and all its aspects are best shared with her so that you can deal with your situation together.
Simply being anxious about being able to sustain an erection can by itself create or at least increase the problem. Often ongoing discussion about these concerns is all it takes to reinvigorate sexual capacity within a relationship.
More than 30 million men in North America alone have some degree of erectile dysfunction or impotence. The incidence increases with age -- about 5 percent of men at the age of 40, and between 15 percent and 25 percent of men at the age of 65 experience some impotence.
Erectile dysfunction might be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief or incomplete erections.
Erectile dysfunction often has a physical cause, such as disease, injury or drug side effects. Diseases -- including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis and vascular disease -- account for about 60 percent of cases.
Surgery, such as prostate surgery, can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder and pelvis can lead to impotence by harming nerves, smooth muscles, arteries and fibrous tissues of the penis.
Common medicines, too, can cause impotence. These include high blood pressure drugs, antihistamines, anti-depressants, tranquilizers, appetite suppressants and cimetidine (an ulcer drug). Drug effects account for up to 25 percent of cases of impotence.
Additionally, psychological factors -- including stress, anxiety, guilt, depression, low self-esteem and fear of sexual failure -- are believed to cause 10 percent to 20 percent of cases of impotence. If you have occasional nocturnal erections without arousal, your erectile problem is probably at least partly psychological.
The good news is that, almost regardless of cause, erectile dysfunction is treatable -- but you need to find the cause before starting the best treatment.
A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish among problems with erection, ejaculation, orgasm and sexual desire.
A psychosocial examination, using an interview and questionnaire, might reveal psychological factors -- both those you are and are not aware of.
Treatment for impotence should proceed along a path moving from least invasive to most invasive. This means cutting back, first, on any harmful drugs. Behavior modifications are considered next, followed by medications. Vacuum devices, locally injected drugs, surgically implanted devices and finally, in rare cases, surgery involving veins or arteries might be tried.
There are many good sex therapists, including psychologists and psychiatrists. But finding out who is best for you isn't easy. Friends don't talk about their experience much, sex therapists are often not listed in the yellow pages, and there's a lot of clutter on the Internet that gets in the way of good information.
Since you ought to have a good relationship with a doctor anyway, my
advice is to find one with whom you can communicate on general medical
problems and talk about this issue. Depending on what you discover, you
can decide how to take the next steps.
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