Don’t let erectile dysfunction get you down. Psychotherapist Nuala Deering (2017)

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Friday, April 28, 2017, By Sharon Ni Chonchuir

With one in 10 men experiencing erectile dysfunction, specialists urge men to seek help and avail of a growing range of treatments, says Sharon Ní Chonchuir.

ERECTILE dysfunction (ED) affects one in 10 men at any given time. According to the Irish Heart Foundation, 18% of men aged 50 to 59, 38% of men aged between 60 and 69 and 57% of men aged over 70 suffer from the condition.

“It’s a common problem and it’s actually a natural and expected part of the ageing process for many men,” says Dr Ivor Cullen, a consultant urologist at University Hospital Waterford.

As anyone who followed Charlotte and Trey’s storyline on Sex in the City will remember, there is a lot that can be done to treat ED. 

One of the best-known ways is with a little blue pill called Viagra.

“It’s one of four different drugs called PDE5 inhibitors which revolutionised the landscape when they came online in the mid-1990s,” says Dr Cullen. 

But new forms of treatment are coming on stream.

Former cricketer Ian Botham dominated the cricket pitch in the 1980s but, off the pitch, it was his sex life that generated headlines, with one lover claiming their trysts were so energetic that they broke the bed. 

It’s why eyebrows were raised when the 61-year-old spoke about receiving treatment for erectile problems last year. 

However, he didn’t opt for Viagra or any alternative pills. He received a course of low-intensity shockwave treatment (LIST), which is newly available in Ireland.

It’s easy to see why he chose this treatment. It is said to have a high success rate and to show visible results within three weeks.

According to a 2015 study in the Scandinavian Journal of Urology, researchers took 112 men who were unable to have sex without medication and gave half weekly doses of LIST and the other half a placebo. 

By the end of treatment, 57% of those who had LIST were able to have intercourse compared with 9% of those who received the placebo.

Despite such promising results, Dr Cullen cautions against concluding that LIST represents a miracle cure. 

It doesn’t work for everyone and in up to 40% of cases, it won’t work if the ED is the result of diabetes, prostate surgery or pelvic fracture.

In just the same way, Viagra and PDE5 inhibitors aren’t a cure-all.

Viagra can have side effects such as nasal stuffiness, headache and heartburn. Then there’s the fact that it cures only the symptoms and perhaps not the causes of ED. 

Over time, the underlying cause may worsen and Viagra may not produce the same desired result.

ED often occurs because of a diminished blood flow and drugs like Viagra restore the supply. But if the blood vessels surrounding the penis are narrowed, it’s likely other blood vessels are too. By prescribing the likes of Viagra or LIST, doctors may be ignoring the primary problem.

“The penis is seen as a window on the heart and a problem with the penis can be an indicator of cardiovascular problems,” says Dr Cullen. 

“ED can also result from diabetes, prostate problems or the side effects of drugs such as antidepressants. When doctors are assessing patients, we have to ask them questions and run blood tests to see if there are any previously undiagnosed problems of which ED is just one symptom. That problem will then have to be treated before we treat the ED.”

The manopause (or male menopause) may have a part to play in ED too.

Just as women’s hormones change in middle age, causing low libido, so too can testosterone decline in men, with much the same results.

This has led some experts to believe that testosterone replacement therapy could help improve men’s erections. Dr Cullen has seen this work, especially when combined with other treatments. 

“There is unambiguous evidence that improving testosterone levels in men with low levels can improve ED and enhance their response to Viagra-type medications,” he says.

It’s not just medical interventions that can help. Diet may be a factor too. 

“79% of older adults are overweight according to the Over 50s in a Changing Ireland Study published in 2014,” says Orla Walsh, a dietician with the Dublin Nutrition Centre. 

“Overweight men are more likely to suffer from ED as their blood vessels are damaged and their blood flow is affected.”

This means that losing weight can make a difference. Walsh recommends taking 30 minutes of exercise a day, stopping smoking and drinking moderately.

She also suggests adding elements of the Mediterranean diet to your meals. 

“Basically, anything that is good for the heart is good for the penis,” she says. 

