Last Updated on December 29, 2021 by Neelam Singh
Erectile Dysfunction is not just a man’s thing, and if not nipped in the bud, it can wreak havoc on intimacy in a couple’s life. Here’s what the experts have to say on the much-ignored issue of a man’s health.
Actor Ayushmann Khurrana as Mudit Sharma made erectile dysfunction or ‘gent’s problem’ a dinner table conversation in his most-talked-about performance in the 2017-release Shubh Mangal Saavdhan. “Ek chai mein duba hua biscuit?” is how Mudit explained Erectile Dysfunction (ED) to his love interest Sugandha Joshi played by Bhumi Pednekar in the film. Director RS Prasanna and writer Hitesh Kewalya deserve special praise for broaching the topic without even mentioning the actual term in the two-hour movie, except for the writing on a book that read Erectile Dysfunction towards the end of the film. But by doing this, Shubh Mangal Saavdhan also highlighted the predicament most men face around their ‘gent’s problems’. It is easier said than done, and men always find it challenging — first to accept, seek medical help, and get the problem sorted.
Boston Scientific organised an online conclave titled, “It’s a Man Thing: Below-the-Belt Conversation”, to normalise the much-needed narrative around ED.
- 50% of men who are past the age of 40 suffer from ED, while 10% have it before 40
- 40% of men who have diabetes, also have ED
- Lifestyle factors that lead to ED include obesity, alcohol and smoking
- Most men rely on herbal medicines and supplements and prefer self-treatment before reaching out to the right specialist/doctor for ED, and it takes almost four years to do this
- Only one in three men seek help for ED
- 20-30% of marriages break due to ED
These startling facts and figures were revealed at the onset of the Conclave to lay the ground for experts to explain the problem in easy-to-understand terms, find out its probable causes, and deal with the issue at the physiological, psychological, social and medical levels.
Understanding ED and its symptoms
Calling ED as just a descriptive term for a problem with the erection, Dr Rupin Shah, consultant andrologist and microsurgeon, clarifies that it’s not a label, a diagnosis or a stigma. He adds how somebody who has no problem otherwise, can also have ED. “We need to start by understanding that it’s nothing to be ashamed of or worried about, and neither does it necessarily mean that there is something wrong. A problem with erection, which is what it is, could happen in any young person, just because he was anxious or tense or misinformed or was trying to impress a new partner so could have ED due to performance anxiety. It could happen in middle-aged men who again don’t have a real problem, but they’re stressed out, have work-related tension, work pressure, and come home very tired. And it could happen in older men who have an actual physical problem because of diabetes, hypertension, high cholesterol, smoking, all of which compromise the blood flow,” says Dr Shah, who is also the founder president of the South Asian Society for Sexual Medicine.
Boston-based Dr Anita Shyam, psychiatrist, clinical sexologist, and sex and intimacy coach, often meets patients who come to her after having met other doctors and have long term ED. Taking us through the process, Dr Shyam states, “I follow a simple phenomenon — take into account a detailed sexual and relationship history. So that pretty much gives me a wider view of what the cause can be. Is it an organic cause? Or is it something to be a psychological cause? Is it a social cause or it’s absolutely a relationship problem which we are dealing with?” When the causes are organic, she refers the patient, to physicians who specialise in that field, whether it’s a cardiologist or an andrologist, and if it is a psychological cause, then she digs more into the detail to ascertain if the individual has primary ED or is it anxiety or depression or drug or alcohol or sometimes a partner’s problem. “The partner must be suffering from some type of Vaginismus or desire disorder or depression, leading into ED. I try to find out if the couple has a relationship problem. If there’s any, then in such patients, I look holistically on the triangle’s three parts: the individual, the partner and the relationship,” adds Dr Shyam.
Dr Shah agrees that ED has become an umbrella term for various issues that men may have in most cases. “It could be a libido problem, which means he doesn’t feel the urge for sex, or he may have an arousal problem, he’s not attracted to his partner, or he may have an erection problem, which again, maybe a problem with getting or sustaining an erection. And then sometimes, he may have a problem with early orgasm or premature ejaculation. Each of these conditions have different causes and treatments but all are clubbed under the umbrella term ED, which is not the case,” he says.
Obesity increases the risks
An individual is considered obese when the actual weight is 20% more than the ideal weight (as per the height). Obesity is one of the significant health challenges globally, especially in developed nations. It is the root cause of ill-health. Being overweight increases the risk of heart diseases, diabetes, hypertension, stroke, osteoarthritis, and cancers such as colon, pancreas, stomach, and breast. Unfortunately, obesity can be physically and psychologically restrictive, thus preventing intimacy, adversely impacting one’s sex life.
