Now 57, I have been experiencing problems with maintaining an erection over the past two years. What was an occasional occurrence has become a regular event. I am embarrassed to talk to anyone about it and wonder whether I should accept it as an inevitable part of ageing.
Conventional remedy:
A persistent inability to achieve or maintain an erection of the penis sufficiently to have intercourse is known as erectile dysfunction or impotence. It is a common and significant problem, with approximately one in 20 45-year-old men and one in three 65-year-old men experiencing it.
For such a common problem, there is great reluctance to discuss it in an open way. This embarrassment adds to the anxiety often experienced by sufferers. Although the risk of impotence increases with age, it is not inevitable.
The physical causes are many, and include diabetes, heart disease, hypertension and stroke. Medication such as blood-pressure drugs, sedatives, tranquillisers and antidepressants can produce erectile dysfunction as an unwanted side effect. Previous surgery for prostate problems can also affect the ability to maintain an erection. Alcohol, heavy smoking and the use of recreational drugs increase the risk of impotence as well.
Psychological factors such as stress, fatigue, anxiety and depression are all known contributors to impotence. Performance anxiety, often associated with repeated episodes of impotence, can cause a vicious-circle effect. For some, there may be no identifiable cause of the problem.
Make an appointment to see your family doctor. Don't worry, he has seen and heard it all before, so do not be embarrassed.
He will carry out a comprehensive sexual, medical and psychological history, and perform a physical examination. He may also recommend a laboratory assessment or refer you to a a consultant urologist.
Treatment options are wide and varied, and will be tailored to meet the needs of the individual. These include lifestyle changes, such as reducing alcohol consumption, cigarettes and stress levels; psychosexual counselling; and erectogenic agents, such as Viagra.
For many men, these preparations are effective and safe, but care is needed for those who are already being treated for heart problems, for example. Those taking nitroglygerin and long-acting nitrates commonly used for chest pain should not take erectogenic medication.
Some types of impotence can be treated with injections and prosthesis. Surgery, where a device is implanted in the penis to help maintain an erection, may be recommended, but would be considered only where first- and second-line therapies have failed.
Dr Muiris Houston
Alternative remedy:
Traditional Chinese medicine has been used to treat impotence for centuries. In order to treat the condition, the practitioner must first determine the cause, which can be any of a number of physical, emotional and nutritional problems.
An overindulgence in sexual activity can deplete a person's "essence", which is stored in the kidneys. This essence is important for development and reproduction. We have two types of essence: congenital, which we inherit, and acquired, which we gain from nutrition and lifestyle. One way, a man can lose his essence is through ejaculation.
The acquired essence is also depleted by poor nutrition, especially too much alcohol and greasy foods, which injure the digestive system, causing what traditional Chinese medicine refers to as "damp and heat" to be driven downwards, making the penis unable to become erect.
Emotional factors such as fear, worry, stress or trauma can cause stagnation in the body, damaging the kidney and digestive system, which may also lead to impotence. The psychological effect of a weakened sexual function can exacerbate the problem.
Acupuncture and Chinese herbal medicine can tonify the kidney to replenish essence, strengthen the digestive system to clear the damp and heat from the body and move the stagnation to smooth the emotions and de-stress the person.
Deirdre Courtney, acupuncturist and Chinese herbalist
The Irish Register of Chinese Herbal Medicine is at 01-8533043; the Acupuncture and Chinese Medicine Organisation is at 01-4640444