Erectile dysfunction (ED) and infertility are two major issues generating concerns the world over, and particularly in the Sub-Sahara Africa, where the prevalence of risk factors, such as diabetes, dyslipidaemia, hypertension, is on the increase.
ED could simply be described as a condition, in which a man experiences consistent or recurrent inability to achieve and/or maintain a penile erection, sufficient for satisfactory sexual performance. This is the major sexual dysfunction that affects men.
Infertility, on the other hand, is a health condition common in both males and females. It is the inability to conceive or produce offspring, despite having regular unprotected sex. It occurs when a poor reproductive system impairs the ability of the body to perform necessary functions of reproduction.
Contrary to the misconception that ED is an age-related condition, a Consultant Urologist at the Lagos State University Teaching Hospital (LASUTH), Ikeja, recently explained that erectile dysfunction has nothing to do with old age.
Defining ED or impotency as a state where a man cannot get an erection to have sex or cannot keep an erection long enough to finish having sex, she added that it is not necessarily a symptom of old age, as older men should still be able to get an erection for sexual pleasure.
The urologist listed some of the risk factors that can cause ED to include diabetes, which is high blood sugar; hypertension, which is high blood pressure; atherosclerosis, which is the narrowing of the arteries that take blood to the male organs; excessive alcohol intake; excessive smoking; and drug abuse can lead to erectile dysfunction.
Abolarinwa, therefore advised men to keep their blood sugar and blood pressure under control to prevent erectile dysfunction.
In addition to the highlighted causes of ED, Dr Anna Cole, a clinical psychologist with Mental Health Foundation, said psychological issues and problems in relationship with a sexual partner could also cause erectile dysfunction.
Feeling nervous about sex, feeling depressed and feeling stressed, including stress from work or family situations could degenerate to ED, she noted.
Also, a new research published in Science Alert with the title, “Erectile Dysfunction and Hypertension among Adult Males in Umudike, Nigeria: A Study of Prevalence and Relationships”, found it that ED affects approximately half of men of over 40 years of age and results in an inevitable loss of quality of life of the sufferer and his partner.
As regards the link between ED and infertility, Dr Michael Roizen, Medical Director of Internal Medicine, said ED and infertility are very different terms, noting that a man may be producing perfectly good sperm, but having trouble with his erection, which is what he termed ED. On the other hand, he explained that a man may have no trouble raising the rifle, but he is shooting blank, that he called infertility.
A man’s fertility generally relies on the quantity and quality of his sperm, if the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy. Conversely, a woman’s fertility can be measured through various means, like the regularity of the menstrual cycle, among other things.
Dr Franklin Meme, a gynaecologist with the Federal Medical Centre (FMC), Yenagoa, Bayelsa, said evaluation of women infertility could be done through blood tests, ultrasound examinations of the ovaries or an ovulation home test kit.”
“An irregular menstrual pattern would make us suspect an ovulation problem, but it is also possible for a woman with regular periods to have an ovulation disorder,” he stressed.
He identified conditions such as polyps; adenomyosis; an abnormal uterus; fibroid; sexually transmitted diseases (STDs); as some of the major causes of infertility in women.
Statistics on erectile dysfunction in Nigeria
Accurate statistics are lacking on how many men are affected by infertlity, but some doctors estimate that about half of men aged 40 to 70 have frequent problems achieving or maintaining an erection. The number of men with erectile dysfunction is low for those under the age of 40, but it increases with age.
Causes of erectile dysfunction
- Circulatory problems: An erection occurs when the penis fills with blood and a valve at the base of the penis traps it. Diabetes, high blood pressure, cholesterol, clots, and atherosclerosis (hardening of the arteries) can all interfere with this process. Such circulatory problems are the number one cause of erectile dysfunction.
- Peyronie’s disease: This disease causes fibres and plaques to appear in the genitals, interrupting blood flow.
- Cancer: Cancer can interfere with nerves or arteries that are vital to erection.
- Surgery: Surgery to the pelvis, and especially prostate surgery for prostate cancer, can damage the nerves and arteries that are required to gain and maintain an erection.
- Spinal cord or pelvic injury: The nerves that stimulate erection can be cut by injury to them.
