Solving erection problems

IT is doubly frustrating for a man when he can't get or maintain a firm enough erection to make love.

Not only does he feel unfulfilled sexually but it is so maddening to know you want to make love, know you desire your partner, but find yourself unable to control the crucial bit of your body.


It's even worse when your partner feels very threatened by your not making love to her and starts accusing you of not loving her or of having an affair.

So one of the first steps you have to take to resolve this problem is to be honest with your partner.

I know it's hard for a man to admit he's experiencing erection problems but the overwhelming majority of women are very understanding - in fact, they are often relieved to discover that's what the problem is.

Sharing this with your partner will also have the effect of relieving some of your anxiety - and that in itself will help since anxiety alone can cause, or certainly contribute to erection problems.

Most cases of temporary erection difficulties are simply cleared up if you and your partner agree that you won't try to have intercourse for a while.

That absolutely does not mean that you give up all the other ways of making love - kissing, cuddling, caressing, doing everything loving, arousing and satisfying you feel like doing.

Massage is a good way to get that loving closeness, and stimulate your hormones and physical responsiveness. The only thing to avoid is attempting intercourse itself.

After a few days, or weeks, you should find that one time you have intercourse easily just because you weren't worrying about it.

If you're a man without a regular partner you may wonder how you can help yourself with this problem. I often hear from men who are avoiding all relationships for fear of failure. The answer is to enjoy as much masturbation as you feel like.

Just follow your fancy. Try allowing your arousal to subside and then build it up again. When you do meet a partner with whom sex seems likely, confide in her.

Most women will be very sympathetic about this problem as long as you explain, and an affectionate couple can share plenty of sexual pleasure without needing a rock-hard erection. In fact, most women reach orgasm through stimulation other than intercourse.

Although most cases of temporary impotence are psychologically based, keeping the body in reasonably good working order helps keep us ticking over well sexually, too.

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Drinking too much alcohol lessens sexual responsiveness, both at the time (the notorious brewer's droop) and generally.

Three pints of beer or six single measures of spirits or small glasses of wine are as much as a man's body can cope with healthily in a day. Cut down if you're regularly drinking more than that and always have a couple of alcohol-free days a week.

Smoking has been realised to be an important cause of loss of sex drive and impotence in men. Smoking and unhealthy diet can both cause circulation problems which affect the blood supply to the crucial parts.

The first thing that many top specialists now recommend to people with such sexual problems, particularly if they are 40 or over, is to stop smoking and follow a healthy, high-fibre, low-fat diet. Regular exercise can also benefit your sexual well-being.

Be careful though about excessive cycling, either on an exercise bike or a real one with a hard narrow saddle.

This can damage the main artery to the penis, which in turn causes problems with erections.

Sexual problems are often also linked with anxiety. If you have been suffering from a lot of tension or worry it will help you recover your sexual responsiveness if you can learn to relax more out of bed as well as in it.

If you write to me I can send you my free leaflet on how to relieve stress.

If you feel your relationship is not close enough for you to begin loving and caressing one another as suggested, then that may be the problem causing the sexual failure.

Unresolved bitterness and unhappiness very often show up in sexual difficulties.

You may be subconsciously punishing your partner. If you can't sort out what are the real problems in your relationship by talking about it calmly between you, then make an appointment to see a counsellor at your local branch of Relate (0845 456 1310, www.relate.org.uk).

Relate also aim to have a sex therapist within 20 miles of everyone in the country, and you can also find a qualified sex therapist near you by contacting the British Association for Sexual and Relationship Therapists (020 8543 2707, www.basrt.org.uk) but expect to pay private fees.

Now it can happen that, in spite of taking the emphasis off intercourse, and in spite of lots of loving and caressing, a man still can't manage to make love.

If you have been suffering from this problem for three months or more then you should see your GP to check whether there is a medical problem.

There have been considerable advances in treating this problem when it has a physical or hormonal cause, and seeing the doctor is important because erection difficulties can be an indicator of heart problems, for example.

You can also see a specialist at your local genito-urinary clinic - it's where they treat sexual infections but don't let that put you off benefiting from their expertise in this area.

What sorts of treatments are on offer? Viagra is the best known. It helps blood flow to the penis and seems to work in about 70 per cent of cases, whether the cause is physical or psychological, though it may not be so effective long-term if difficulties in your relationship are affecting your sex life.

There are worries about side-effects, such as heart attacks, especially if over-used, and it's obviously not suitable for some men, such as those with serious heart problems.

