"My husband thinks I'm unattractive…"
"He's gone off me…"
"He's having an affair…"
Erection failure is one of the most misunderstood issues in any relationship. It is the cause of extreme frustration and anxiety in women, and a common cause of relationship tension or marital failure.
Whilst most men will never talk openly about this problem, erectile dysfunction is an extremely common condition. The Massachusetts Male Aging Study, one of the most comprehensive studies to date on male sexual performance, reports that a staggering 52% of men aged between 40 and 70 years of age, suffer to some degree from erectile dysfunction. If ever there was one, this is truly the silent epidemic.
Erectile dysfunction is more commonly known as impotence, and is defined as the inability to achieve, or maintain an erection suitable for normal sexual intercourse.
A normal erection depends on a simple anatomical process, explains Dr Willie Jordaan, medical director of Mens Clinic International , the largest group of erectile dysfunction clinics in South Africa. Mental, visual or sensory erotic stimulation activates the nerves connected to the arteries of the penis. This causes the arteries carrying blood to the penis to dilate and increase the blood flow into the tissues of the penis. The penis fills with blood and becomes larger and erect. The pressure of the blood in the penis compresses the veins which normally drain blood out of the penis, and the erection is maintained. After ejaculation, the arteries close down and the erection subsides.
Probably the most important thing that a woman needs to understand, is that erection failure may be due to physical or psychological problems, or both. Indeed, most causes of impotence are the result of very real physical problems in a man's body.
As we have mentioned, the normal functioning of the penis depends on healthy arteries, veins, nerves, hormones and penile tissue, explains Dr Jordaan, and any disease which affects these components, can give rise to deteriorating erectile function.
There are a great many disease processes which may be involved, like high blood pressure, high cholesterol, diabetes, neurological disease and hormone deficiencies. All of these can affect the normal functioning of the penis. Add to that, the fact that smoking, alcohol abuse and inactivity can worsen the condition, and you suddenly realise how many risk factors are at work in the typical male. We also know that a large number of medications used in the treatment of medical conditions, like high blood pressure, peptic ulcers and cardiac disease, cause impotence as a side effect.
The man with a deteriorating erection process is likely to develop significant psychological effects as well.
For all that is written about the macho man, the male ego is extremely fragile, says Dr Jordaan. Any episode of erection failure, or a progressive deterioration in erection rigidity or sustainability, has profound psychological manifestations for the man.
Arguably, sexual capability is at the very top of the male hierarchy of needs. Everything else is subordinate to being able to perform to expectation, whether realistic or not.
From early childhood, the male role model is always portrayed as an extremely masculine, sexually capable and virile animal. The male sports stars, music idols, and screen celebrities are all highly sexual in image and behaviour, and the average male perceives the expectation of sexual performance by his partner to be very high. Clearly when a man fails to live up to that expectation, either real or perceived, the result is extreme anxiety and frustration.
Unfortunately, this is the start of a vicious cycle. The higher the level of performance anxiety, the more likely it is that a man will experience erection failure.
It's easily explained from a physiological point of view, says Dr Jordaan. The state of anxiety triggers the release of a number of stress hormones in the body, including adrenaline. The penis is an early casualty in this primitive reflex, as the arteries to the penis constrict under the influence of these stress hormones, and erection is difficult, if not impossible. The more the man concentrates on the erection of his penis, the less likely it is to perform normally. The man is trapped in this vicious cycle of declining performance and anxiety/depression, each of which worsens the other.
Clearly then, erection failure is a very real and well understood medical condition, and in most cases, the cause lies with the physical and psychological influences of this male organ.
The reaction of the female partner in this syndrome is a critical one. It is important to realise, says Jordaan, that a man cannot perceive that a woman, however caring, can understand his erection problem. This situation is rooted in male sexual development and mentorship, where, from an early age, a man learns about his sexuality, mostly from his close friends, colleagues, brothers or father. He is indoctrinated by male figures, never even considering that the female could perceive this very private world…
And so when this world falls apart, shattered by weak erections, he may reject the caring and well meant attempts at involvement of his female partner. She in turn perceives this rejection as sexual and emotional abandonment by her man, and the seeds of doubt are planted in her mind, leading to guilt, suspicion and reciprocal frustration.
It is easy to see how even stable marriages or family relationships can break down in the face of this combined male / female syndrome. Social relationships, friendships and even work performance are commonly affected, which further compounds the problem.
A man may love his wife to bits, but will avoid intimacy because of the extreme anxiety associated with his expectation of erection failure. The tragedy, is that it is through no fault of either party, but rather the manifestation of real disease. The great need, says Jordaan, is for adults to understand the causes and implications of erectile dysfunction. This is critical, not only for resolution of a threatened relationship, but also because it may well save the man's life.
Any man who ignores the important clinical symptom of impotence, or weakening erections, is also ignoring the possibility of an underlying medical condition. The same disease process which is affecting the erection mechanism, could be damaging the arteries of the heart, brain or kidneys. Heart attacks, stroke, or kidney failure therefore, are very real threats in a man with vascular disease sufficient to cause impotence. Equally, the lifestyle excesses of alcohol, smoking or stimulants may have begun to take their toll on the body, the penis being affected first. Sexual medicine practitioners at the erectile dysfunction clinics undertake special investigations to establish the underlying pathology and recommend or institute treatment protocols to stop or reverse their progress.
The important issue is that no man should ignore the message that a deteriorating sexual performance may be sending out to him.
The positive news is that treatments for erectile dysfunction have advanced to such an extent that it is now possible to return up to 90% of men with erectile dysfunction, to normal sexually active lives. For the first time in history, there are reliable, safe and effective medical methods to address this common and serious male health issue. In addition, the earlier a man takes active measures to investigate the cause of a deteriorating sexual function, the more likely it is that he may avoid the serious psychological effects that the condition may have on his personal or work life.
And this is the angle that a woman should take when broaching the issue of ongoing erection failure with her partner. It is probably futile, however well meant, for a woman to state that she understands her partner's problem and how he feels about it. A man won't perceive the integrity of this approach. The appropriate approach has to be pragmatic, logical and as unemotional as possible: Real physical disease may underlie a man's impotence, made even worse by associated performance anxiety and depression. The sooner this is investigated and treated, with one of the new, effective therapies available, the sooner both parties will be able to shed their psychological shackles, and regain the sexual intimacy in their relationship.
Mens Clinic International has clinics around South Africa, and offers a helpline on 0860 362867 or +27 11 523 5100.