- Hormonal disorders: A lack of testosterone (male hormone or androgen) can result from testicular failure, pituitary gland problems, or certain medications.
- Depression: This condition is a common cause of erectile dysfunction. Depression is a physical disorder as well as a psychiatric one, and it can have physical effects. This may be true even if you feel comfortable in a sexual situation.
- Alcoholism: Chronic alcoholism can produce erectile dysfunction, even if there is no alcohol in the blood at the time of sex.
- Smoking: Smoking cigarettes causes constriction of blood vessels. This may decrease blood flow to the penis, causing erectile dysfunction.
- Performance anxiety: Most men have had erection problems at some point due to worrying about performing well during sexual intercourse. If this happens often, the anticipation of sex can trigger nervous reactions that prevent erection, setting up a vicious cycle.
- Situational psychological problems: Some men have problems only in certain situations or with certain people. In troubled relationships, men may be unable to achieve erection with their partner but have no problem away from home.
- Sexual aversion: Being repelled by sex is rare. It is most common in people who suffered child abuse and those who have been brought up in strict religious surroundings. Aversion can also exist in homosexual or bisexual people who attempt to lead a heterosexual life against their basic inclinations.
- Drugs: The following can cause erectile dysfunction:
- antianxiety medications
- anticancer medications
- ganglionic and adrenergic (beta) blockers
- MAO inhibitors and tricyclic antidepressants
- narcotic pain relievers
- medications prescribed to control high blood pressure
Symptoms and complications of erectile dysfunction
A man may sometimes have erections, (e.g., when he wakes up in the morning), but be is unable to get an erection during sex with his partner. This is often a sign of a psychological problem that may or may not have to do with that particular relationship.
If a man had regular erections in the past, but suddenly begins to have problems getting an erection, there’s a chance that it’s a nerve or hormonal problem, a circulatory problem, or the effect of alcohol, drugs, or medicine.
If a man still gets erections but they’re not as hard or long lasting as in the past, it’s quite likely that a circulatory problem is causing the dysfunction.
If surgery or injury is involved, the sufferer may already know what’s causing the erectile dysfunction. A doctor should be consulted about possible solutions.
While erectile dysfunction is inevitably going to cause some anxiety, it’s vital for sufferers to keep their relationship with their partner or spouse as regular as possible until a solution can be found. Modern medicine and therapeutic techniques can help over 90 per cent of erection problems.
Diagnosing erectile dysfunction
To find out what’s causing erection problems, a doctor will begin by asking about other medical conditions the man might have, what medications he’s taking, when his erection problems occur, and what form they take.
Standardised questionnaires or surveys about erectile function and the satisfaction of sexual intercourse may be used to identify the nature of erectile dysfunction. Blood pressure tests and tests of hormone levels are standard.
There are tests that aim to distinguish between psychological, nervous, and circulatory causes. One is the nocturnal penile tumescence (NPT) test. A measuring device is attached to the penis to monitor erections during sleep. Men without physical disorders usually have erections during REM (rapid eye movement) sleep.
Several devices, including a Doppler radar, can track blood flow in and out of the penis and identify circulatory problems.
Treatment of erectile dysfunction
There’s a wide range of treatments for erectile dysfunction. Some are pills, and others are injections or devices that should be used just before sex. There are also treatments involving surgery.
Medications for erectile dysfunction include phosphodiesterase inhibitors, prostaglandins, and testosterone.
- Phosphodiesterase inhibitors: This class of medications includes sildenafil,* tadalafil, and vardenafil. They work by inhibiting an enzyme called phosphodiesterase type 5 (PDE-5). This enzyme normally breaks down a molecule called cGMP. Inhibiting the enzyme makes more cGMP available, which leads to relaxation of smooth muscles in the penis, allowing more blood to enter and helping to produce an erection. These medications are taken before sex and will cause an erection only when the man is sexually stimulated. The time the dose should be taken and how long the effects last depend on the medication used. The most common side effect of these medications is a headache. However, there is a potential for certain dangerous drug interactions. Anyone taking this medication must let his doctor know about any medications he’s on, and especially if he’s taking nitrates (e.g., nitroglycerin spray, nitroglycerin pills, or nitroglycerin patch) for heart problems.