Viagra is only available on the NHS to patients falling into specific categories, such as men with diabetes and those who have had prostate surgery or spinal cord injuries, though others can obtain it as private patients.

If you're interested in Viagra, start with your GP. If he or she says you're not going to be eligible on the NHS but you could pay for private treatment, they will have to refer you to another GP or specialist. You'll have to pay for the consultation - costs can vary widely so it's worth shopping around - and then pay several pounds per tablet.

It may sound a lot but I suppose you have to decide whether a reliable erection is worth the price of a round of drinks down the pub.

I know Viagra is now on sale over the counter in Boots with certain restrictions but buying it this way tends to be even more expensive and a real snag is that Viagra needs to be taken at the correct strength to be safe but effective, so my advice is still to consult your GP, especially as erection difficulties can be a sign of a medical problem such as heart trouble.

While Viagra is still the best known, there are other drugs such as Uprima and Cialis, which can be more suitable than Viagra for some men. Cialis, for example, can now be prescribed in 36-hour and daily formulations, so you can choose to take one to cover the weekend, or a daily pill so you can always rely on being "up for it".

Cialis sales have overtaken those of Viagra now. The same prescribing restrictions apply as apply to Viagra, so it's a case of talking it all over with your own doctor first and whether you can afford it if you're not eligible on the NHS. And of course, none of these is a miracle drug.

A man still needs sexual stimulation and the desire to make love.

You can also talk to your doctor about other options. If you have been impotent for a prolonged period, treatment with the hormone testosterone might give your body the "kick-start" it needs to get back into action.

More and more is being understood now about how our body chemistry affects our sexual responsiveness.

However, hormones aren't a magic potion. Hormone treatment will only work if your hormone levels are the problem - though it can certainly be combined effectively with counselling or other talking-it through therapy. You can ask for a blood test to check your hormone levels.

Your GP can also prescribe the Muse system. This uses an applicator to insert a drug pellet into the urethra, the tube through which urine is passed.

It produces an erection in about five to ten minutes, during which time the penis needs stimulation, so you can continue with foreplay. It works well mainly for erection problems with a physical cause but you need precise instruction in how to use it.

Your doctor or a specialist can also instruct you in how to inject your penis with a drug that produces an erection. If your impotence has a physical cause, is not bound up with problems in your relationship, and you and your partner are happy about your producing erections with injections, this method may suit you.

Vacuum devices are also on the market but are clumsy to use, and rings which fit around the base of the penis to aid erection are available through your GP or specialist.

Gadgets, pills and potions sold in sex shops are often useless or even harmful. Do look for help via your doctor.

What it is important to realise about even reputable treatments is that they will never be the answer if the real problem lies in your relationship. Unless you have already seen a Relate counsellor or other properly qualified sex therapist about your impotence problem, I would strongly recommend that as the most promising place to start, as well as checking with your GP to see if medical treatment would help or perhaps a change of medication.

This is important, even if you find the idea of talking to your GP about sex problems embarrassing, as erection difficulties can be an indicator of heath problems.

Illnesses affecting nerve tissue, such as some cases of diabetes, can damage the nerves involved in causing erection. Circulation problems and some drugs, such as steroids, diuretics and those used to treat high blood-pressure problems, can make a firm erection difficult. Pain and infections can obviously damp down sex drive, as can depression and some of the drugs used for treating it.

GPs vary as to how knowledgeable they are at helping with sexual difficulties, but your GP can refer you for expert treatment if necessary. Some GPs have specialist training from the Institute of Psychosexual Medicine, and you can ask the Institute for details on 020 7580 0631 (www.ipm.org.uk ). Some hospitals have a special clinic attached to them, and you can ask for a referral there. However, most psychosexual medicine services are based in the community, usually attached to family planning services.

Some hospital genito-urinary medicine or GUM clinics - often called the special clinic - can help with this sort of problem. Treatment is totally confidential and you can usually refer yourself without having to go through your GP, which can be an advantage. It's certainly always worth asking.

If you can afford private treatment, you can also ask your GP to refer you to a private specialist. This is usually a better route to a reputable specialist than responding to an advertisement for a private sex clinic. You can also get advice from the Sexual Dysfunction Association on 0870 7743 571 (www.sda.uk.net).

I hope this has helped you understand the range of treatments available for impotence and will help you solve your erection problem. If you would like any further personal advice, do let me know. Write to problems@deardeidre.org. I'll look forward to hearing from you.