Man talk - Erectile dysfunction

Dr Rob Hicks talks 'Erections'.

Problems in the bedroom department, trouble down below, losing my manhood: all phrases men use to ask for help when erections are not what they are expected to be.  Nowadays, more men are asking for advice about impotence, or erectile dysfunction (ED), and the media is continually adding column inches to the subject, as I’m doing here.  After all, ED is a common problem estimated to affect most men once in their life, and around one in two of those aged over forty is likely to suffer more frequently. 

Most men, and women, are aware that erectile dysfunction exists, and are well aware of the oral treatments available (at low cost privately, and also on the NHS). But what can we do about the psychological factors?

As outlined at, older men generally experience impotence because of physical factors just as younger men usually develop erectile problems because of psychological factors.

ED is an inability to get and maintain an erection that’s sufficient for satisfactory sex.  In real terms, if you don’t get any erection at all, or your erections don’t last, or are not firm enough for penetration, then you’ve likely got ED.

Many barriers get in the way of overcoming ED.  Men will ignore the problem hoping it will go away.  Many still wrongly believe it’s the legacy of getting older.  All too often men are embarrassed to seek help.  After all, people are reluctant to discuss their genitals anyway – reflected by them being referred to as ‘private parts’ – especially when these malfunction.  Men often feel ashamed, and less  manly, when their equipment doesn’t work properly.  But this silence exacerbates the problem.

All too easily a vicious cycle develops, making matters worse.  A woman fears her partner is having an affair or that she’s no longer attractive to him and can no longer turn him on.  The reality is that he’s terrified his equipment is going to let him down and that he won’t be able to live up to his or his partner’s expectations.  This pressure causes performance anxiety, which in turn makes successful performance even less likely.  The solution for many men is to avoid any intimate situation where he may find himself having to perform: for example, by staying up late watching television, checking e-mails, finally getting around to finishing that DIY project or doing anything that allows him to be sure his partner will be asleep when he climbs into bed.  Even cuddles, hugs, and hand-holding cease because of the worry this simple show of affection may develop into something more intimate.  This reinforces a woman’s fears, so perpetuating the problem and further damaging the relationship.  This just goes to show how – although ED is technically a man’s problem – it has a knock-on effect such that women suffer too.

Around 80% of ED has a physical cause, for example high blood pressure or diabetes.  Seeing a man with these conditions a doctor may ask him about his erections.  Although this may seem totally inappropriate, it isn’t perverse curiosity.  It’s because this is a comfortable way to open up the discussion.  I often see men who want their blood pressure checked, and who casually ask, “High blood pressure can make you impotent, can’t it?” which they may find a less embarrassing way to kick the discussion off.  Since ED is a risk factor for heart and circulatory disease, seeking advice can not only save a man’s relationship but may also save his life.

Most men, and women, are aware that erectile dysfunction exists, and are well aware of the oral treatments available.  My message to men, and women, is: “it’s good to talk” – because couples who do talk about ED have a better chance of maintaining their relationship, a better chance of getting help, and a better chance of successfully overcoming the problem.

Article published in issue 2 of Uncovered magazine buy here.

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