Men and erections
This Update presents a commentary on the impact of erectile dysfunction in older men and their partners. It is by Bettina Arndt, BSc, MPsych.
Bettina Arndt, BSc, MPsych
Social commentator, writer and public speaker; author of What Men Want
These are exciting times for men. New drugs are changing the lives of men all over the world, men who have been devastated by losing what they see as a vital aspect of their manhood.
When I was working as a sex therapist in the 1970s, I’d watch these men weep with frustration. We had nothing to offer them. We didn’t even know much about what caused erections, let alone how to fix them when they stopped working.
It’s been exciting watching researchers gradually put together this complex
puzzle. The sexual equipment is a wondrous piece of engineering and now, finally, we have the means to tackle the various problems that cause the whole thing to break down.
What’s infuriating for people like me is despite the fact we now have good treatments for erectile dysfunction (ED), the snake-oil salesmen are still out there, ripping men off with products that do nothing but deflate their bank balances.
THE EXTENT OF THE PROBLEM
At a recent Fathers Conference, I watched as the owner of a natural health company sneered at Viagra, hugely exaggerating the drug’s risks and side-effects.
He then flogged his ‘natural’ product, using pseudo-scientific claims for its effects on potency.
But health products are the least of it. There’s a mighty impotence industry making millions of dollars preying on Australian men. About one in two men older than 50 has ED; 40% of 40-year-olds, 60% of men in their 60s. The market is huge.
It’s hardly surprising that the impotence industry has attracted very nasty operators. In Australia, the major players advertise their services using billboards promising longer, better sexual performance. One of these companies makes more than $70 million a year in this country. Consumer protection organisations regularly receive complaints from men about the company’s practices: patients paying thousands for expensive treatments that don’t work; lies about the effectiveness of their treatments; salespeople illegally withdrawing money from patient’s credit cards; dubious tactics to avoid money-back guarantees; failure to properly check medical histories or warn of dangerous side-effects.
But the real outrage is not what they offer, but what they don’t. For the first time in history, we now have proven treatments effective for most men with erection problems. Yet they fail to offer most of these effective treatments. They choose instead to mix tiny quantities of these drugs into a nasal spray with no sound research supporting this approach. That’s like throwing together a dozen soufflé recipes and hoping in vain that the result will rise.
The Department of Fair Trading has received many complaints from disgruntled consumers who paid thousands of dollars for this ‘nasal spray’, which then proved not to work.
Men are devastated about paying so much for treatments that do nothing for them, then quickly discover there’s a catch to the much-promoted money-back guarantees. While lacking many of the proven treatments, the clinics’ packages often include injectable products, an option many men baulk at using. So when the other treatments don’t work, they refuse to self-inject and miss out on their refunds.
It’s extraordinary that doctors would work for an organisation where they aren’t even required to talk to patients they are expected to treat. One doctor was charged with unsatisfactory professional conduct after prescribing a $4000 nasal spray after a cursory telephone call with a patient, with no attempt to take his medical history, nor do a physical examination or advise on side-effects.
SEEKING A SOLUTION
I recently conducted some research involving 150 men writing for me about sexual issues – published in the book What Men Want – including many older men who were dealing with ED.
It was alarming to hear from many who’d been given the most cursory advice about the problem, sometimes having their concerns totally dismissed.
Many prostate cancer patients reported that their urologists showed little interest in restoring sexual functioning, glibly dismissing the problem with comments like, ‘You’re lucky to
The patients know that. But once they have made it through the life and death crisis of treating the cancer, many reported that sex was the next thing on their agenda. Sex can be a wonderfully life-affirming experience and it is hardly surprising that many seek to celebrate in this way.
I recently received a letter from a man who turned to one company after seeing an eminent physician who brushed off his erection problem with minimal advice and no treatment. He ended up paying many thousands of dollars for injection treatment – the one thing the company offers that can work well.
He argued that the failure of the medical profession to deal effectively with ED drives men into the hands of these organisations: “My anger about these dodgy practices is greatly tempered by my firm belief that at least they came forward to the male community in their hour of need, while the whole medical profession, in my opinion, just sat on their hands!”
Back in the 1970s I was involved in providing minimal education to doctors about sexual counselling. It’s alarming that 30 years later, most doctors still haven’t been properly trained in this area. While scattered across the country are excellent doctors doing sexual counselling, these are men and women who have made extra efforts to acquire the expertise they need to handle these issues properly – their medical training in this area was sorely lacking. Yet much of the medical profession – particularly GPs, gynaecologists, psychiatrists and urologists – regularly see patients with health issues that impinge on their sex lives.
ASKING THE QUESTION
As one example – the penis is the canary in the mineshaft.
Erection problems are usually caused by problems in blood flow, which may show up in the penis long before they lead to a major health crisis such as a stroke or myocardial infarct.
Therefore, while checking blood pressure is routine, so too could be checking in with the patient about their sexual function.
When a doctor asks the right questions, it can make all the difference. I had one couple participating in my research who were seeing their urologist before the man’s prostate cancer surgery.
The doctor turned to the patient’s wife and asked, ‘How do you feel about sex?’
