A recent survey has found that workers who spend all day sitting down are less likely to do well 'on the job' after hours. But a few lifestyle changes can help men who suffer the common problem of erectile dysfunction, explains DR DAVID OBERKLAID
IT'S A COMMON PROBLEM THAT NOBODY wonts to admit to having, but, according to a survey conducted by Decisions Research Asia, accountants and bankers are the first to seek medical help for impotency problems.
Men working in the finance sector are also among the high-risk group for suffering erectile dysfunction, along with workers in sedentary jobs like driving buses or cabs. There is also a link between stress levels and erectile dysfunction, meaning finance workers may have the odds doubly stacked against them, given their often high-pressure working environments. But unlike men who see their jobs as macho, it's the money men who head to their GPs first and reveal all.
So what, exactly, is erectile dysfunction? It's the persistent or recurrent inability to achieve or maintain penile erection sufficient to complete satisfactory intercourse (or any other chosen sexual activity). Erectile dysfunction does NOT, however, mean that you're infertile, or that you can't ejaculate or have an orgasm. It's a common myth that people with erectile dysfunction lack virility - this is simply not true.
For years ED was rarely mentioned or discussed. It was believed to be due to psychological problems and treatment was in the hands of the psychologists and psychiatrists. We now know that most cases of erectile dysfunction occur as a result of vascular disorders, which restrict the circulation of blood to the penis.
Most men will experience occasional impotence - usually resulting from stress, tiredness, anxiety or excessive alcohol or other drug consumption. These failures usually resolve with a little time, reassurance and patience. Having an understanding, non-demanding partner with whom you can talk frankly is a big help.
Worrying about impotence may set the scene for a more persistent problem due to 'fear of failure', known as performance anxiety. This is when the man becomes so preoccupied with previous erectile failure that he is unable to enjoy the arousal feelings associated with sexual stimulation. And this, in turn, decreases his sexual arousal and stops an erection from occurring.
Typically, psychological ED has a sudden onset and erections can be achieved under some circumstances.
It is estimated that 80 per cent of persisting ED is due primarily to a physical cause. These men generally have a more gradual onset of symptoms, including reduced hardness of erections, but eventually are unable to have an erection in all situations. The physical causes of ED include diabetes, high cholesterol, alcohol, and some prescribed drugs, such as blood pressure and anti- depressant medications. Many with a physical cause for ED will have associated psychological factors contributing to their symptoms.
It is also estimated that ED affects less than five per cent of men in their thirties and climbs to approximately 60 per cent of men in their seventh decade of life.
ED may often be prevented; a well-balanced diet and regular exercise helps to prevent the physical risk factors for ED, as does quitting smoking, reducing alcohol intake and trying to reduce stress. If such changes don't help the problem, then medical advice should be sought. In the first instance the regular GP should be consulted.
In recent years, treatment of ED has progressed enormously. Unfortunately, most men do not seek help for a condition which can usually be successfully treated.
Generally, GPs will perform a brief physical assessment and some baseline tests - these tests often include blood sugar, cholesterol and testosterone.
Only a very small proportion of those with ED will have low testosterone - most with reduced testosterone have reduced libido, and this is generally not a feature in ED. There is rarely any need for sophisticated tests.
For those with a psychological cause, sometimes supportive counselling may be all that is required. For those in need of more assistance, specific counselling can decrease anxiety of intercourse. Partners can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques can also help relieve anxiety when ED from physical causes is being treated.
The first line of treatment for virtually all sufferers with a physical cause is a group of oral medications known as PDE5 inhibitors. The first and the best known of these drugs is Viagra. These drugs assist up to 75 per cent of those with ED and they are generally well tolerated. It is important to realise, however, that these medications do not function as aphrodisiacs. Furthermore, they will not cause an erection without sexual arousal.
The second line of treatments is the use of self-administered injections into the penis and this will provide assistance for up to 95 per cent of individuals. Although most men think this would be an excruciatingly painful intervention, there is very little discomfort associated with the injection.
In some individuals, vacuum constriction devices may be of assistance, but surgical procedures have a very limited role.
Many with ED attend entrepreneurial impotence clinics in the mistaken belief that they can access superior treatments. These clinics sometimes promote more expensive interventions, so it is advisable to consult with your GP in the first instance and, if necessary, specialist consultation can be organised.
ED: The hard facts
* Most men suffer from occasional episodes of ED
* Many cases of ED can be prevented by adopting a healthy lifestyle
* The vast majority can be helped by modern treatments
* Most men with ED will not benefit from testosterone supplements
* Men should be encouraged to overcome any embarrassment and seek assistance from their regular doctor
* Entrepreneurial impotence clinics do not have access to superior ED treatments
'Having an understanding partner ... is a big help'
Copyright CPA Australia Aug 2004