- Prostaglandins (alprostadil): Alprostadil can be injected into the penis or inserted as a pellet through the urethra. It causes an erection that usually lasts about 60 minutes. The danger with this method is that too high a dose can cause priapism, an erection that won’t go away. This condition can cause serious bruising, bleeding, and pain. Once the doctor is sure of the right dose, the man can self-inject at home. Some doctors may prescribe a combination of alprostadil with additional ingredients such as phentolamine to help the medication work more effectively. This mixture is prepared by the pharmacy according to the directions of the prescribing doctor. It is injected into the penis before sex.
- Testosterone: This is only useful for people with specific disorders like hypogonadism (small testicles) that result in lower than normal amounts of testosterone in the blood stream. Testosterone increases interest in sex, as well as erections. Common non-medication ways of treating erectile dysfunction include vacuum devices and penile implants.
- Vacuum devices: This involves placing a tube over the penis, forming an airtight seal around the base. By pumping air out of the tube, blood can be drawn into the penis. Placing a ring around the base of the penis will maintain the erection.
- Penile implants: This treatment involves permanent implantation of flexible rods or similar devices into the penis. Simple versions have the disadvantage of giving the user a permanent erection. The latest (and most expensive) device consists of inflatable rods activated by a tiny pump and switch in the scrotum. Squeezing the scrotum stiffens the penis, whether the person is aroused or not. The penis itself remains flaccid, however, so the diameter and length are usually less than a natural erection, and hardness is lacking, although it’s sufficient for intercourse.
Prevention of erectile dysfunction
There are two broad categories that the causes of erectile dysfunction (ED) fall into physical and physiological.
Physical health problems are the most likely cause of erectile dysfunction as earlier mentioned, particularly in older males. Common chronic diseases such as obesity, diabetes and high blood pressure are often associated with ED and therefore, a healthy lifestyle is the best way to avoid ED.
For younger men, ED is often related to anxiety, stress or psychological trauma due to a distressing sexual experience.
Pills such as Viagra can help a man overcome psychological obstacles and give him confidence that everything is working perfectly. However, for older men, consulting a doctor can be an important step towards uncovering and treating underlying physical causes.
The seven top tips to achieve better health, both physical and physiological, are:
- Lose weight: if you are in the overweight bracket, the excess weight may be putting your cardiovascular system under strain;
- Quit smoking: this affects blood flow and neuro-signals which normally ensure correct blood flow into the penis;
- Avoid drinking too much alcohol (no more than two drinks a day);
- Maintain a balanced diet;
- Control and monitor your blood pressure and cholesterol levels;
- Be physically active: just 30min per day can improve your blood flow, state of mind and stress levels;
- Reduce stress and get enough sleep (at least seven hours a night).
In most cases, blood vessel deterioration is the main cause of erectile dysfunction, so you want to make sure that your blood vessels are in good condition to allow normal blood flow. Depending on the state of your health, taking pills might not always prove the most effective solution.
Beware of diabetes
Diabetes is risk factor for erectile dysfunction that is often overlooked. The damage caused to the blood vessels by abnormal blood sugar levels can, in the long run, result in ED.
Type 2 diabetes stems primarily from unhealthy diet and lack of exercise (yet another reason to maintain a healthy lifestyle to prevent ED).
Erectile dysfunction in young men
Young men often suffer from “performance anxiety, which can result in erectile dysfunction. Being psychologically healthy does not require you to have nerves of steel. It’s simply important to be open with your feelings, and it may be beneficial to express and discuss how you feel.
Seeking help from a sexual health expert can prove very effective, especially to work through relationship issues or anxiety, both of which may result in ED. You should note that, while recreational drugs and low levels of testosterone are not directly responsible for erectile dysfunction, they may well affect a man’s sexual drive.
Old or young, remember that it is normal to experience engine failure”once in a while. Look for diversity and new experiences with your partner so that you can focus on present pleasure again rather than reviewing past failures.
Pills or emotional support?