It was an important question. He was asking her how she felt about intercourse, about erections. How would she feel if she never again saw an erect penis in the marital bed?
Well, it turned out she was delighted at the prospect.
Here was a woman who never enjoyed intercourse, never climaxed that way – she far preferred touching or oral sex.
The doctor’s clever question opened the door for this couple to have a conversation about all this, which eventually led them to decide not to use erection treatments but to focus on ‘outercourse’.
They both wrote to me to say they have never been happier. She’s having the type of sex she always preferred, and he’s happy that she’s now initiating sex and enjoying it so much more.
That’s one couple with their own particular sexual wants and needs. Others are very different.
THE SEXUAL RELATIONSHIP
I have had women writing to me who cried themselves to sleep when their husbands refused to use the erection treatments, women who longed for their partners’ lost erections.
There were also women who were delighted at the prospect of their partner hanging up his spurs and totally horrified when he came rushing home from the doctor’s office waving a Viagra script.
The sexually disinterested partner is probably the major reason most men give up on ED treatments. It’s common for older women to have lost interest in sex.
My earlier research on mismatched desire (published in The Sex Diaries) showed that once women settle into their relationships, many go years with no spontaneous desire, with menopause often adding to the problem as loss of lubrication and thinning vaginal walls leads to painful intercourse. ‘I deserve a rest,’ one woman told me.
Women often fail to understand why sex means so much to men. Recently I was giving a talk in a country town about these issues and an older woman came up to me and said, ‘I think you’ve saved our marriage.’
With tears in her eyes, she explained she’d never listened to her husband when he tried to explain it wasn’t just sex he craved, but the connection he felt through making love.
Women tend to think it’s about getting their rocks off – ‘Oh, for goodness sake, go run around the oval or have a cold shower!’
But men know they can masturbate for sexual relief. Their struggle is for physical intimacy, the joy of feeling wanted rather than constantly rejected. We need to do a much better job explaining this to women.
Yet some men behave very badly when they regain their sexual youth, driving their partners crazy. Just when lovemaking shifts towards the more sensuous experience she’d always wanted, he regains firmer erections and wants to have intercourse all the time.
The thrill of that erection can lead men to become very demanding and inconsiderate of their partners’ needs.
Helping couples work their way through this difficult transition in their love lives isn’t easy. Of course, many doctors aren’t interested or trained to do this type of counselling, but they need to be aware of the corrosive effect on relationships of sexual tension. This is an important issue for many couples and they deserve to be referred on to professionals equipped to help them.
It’s not good enough just handing out Viagra prescriptions without the proper education as to how to use these drugs. If a man isn’t told that he might need to try this medication six to eight times to find out if it really works for him, he’s likely to try it once and just give up – or head off to a company that promises a solution.
While there are effective treatments available for almost all men with erection problems, it’s amazing how varied men are, with some responding well to one treatment and not another.
One major focus in my research was to publish men’s experiences with these new treatments so men can learn from one another. It is tragic how rarely men talk to each other about these experiences – their silence leaves them particularly vulnerable to exploitation.
I encouraged my research participants to describe in detail what it feels like to pop a little blue pill or to inject the penis. Men are naturally very nervous at the idea of injecting, but their fears are overblown. Most of the men who used these treatments reported considerable trepidation, yet the pinprick ultimately proved to not be a big deal, provided they were shown how to do it properly.
Men need to be taught to use this medication under supervision to avoid dangerous, long-lasting erection (priapism), yet this was rarely the case with my participants.
What was very clear from their reports was how much erections matter to them.
‘I feel like half a man,’ wrote one man describing the shattering effect of ED.
He had a loving marriage to a woman who loved sex as much as he did and made him have lots of sex in the weeks leading up to the prostate cancer surgery ‘in case things didn’t work afterwards’. Sadly, when he first wrote to me, none of the treatments were working for them.
‘This is not living, it is just existing,’ said another devastated man. There’s solid research showing ED can impact not only on a man’s sex life, but also his confidence and wellbeing in many other aspects of
Adding to the problem of educating men about ED is the fact that as a society we don’t take this issue seriously enough.
The blow to a man’s psyche of losing his erections can create problems that destroy relationships.
Keith’s story is a good example. He went from being a happily married man to a shaky soul who lost his wife, his marriage and much of his confidence.
It all started three years ago when the 61-year-old’s sexual functioning began to fail.
He was utterly devastated and didn’t know how to talk to his wife about it. He couldn’t discuss it, so he stopped going near her. Instead of going to bed together, he stayed up later and later watching television. She’d lie in bed wondering why he wasn’t interested in making love anymore. Didn’t he find her attractive? Was he having an affair?
Eventually she moved into the spare bedroom, and the couple is now divorced – their 20-year marriage ended because they didn’t know how to tackle this common problem.
Well-informed doctors willing to chat with their patients about sex can do so much to help couples maintain physical intimacy.
- New treatments are changing the lives of men devastated by losing what they see as a vital aspect of their manhood.
- Erection problems can be an early marker of cardiovascular disease.
- Well-informed doctors willing to chat with their patients about sex can do so much to help couples maintain physical intimacy.
- Men need to be properly informed about how to use the treatments.