The one certain thing we know about erectile dysfunction (used to be called impotence) is that it is very common. It's estimated that approximately 10 per cent of the male population suffer from it. It tends to affect all age groups, though probably men in middle age and later life are more commonly affected.
What is "erectile dysfunction"? A sensible definition would be the inability to achieve an erection in circumstances where a man would want one. That means that for some men it will be in a sexual situation with one or more other people, but it can also mean a failure to achieve an erection for masturbation. For some men also, erection is possible, but it doesn't become hard enough for successful penetration - so this too, would fall within my definition.
Erectile failure has many causes, including trauma, certain drugs - prescribed and illegal, neurological problems, diabetes, hypothyroidism, any chronic illness, depression, anxiety, smoking, alcoholism etc, etc.
The sorts of drugs which may cause erectile failure are many and varied. They include drugs used to treat blood pressure, tranquillisers, anti-Parkinsonian drugs, antihistamines, ulcer healing medications, betablockers, antidepressants, antispasmodic drugs, illegal drugs like cocaine, heroin, barbiturates, cannabis etc.
Generally, men with erectile problems suffer huge embarrassment and find talking to a doctor about the problem very difficult. Hopefully, the climate is changing and because more men are becoming aware that there are convenient effective treatments available more are presenting to their doctors.
When you visit your doctor to discuss the problem, he or she will need to ask quite a few questions to understand the true nature of the problem so that treatment can be tailored accordingly. You will probably be asked about how long you've had the difficulty, what happened at the original failure, about possible depressive or anxiety symptoms, drug use, alcohol consumption, sexuality, what steps you've taken already to deal with it.
Physical examination will probably be restricted to blood pressure, maybe a urine test for diabetes, examination of the genitals and prostate gland, check of the shaft of the penis for any fibrous areas and also a check to make sure the foreskin pulls back over the head of the penis easily. Occasionally, more elaborate examination is necessary if the history suggests a more significant problem. Where there is concern that the amount of male hormone, testosterone, is reduced then a blood test to determine this may be requested.
Treatment these days is varied and the choice of treatment depends on what the patient feels is most appropriate and convenient. Very often though there is a psychological component to the problem and psycho-sexual counselling is often helpful in addition to physical treatments.
Currently the most convenient treatment is Viagra (sildenafil). This comes as a tablet of varying strengths taken approx. 1-2 hours before sexual activity is planned. The drug is safe and achieves improvements in about 50-90% of patients. It should not used with heart medications which contain nitrates or with "poppers" which contain amyl or alkyl nitrate, as the combination of the two can cause a fatal drop in blood pressure.
It does have side effects, notably that it may cause some people to flush and to look a little "pop-eyed". In addition it causes a bluish tinge to vision, which is reversible on stopping the drug. Some other drugs will cause an elevation in the drug level in the blood stream - notably some of the anti-HIV medications, so if you are taking other medications always consult your prescriber and the pharmacist before taking Viagra.
If you are obtaining Viagra via a private prescription, then the purchase of the 100mg tablets may result in a cost saving as the co