Erection problems: how to approach your doctor

According to Men's Health magazine, on the Richter scale of embarrassment, impotence comes near the top. The Viagra publicity has loosened the taboo to some extent, but this is still the problem men least like discussing with their family doctor. A survey by the Sexual Dysfunction Association found that almost half of impotence sufferers took 2 years to summon the courage to seek treatment. So you are not alone in your embarrassment.

But of course impotence is the one problem that the family doctor will not be able to guess that you have, unless you mention it. When you do manage to discuss it, you will probably find that your family doctor is surprisingly matter-of-fact about it. Impotence is a standard medical problem that doctors are now trained to deal with. It is also possible that there is a local specialist hospital clinic in your area.

If you keep avoiding the issue with your family doctor, there are two other possible approaches. Your partner could have a preliminary discussion with the doctor to pave the way. Or you could write to your doctor, marking the envelope Confidential and explaining that you have been too embarrassed to mention the problem, but would like an appointment to discuss it, if possible at the end of a surgery when the doctor would have more time.

Even if you convince yourself that the problem is due to stress, see your doctor. You may be wrong, and even if you are right your doctor should be able to help.

What your doctor can do about erection problems

Your family doctor will consider whether impotence is the result of some medical condition or any drugs that you are taking. Impotence can also result from depression and from relationship problems, so be prepared for some talk along these lines. However, most doctors believe that there is no point in deep psychoanalytical-type discussions; they prefer to do a few simple investigations and then deal with the problem in a practical way.

Your doctor will take your blood pressure, and will discuss smoking and weight loss. This is because impotence can be an important early-warning signal that your arteries are unhealthy, which could lead to a heart attack in the future.

Tests. The following tests are usually carried out.

Blood or urine are tested for glucose, to check for diabetes.
A blood test for cholesterol and other lipids (fats) is done, because erection problems can mean your arteries are unhealthy.
The blood testosterone (male hormone) level can be measured. However, it is unusual for impotence to be caused by a low testosterone level, so the result is usually normal. The exception is when there has been a reduced sex drive for some time before any problem with erections; in this situation a testosterone test is worthwhile.
Blood prolactin level is sometimes measured if erectile failure was preceded by a reduced sex drive; a high level of this hormone is extremely rare, but may be associated with impotence, and can be an indicator of other diseases.

If a prescribed drug might be the cause, your family doctor will probably be able to change to another pill. For example, if you have high blood pressure, your family doctor might change to a calcium-channel blocker, an ACE inhibitor or an angiotensin-receptor blocker; these are less likely to cause impotence. If the drug was responsible, you can expect to see an improvement in 2-3 weeks. Unfortunately, changing the drug seldom helps, because the real problem is usually the condition for which the drug you need the drug. (For example, high blood pressure causes damage to arteries, which results in impotence. So changing the blood pressure drug will not improve matters if the damage has been done.) Alternatively, you may have developed a psychological block fear of failure which may take time and counselling to overcome.

If stress, depression or a relationship problem seems to be a factor, counselling and/or antidepressant medication may be the answer. If you require an antidepressant do not worry that you will be hooked for life; these drugs are given for a limited period to kick-start you out of your depression. However, they may take several weeks to work, and some antidepressants can themselves impair erections.

Your family doctor will then advise you about specific treatments.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Saturday, September 3rd 2011

In part 3 of his penis trilogy, Dr Phil Hammond discusses penis size, shape and function, and what you can do about erectile dysfunction. Click on the video below for more information.

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