OS has been experiencing poor sexual satisfaction since his marriage a year ago. He has a history of use of marijuana. This habit started after a series of job losses. Medical evaluation revealed that his organs are fine. He undergoes psychotherapy, drug rehabilitation, and behavioral change counseling. He has noticed some improvement…….
Weak erection is medically called Erectile Dysfunction. This is the inability to maintain adequate erection for satisfactory sexual performance for 12 weeks. It is a common condition among men. It may be seen as a shameful thing to discuss and may be a cause of marital disharmony. There are many causes which medically are divided into organic and psychogenic causes.
An organic cause means there is something wrong with the system responsible for erection, either the nerves or the blood vessels of the penis. The carvernosal system ( the reservoir that holds the blood during erection) and/or the hormones may be affected also. Common organic causes include hypertension, diabetes, elevated or abnormal blood fat, prostate diseases, varicocoele, abnormal hormone levels, smoking and excessive alcohol intake. Where any of these causes is identified, it has to be controlled or eliminated for the affected individual to achieve result. The doctor may recommend a check of the blood sugar, blood lipids (blood fats), sex hormones and an evaluation of the electrical activity of the heart called electrocardiogram.
The psychogenic cause means while all the systems mentioned above are normal, the brain is the one preventing satisfactory erection. The brain may be affected by stress at home (probably from marital disharmony and other domestic issues). Stress may also be from work, other social communities, and an exaggerated personal target. Other psychogenic causes include anxiety disorder and depression (perhaps from reduced libido).
Due to the availability of powerful drugs, most cases of weak erection are treatable. It is important to be evaluated by a medical doctor who will check for a possible cause. There are many available treatments for weak erection which include oral and other formulations.
The oral medications include phosphodiesterase type V inhibitors such as sildenafil, vardenafil and tadalafil and there is a sublingual apomorphine. These are usually the first drugs given and they work for most people. Those who do not respond may have to use other more invasive means such as giving injection to the penis. The injectable agents used are papaverine, phentolamine, and prostaglandin E.
Prostaglandin E is also available as a cream to be applied to the head of the penis and as a pellet inserted into the pipe for urine in the penis (MUSE –Medicated Urethral System for Erection). There are mechanical means of achieving erection such as the vacuum pump and constriction ring. A word of warning is that if the constriction ring is forgotten on the penis, it can lead to lack of blood supply and eventual gangrene of the penis.
All the above medications MUST be used under the supervision of a trained medical doctor.
The psychogenic causes are managed with counseling, stress reduction techniques, and treatment of any mental health disorder – depression – anxiety disorder – if found.
Dr Benjamin Odusanya is a Consultant Urologist. He is a Fellow of The West African College of Surgeons (FWACS) and The Medical College of Surgeons (FMCS). He works at The General Hospital, Marina, Lagos. He can be contacted on firstname.lastname@example.org.