Erectile dysfunction
Life was sweet until Emeka was made the regional manager of his organization five years ago. Emeka is a happily married 44-year-old man, who’s been married for 15 years to his childhood sweetheart Efe. Their union was also blessed with three children ages 8, 10 and 14 years old.

Emeka is 5 feet eleven inches tall, he has put on about 12 kg in five years and has a little pot belly – middle age spread, though he still looks good. His job entails working on the computer all day long. Emeka does not smoke, but he drinks alcohol occasionally. Recently, he noticed that he’s been taking a little more alcohol to unwind.

Before he was promoted, he managed to exercise a few days in a week, but lately, he’s so fagged out he can’t even imagine tying his own shoelaces, talk more of exercising. Emeka wakes up daily at about 5 am, leaves for work at about 6m to beat the traffic. He gets home about 9 pm and eventually goes to bed at about 12 midnight.

Unfortunately, due to the long commute time, he leaves home without eating breakfast so more often than not he grabs a burger or shawarma when he gets to work; lunch and snacks are whatever he can lay hands on. However, he always gets to eat dinner at home.

Emeka is so busy he rarely has time for his family, weekends he hangs out with friends and colleagues. When his wife complains, he tells her “I have to maintain you and the children’s standard of living.” This has gone on for a long time, and his wife is beginning to wonder if it’s really work, or an affair; because lately, she has been the one making the advances in bed while he makes the excuses – check out role reversal!

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For fear of being called insecure or a nag, she’s found ways of engaging herself and the children without involving him. She wonders if he is no longer attracted to her as they barely communicate or do things together anymore. Something must be keeping him away. Could it be that his health is failing? Three years ago, an annual health check revealed his blood pressure, blood sugar and cholesterol were more than slightly elevated.

Initially, Emeka was advised to modify his lifestyle, but this was not effective because he had neither the time nor energy to exercise. After six months of trying, with an increased blood pressure and sugar levels, he was placed on medications. And guess what, he took his medicines whenever he remembered, didn’t follow any dietary advice or relaxation tips and then he began to feel depressed. His wife couldn’t understand why as he seemed to be having a ball.

Emeka, on the other hand, noticed he was unable to obtain a penile erection, even when he did, he knew it was not firm enough to penetrate. He began to wonder if he was no longer sexually attracted to his wife, she seemed to have added some weight too, could that be the problem? But he was sure he still loved his wife. Was it a mid-life crisis? He went to his doctor a couple of times, but he was too embarrassed to talk about his problem. Instead, he complained about mundane things like the general feeling of being unwell, headache or a backache. All the physical and lab tests came out negative, the doctor thus advised him to exercise and cut down alcohol consumption.

Afterward, Emeka turned to the internet for help and voila he read that high blood pressure is a cause of erectile dysfunction/impotence! This is where he ended his research; he then began to take his blood pressure medicines but guess what? At a much higher dose and frequency than what, his doctor had prescribed. He didn’t even bother with the medications for his blood sugar. At night he would take about four times his daily dose at once, and would brave attempting to make love to his wife, but instead of a strengthened erection, he’d feel weak and very disappointed. Some days he actually felt woozy at work, he put this down to not sleeping well at night.

He became so fixated he lost count of how much of the medicines he was taking in a day, he was almost like in a trance. How can a whole him have this condition? His self-esteem, masculinity, sense of security and confidence were all in shambles. He was ashamed and felt the essence of his manhood threatened, his pride wounded, and he became aggressive to his wife. He blamed her for his condition, called her fat, yelled on the kids. When she began to exercise to loose weight, he accused her of being unfaithful. He became angry and highly irritable as well as scared of being intimate with his partner. He felt helpless and not sure where to find support. Due to his mood swings, his children scamper into their rooms when he was home from work.

Efe his wife implored him to slow down with work and take care of himself to no avail. Then one day Emeka blacked out for a few minutes at work and was rushed to the emergency room. His wife rushed to the hospital in a state of panic, with all sorts of thoughts in her mind. She was happy to find him conscious and alive.

