Treatment has improved, both in terms of new medication and looking for the underlying issues, writes BRIAN O'CONNELL
THE British Journal of Urology International has just published a report on erectile dysfunction (ED) which found that men often under-reported sexual issues, such as orgasmic and ejaculatory dysfunction, due to social stigmas. While medication such as Viagra has been successful in treating ED in many men, the research suggests there are other common sexual issues that remain largely unaddressed.
Dr Darius Paduch, lead author and male sexual medicine specialist at Weill Cornell Medical Center in the US, said: “We must expand the definition of quality of life when it comes to sexual performance. For the last few decades, we have focused on penile rigidity, with erection as a synonym of normal sexual function. However, many patients say that problems with ejaculation – such as decreased force or volume or decreased sensation of orgasm – are just as critical.”
He believes that, despite the frequency of these issues, non-erectile sexual dysfunction was undertreated due to a misunderstanding about the physiology of male sexual response. “Sexual satisfaction is known to be linked to the likelihood of orgasm, which in turn affects emotional intimacy and relationship satisfaction. The high prevalence of both orgasmic and ejaculatory dysfunction warrants further research into new treatments to improve sexual health and overall quality of life for hundreds of thousands of affected men and their loved ones,” he said.
The study was sponsored by Eli Lilly, which may have an interest in examining whether testosterone-replacement therapy and products can help men who suffer from non-erectile sexual dysfunction.
Dr Tom Kelly, of the Everyman Centre in Dublin, urged caution with some of the findings. “I think this study is wrong if it is implying that a large number of men suffering from erectile dysfunction are unable to achieve orgasm. That is ridiculous. If they are talking about men between 55 and 90 years of age, then that might be true.”
The most common age group Dr Kelly sees seeking treatment for ED are young men, and he says that in more than 30 years treating patients, only a very small minority of these couldn’t achieve orgasm. He did, however, agree that diagnosis and treatment of certain male sexual issues could be improved in general practice.
“Sexual problems are the Cinderella of medicine,” he said. “Doctors and GPs don’t receive adequate training. To say all sexual problems are underreported . . . I think that was true for a long, long time until drugs for erectile dysfunction appeared. I was dealing with it for 15 years before Viagra appeared, and you do have to address underlying issues regardless of the ability to prescribe for problems.”
Reports that offer quick solutions to what are often deep-rooted and complex conditions should be treated with a level of scepticism. Dr Kelly says Irish men are much better at reporting and seeking treatment for sexual issues.
“Seeking treatment has changed hugely,” Dr Kelly says. “In the clinic, in terms of STI testing, 10 years ago I would rarely have got a word-of-mouth referral. Now the number of men who are referred by friends or patients of mine is much larger. That shows men are talking to each other about STIs and coming forward.” He says it is the same when it comes to reporting ED and that men are now far more open.
'OPERATION AFTER PROSTATE PROCEDURE MADE ME FEEL 20 AGAIN'
'Frank' , who is 68, says treatment for prostate cancer led to erectile dysfunction
I had my prostate removed as my prostate-specific antigen (PSA) was up around 16 or 17. My sex afterwards wasn't great. I spoke to my consultant about it and he said there was a procedure where they insert a hydraulic into your scrotum. Then it goes into your penis and it has a pump in your scrotum that you pump. Some people I knew who had their prostate removed were very worried about getting an erection and that no matter what they used, be it Viagra or other tablets, it didn't work. This is a widespread procedure in the US.
When they remove the prostate, they remove some of the nerves and they insert this to take over from that. It really makes you feel like a 20-year-old again. I do think that if you are looking to have a sexual relationship, it is the answer.
Some people my age may be uncomfortable talking about these things. We were brought up in a generation where we weren't educated enough as far as sex was concerned.
I would have been 19 or 20 when my brother took me up to the bedroom and said, "Do you know about the birds and the bees?". I think my sisters would have been very naive – we all were. That is why it is so difficult to talk about these things for some men in later life. I have no problem though. When I was interested in getting this procedure done I spoke to a guy in Wicklow. A super guy, who is very open. He said, "if you want to see it working come up to me and I'll show you." That was taking it a bit too far!
