10 questions about erectile dysfunction

1. How common is erectile dysfunction?

That varies by age. Three Dutch studies show that an average of 14 percent of all Dutch men suffer from it. Among young men this is less than 5 percent, in the age group of 41 to 50 years 14 percent, among men between 51 and 70 30 percent and among 71 to 80 year olds it is as much as 42 percent. Few men go to the doctor for it. Less than four out of a thousand consultations are about erection problems. It’s not just because of shame; older men experience it less as a problem and therefore do not seek help for it.

2. What exactly is it?

The official definition: the persistent or recurring inability to get or maintain an erection sufficient for sexual activity. This description of ‘standard erectile dysfunction’, as its official name is, is included in the guidelines of the Dutch College of General Practitioners. The guideline was published in 2008 and is the first for general practitioners on this subject.

3. What is it caused by?

Erection problems can have a physical or psychological cause, or a combination of the two. At a young age, psychological influences often play a greater role, at a later age physical problems are more likely. The exact nature of the problems can provide clarity about the cause. If the man in question does have morning erections and can get an erection on self-satisfaction and if the problems start suddenly, this indicates a predominantly psychological cause, such as insecurity about sexual performance or fear of failure. If the problems start much more gradually and there are no morning erections and no erections during masturbation, then a mainly physical cause is more obvious, for example a less good blood flow in the penis.

4. What can be done about a psychological cause?

Fortunately a lot. The GP will first try to tackle the problem through information and conversations. He provides information about the natural fact that erections become less hard with age, last less long and are more difficult to achieve. And fear of failure is also discussed: there is nothing more detrimental to getting a good erection than the fear of not being able to get an erection. In counseling sessions, the doctor examines whether stress or fatigue might be contributing to the problems and how something can be done about it. He also discusses the (sexual) relationship: are there problems in the relationship, how does the partner react to the erection problems and what ideas and expectations do both have about sex? In this way, any misunderstandings can be clarified, for example that arousal always immediately leads to an erection. In addition, established patterns, for example a routine foreplay that is no longer sufficient to achieve an erection, can be broken and expectations adjusted. The GP will usually not conduct these conversations himself, but refer patients to a sexologist. Sometimes the use of an erection pill can help to break certain patterns and fear of failure.

5. And for physical problems is there a pill?

Yes, but not alone. Even if the cause is physical, information remains important, for example to adjust expectations: a man of 60 simply no longer has such a smooth and hard erection as a man of 35, just to name a few. If medication has too little effect, additional counseling sessions can offer a solution.

6. What can a man do himself?

Most importantly: move more. That is the only measure that, according to scientific research, contributes to solving erection problems. Other measures, such as quitting smoking or losing weight, will ensure that disorders do not worsen, but will not reduce them. More exercise is good for the vessels and good vessels are crucial for getting a good erection. Quitting smoking and tackling overweight is also good for blood flow, but the damage that smoking and being overweight cause is not so easy to undo and therefore does not contribute to solving erection problems. By the way, ‘moving more’ means sticking to the standard of moderately intensive exercise for thirty minutes a day. So you don’t even have to go to a gym!

7. Can you also wait for it to pass on its own?

You can do it, but the chances of success are slim. In older men, problems often increase simply with age. In younger men, who are more likely to have a psychological cause, the problems can be exacerbated by performance anxiety, which can get stronger over time. In short: the longer an erection problem exists, the more difficult it becomes to turn the tide. Still better to go to the doctor.

8. But how do you get started with the doctor about something like this?

Most GPs will not be surprised if you ask a question about sexuality. GPs know that certain illnesses or medications affect libido, sex drive, or the ability to get an erection, just as they know that older men are more likely to have erectile dysfunction. The problem is often that both the GP and the patient avoid the subject. The GP must be professional enough to bring it up, but the patient also has a responsibility to report complaints if there are any.

9. Is it true that you are more likely to develop cardiovascular disease if you have erectile dysfunction?

Yes, that’s right, but the chances are only slightly higher. Someone who comes to the office with erectile dysfunction is therefore not immediately examined for possible cardiovascular problems. In fact, it mainly works the other way around. For example, someone who has had a heart attack apparently already has vascular problems that can also increase the risk of erectile dysfunction. At the same time, he is often afraid of the effort that sex entails, and that fear can make the problem worse. Knowledge can often reduce that fear. Good to know: sex is exercise and that’s great for heart patients!

10. For example, if you have diabetes, does your doctor automatically ask about erection problems?

There is a chance yes. But also people who have another condition that increases the risk of erectile dysfunction, such as depression with the use of anti-depressants, cardiovascular disease with the use of high blood pressure drugs or another chronic illness, he will ask if there are any problems. Often they have problems, but they don’t talk about it. GPs try to reach them by asking them directly. But of course you don’t have to answer the question if you don’t want to, or if you do have erectile dysfunction but don’t see it as a problem. The good thing is of course: if you ever want to bring up the subject, you know that your GP is open to it.

With the cooperation of Peter Leusink, GP and sexologist NVVS (www.nvvs.info)