“So add things like beans, peas, lentils, olive oil, fish and nuts like walnuts and brazil nuts.”

She particularly recommends beetroot juice. 

“It’s full of nitrates which help the blood vessels to dilate and the blood to flow more easily,” she says.

In up to 20% of cases, ED stems from a psychological or emotional problem, which means that counselling can help.

Nuala Deering is a relationship and psychosexual therapist and ED is one of the most common issues she encounters.

She works primarily with couples who are in committed relationships and includes the man’s partner in the counselling sessions. 

“It’s important they work as a team to overcome this issue,” she says. 

“It’s not good if the partner is angry, upset or annoyed. That will only make the man feel guilty or bad.”

Deering also treats a significant number of young men in their 20s. Even though their issues are different, they do have a lot in common with her older clients.

“Their confidence and self-esteem are affected,” she says.

“They often feel hopeless by the time they come for therapy, believing they can’t be helped. But in almost all cases, therapy helps.”

There are many psychological causes of ED. 

“Stress, anxiety and depression are all factors,” she says. 

“Performance anxiety is something many men mention too. With the amount of sex in the media around us, it’s easy for them to believe that everyone else is having great sex and that they’re inadequate because they are not.”

Porn also has an impact. 

“Lots of young men have learned how to be sexual through porn rather than through an intimate sensual relationship with an ordinary human being,” she says.

“They have learned to have an unhealthy fixation on the end result — the orgasm — rather than on the sensual pleasure. This can cause big problems.”

Treatment begins with the men stopping all sexual activity. 

“They have to go back to the beginning, with no pressure or anxiety,” she says.

“They have to build confidence and understanding and they do this by focussing on sensual pleasure. They take time to work up towards full sexual relations again.”

While they do this, they also tackle their problems with self-esteem, anxiety and depression in their therapy sessions. 

“My bio-sexual-social approach takes everything into account,” says Deering. 

“This allows them to deal with underlying issues and it affects how they feel, their relationships and their intimacy levels. It doesn’t just improve their sex life. It improves their whole life.”

Ian Botham appears to have done men a favour. ED is a problem that most men experience in their lifetimes and yet it’s still a taboo subject.

Viagra may be the best-known treatment but as Ian Botham’s story shows, it’s not the only one.

Men often find it difficult to open up, says Deering. 

“But they should because they might just discover that they can be helped.”

They might be helped by diet or lifestyle changes, psychosexual therapy or medical interventions.

“The range of treatments is expanding all the time and the more options we have, the better the chances of improvement,” says Dr Cullen. 

“There’s a lack of understanding and embarrassment around this topic but men should see their doctors about it. They will be helped.”

There is a range of medical treatments for erectile dysfunction:

1. Viagra is one of four PDE5 inhibitor drugs. All are taken in pill form.

Some — like Viagra — are taken up to an hour before intercourse while others are taken on a regular basis in low doses. 

While Viagra drastically increases the blood flow to the penis in the short term, the low-dose option increases blood flow over time, with a view to improving the quality of erections in the long term.

2. LIST is a procedure where doctors use an ultrasound probe to deliver 1,500 shocks to five points along the penis. This procedure is carried out over four to 12 sessions over the course of four weeks. It works by encouraging the growth of new blood vessels to the penis.

3. Injectable therapies involve a drug called prostaglandin being injected directly into the penis. They are effective within five to 10 minutes.

4. This same drug can also be taken by inserting a pellet into the urethra or by massaging a cream onto the end of the penis. 

“There are drawbacks to both of these options,” says Dr Cullen. 

“With the pellet, the end of the water pipe can become sore and with the cream, you can’t have oral sex or use a condom.”

5. Surgery is an option. A permanent prosthesis can be implanted into the penis. Nothing is visible externally. The resulting erection is as hard and sensitive as before and the man can achieve climax.

6. There’s a less complex option involving a malleable implant or the non-invasive option of a vacuum device. 

“This involves the penis being inserted into a vacuum tube where negative pressure draws blood into it and a constriction ring then traps that blood there,” says Dr Cullen. “The resulting erection is different to a normal erection but some patients are very satisfied with it.”