When your confidence is at stake, taking pills such as Viagra can help you to realise that there is no problem with the engine and give you that confidence boost.
However, if you are facing bigger issues, then expert help and knowing fully what you are dealing with can help relieve your fear and anxiety.
This will help you to find out the real causes of the problem too, which will help you reach the best solution for you.
If you feel too embarrassed to raise the topic with your doctor, you can use our online services to directly contact one of our GPs. They can assess the causes of your ED and suggest a treatment that fits your needs.
Relationship issues and erectile dysfunction
While you are working out the causes of your problem or being treated, it’s fundamental that you focus on your relationship.
Couples who have difficulties communicating on both sexual and heart matters are more likely to develop issues related to intimacy and sex. Talking about your feelings and anxieties, although this may sound difficult, is crucial: your partner needs to understand how you feel and what you need.
Just remember, if you are having problems with your impotence, your partner will be affected by this too. There is nothing to lose by talking about it; so it’s often beneficial to be pro-active by raising the issue and then working through it together. You may well find yourself addressing broader issues in your life, which can also improve your mood and relationship.
Erectile dysfunction exercises
A recent research by the University of the West of England, Bristol, suggests that erectile dysfunction exercises may be a very effective way of improving your erections. Similar to the pelvic floor exercises recommended to women after childbirth, these exercises involve clenching the muscles you use to control urination.
Pelvic floor exercises have long been known to help patients with incontinence. The study conducted by a team of scientists in Bristol involved participants who had been suffering from erectile dysfunction for at least six months. 40 per cent of participants reported that they regained their erectile function within 3 to 6 months. A further 35 per cent reported, that they noticed a significant improvement to their condition.
The scientists from Bristol compared the effectiveness of these exercises to that of Viagra and believe regularly exercising your pelvic floor muscles may be the best way of preventing erectile dysfunction. The exercises train the muscles surrounding your penis, which improves the blood flow and improves your ability to gain and keep an erection.
Physical exercise – how sport can help
Exercising regularly is a great way to improve the state of your general health and boost your performance. A series of prolonged bad habits can damage the tissue responsible for erections over the years.
When combined with a healthier lifestyle, regular physical activity can contribute to improving your blood flow and restore your ability to get erections. All you need to do is to maintain a regular activity, even if it’s just 30 minutes a day, to improve your blood pressure, blood flow, cardio and overall health. Even walking is a good option, although it’s better to practice a sport or do some hard exercise to push yourself!
In addition, it’s important to achieve and maintain a healthy weight. This is a great long-term prevention strategy for erectile dysfunction.
However, there is one sport you may want to avoid: cycling. Long-term and long hours of outdoors cycling can damage the nerves in your pelvic area which control erections. Indoors cycling is much less hazardous as the seat is generally wider and less prone to damaging your body.
Statistics of infertile women in Nigeria
Infertility affects nearly 25 per cent of couples in Nigeria and experts claim that 40 to 45 per cent of all consultations in gynaecological clinics are infertility-related.
There are two types of infertility:
- Primary infertility: where a woman who has never conceived a child in the past has difficulty conceiving and;
- Secondary infertility: where a mother who has had one or more pregnancies in the past, is having difficulty conceiving again.
Causes of infertility
There are many causes of infertility. Common causes of infertility in women include lack of regular ovulation (the monthly release of an egg), blockage of the fallopian tubes, age and endometriosis.
Treatment options for infertility
Infertility can be treated with therapies such as medication or surgery. The most common types of fertility treatments available include:
- Medical treatment for lack of regular ovulation
- Surgical procedures, such as treatment for endometriosis
- Assisted conception, which may be intrauterine insemination (IUI) or in-vitro fertilisation (IVF)
There are numerous clinics and medical centres in Nigeria that can help couples having difficulty conceiving children. The cost for fertility treatments varies, with IVF treatments costing between N800,000 and N1,000,000.
Note that while some couples find it easy to get pregnant quickly, it can take longer for others. However, if you have been unable to conceive after one year of trying, it’s time to consult your doctor or medical provider.
Compiled by Temitope Obayendo with information from Science Alert; Health Bridge Limited; WebMD; The Daily Independent Newspapers.