Highlighting some lifestyle and medical issues in daily lives that are contributing to ED in terms of man capacity, Dr Shah says, “Sex is best when you’re at the peak of your health, then you have the greatest urge, the greatest energy, the greatest capability. As your general health diminishes, your sexual abilities decrease, even though that desire may be there. So the middle-aged executive who’s overweight, not exercising, eating too much sugar, smoking 10 cigarettes a day is going to have a lifestyle-induced sexual problem.”
India is the diabetes capital of the world as 50 to 70% of men with diabetes will eventually develop ED as a consequence of the disease. “It is imperative to realize that diabetes will affect the nerves, small blood vessels, the large blood vessels, the endocrine system, and predispose the men to erectile problems. Likewise with hypertension. Both hypertension and the medicines consumed to control hypertension could cause ED,” Dr Shah states.
Explaining the commonality of the problem among men, Dr Raman Tanwar, andrologist and urologist at Urocentre, Jyoti Hospital, Gurugram, says, “ED is one of the most common complaints in my outpatient department, and I see at least 20-30 couples with this problem daily. Most patients are quite reluctant to speak about it, but the comfort has increased over my decade of practice as an andrologist.”
Most Dr Tanwar’s patients have psychogenic ED, which usually results from false perceptions or failures in intimacy due to anxiety and poor sexual education. “Typically counselling and a few medications to instil confidence are all we need for many patients. In patients with psychogenic ED, the problem is curable if intervention happens in time. After a couple of weeks or months, most patients won’t need any therapy.”
Finding the causes of ED
It takes patience and experience to find the right cause of ED. “It is a complex problem as it arises from the faulty interplay of the mind, the nerves, the arteries, the corporal sponge, the veins, and the influence of hormones. It can be both physiological or organic as well as psychological,” explains Dr Tanwar.
On her part, Dr Shyam believes in listening to the patients to get to the root of the problem. “I go into the holes of what is happening in an individual’s life. And that helps me to make a proper diagnosis. I suppose the most important thing which I do with my client is to spend my time listening to their problems,” she says.
In most cases, the man’s thing becomes a couple’s phenomenon. Does the woman come forward to help the other partner work on ED so that the couple could lead a fuller life? “Absolutely, I have patients’ partners coming to me with a relationship problem. But on a detailed history, it is revealed that there is a problem happening with the erection. And I also always encourage my clients that you know, even if you have a problem with ED, let’s get together and try to solve this problem together. There’s a lot of support, and these encouragements certainly help the client,” says Dr Shyam.
Stress, anxiety, depression and mental health issues have aggravated during the pandemic and that adds to the intimacy woes. These contribute significantly and worsen the modern man’s thing, while his capability goes down. What makes it worse is the acceptance of the fact that often people refuse to believe that they are depressed, anxious and stressed.
“Stress plays a major role in an individual’s relations causing a lot of relationship problems that go on to cause a lot of sexual problems,” tells Dr Shyam.
Plan of action
Once a cause is ascertained, treatment can be very beneficial. “In organic ED, there is a need for long-term medications just like for any other disease arising from endothelial dysfunction like diabetes or cardiac illness,” states Dr Tanwar. But in most cases, thanks to the shame and ignominy, patients refuse to seek help and prefer self-medication and Google-aided treatment that may do more harm than good, much like Mudit Sharma of Shubh Mangal Savdhaan.
Dr Shah has the final word on how an andrologist chooses the dosage, the kind of medications, and why consulting an expert is important. “The pill is a double-edged sword. Those who are exploring self-medicating in such cases are losing out on the possibility of discovering why they are having the problem in the first place and solving the root cause of the problem. On the other hand, I’ve seen medicine work very well but the person is reluctant to take it because he is scared that it will harm him. I want to reassure men, and their partners, that used correctly these medicines are not dangerous. They do not damage the heart, kidneys or liver and can be taken long-term. In fact, Viagra (Sildenafil) was originally discovered in a Pfizer Lab while researching medicine for cardiac angina. Hence, it should not be taken by men who use medicine for angina (like Sorbitrate) as there will be a multiplying effect of the drug. Otherwise, it can safely be taken by men who are on antihypertensives or medicines for diabetes as long as they are otherwise physically fit for sex. But because of that limitation, people have missed the point, thinking that it is bad for the heart, kidney and liver. I have seen cases where I give them the prescription, and then they come back one day or one week later, saying that ‘I didn’t take the pill because my wife said, Don’t, it’s okay if we don’t have sex or my GP said, take it but be careful.’ So it’s both ways. Don’t self medicate. You may be missing out on something important. But don’t hesitate to take it if you need it.”
According to a study, about 30% of obese people who seek help in controlling weight indicate problems with sex drive, desire, performance, or all three. So, suppose a person desires to have a better sex life. In that case, the health goal should be to cut down on that extra weight and maintain an ideal weight because, all said and done, obesity is a barrier to enjoying the sexual experience thoroughly.
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