On examination, his random blood sugar level was over 750mg/dl (normal is less than 140mg/dl)! His blood pressure was very low, and he was very dehydrated. So he was admitted, and when he came around, he was so scared he told the doctor how and why he had been taking his medications. He completely ignored his sugar levels because he didn’t think that was the problem.
His blood sugar was brought down, and he was sent home three days later after proper counseling, medications, and advice on lifestyle modification and the role it plays. He was also told to work with his wife, who was relieved to know her husband was passing through a phase.

Emeka would have died due to ignorance! What if he had passed out while driving? What if he had been adventurous enough to combine his hypertension medicine with medications for erectile dysfunction? Thankfully his internet search didn’t take him that far.
What is erectile dysfunction (ED)?
Erectile dysfunction also known as impotence is a condition in which a man cannot achieve or maintain an erection to complete a sexual activity. ED use to be referred to as a disease of the elderly but incidence in the younger age group has greatly increased in recent times. This increase in incidence impotence has been attributed to our unhealthy lifestyle – sedentary life, lack of exercise, excessive consumption of alcohol, and smoking. Therefore it is best prevented and treated by adopting healthy lifestyle choices, before attempting invasive procedures such as surgeries.

ED has a psychological and emotional impact on sufferers. I am not sure any man can shrug off impotence without thought- because it can be very distressing. Coping is hard and most men identify themselves with their penis. Emeka exhibited all these features. Attaining an erection is a complex process that involves the brain, hormones, muscles, nerves and blood vessels, a breach in any of these components prevents the penis from performing optimally.

Causes of ED
1. Mental factors: stress, fatigue, depression, relationship problems; all these creating a vicious cycle. Performance anxiety and unrealistic expectations especially when you compare yourself with what you see in porn movies may also be a cause of ED.
2. Several disorders and illnesses including- diabetes, neurological and nerve disorders, hypertension and heart-related diseases, enlarged prostate gland, abnormal curvature of penis during erection, clogged blood vessels, obesity, and high blood cholesterol
3. Hormone imbalance – low testosterone, abnormally high estrogen in men (seen in obsessed men)
4. Lifestyle: excessive consumption of alcohol, smoking, street drugs, steroids use for body building, excessive ingestion of caffeine. Alcohol also causes premature ejaculation. Long term opioids abuse and other illicit drugs affect ED indirectly.
Symptoms
1. Penile erection occurs when alone or in the mornings but cannot be maintained for the length of sexual activity
2. Erection not firm enough
3. Unable to obtain an erection

Prevention
Treat underlying cause, manage stress and anxiety. Regular exercise – improves blood flow, helps with weight loss, manage diabetes, high blood pressure and high blood cholesterol as well as help relief stress. Even when you resort to taking medications for ED weight loss makes it more effective. Deep breathing exercises, massage therapy, yoga, all help in reducing stress

Smoking worsens or could lead to ED, so quit.
Food that eases the symptoms of ED – beets, food rich in vitamin D. Before trying herbs and supplement ask your doctor about it. A few examples: red ginseng, Indian ginseng, L-arginine, zinc supplements, ginkgo

Treatment
1. Psychotherapy
2. Medicines: oral or injectables or inserted into the penis. Medications like Viagra, increase blood flow to the penis, but they are not for everybody. The come with side effects such as a headache, nasal congestion, stomach upset, change in vision, dizziness. Please note: men who have had a stroke, or uncontrolled diabetes, or low blood pressure shouldn’t take ED medicines.
3. The use of a vacuum pump
4. Testosterone replacement – side effects: acne, breast enlargement, painful penis, frequent urination, gum and mouth sores/irritations
5. Surgery

ED is so common now that teas, ice cream, and drinks are spiked with viagra both in public places and in homes…careful, Viagra isn’t for everybody.

Note in a lot of cases, lifestyle modifications alone can make a significant difference in erectile functioning.

… To be continued

Author: Dr. Nse