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Erectile dysfunction: Sick heart, sick penis

October 27, 2021

Heart disease, diabetes, depression: Lots of things cause erectile dysfunction. It can be treated but you need to get over the shame and visit a doctor.

Statues of the naked pelvic areas of a woman and a man
Sexual virility is often confused with what it means to be 'a man,' so many feel shame when they have erectile dysfunctionImage: Julian Stratenschulte/dpa/picture alliance

People don't like talking about sexual impotence. Unless they happen to be urologists and think that talking about it is the only way to help — especially help men who have erectile dysfunction.

Take Atiqullah Aziz, for example. Aziz is a principal consultant at a clinic for urology in Munich, Germany. Talking to Aziz, it quickly becomes clear that erectile dysfunction seldom comes alone.

Sexual virility equals masculinity

"In Germany alone, 4 to 6 million men are affected by erectile dysfunction," says Aziz.

But that's just the official numbers that get collected for epidemiological studies. "The real number would be much higher," he says.

It's safe to say that men with erectile dysfunction are common.

Experts estimate that only about 20% of men affected by erectile dysfunction seek help from a doctor.

In Germany, one self-help group called "Selbsthilfegruppe Impotenz" suggest there are cases where men see their sexual virility and masculinity as the same thing. That they are not "proper" men if they can't get it up. They feel a sense of shame. So much so that they often won't even speak to their partners about it.

And that shame can be fatal.

Overweight man sits in public eating a burger, the wrappers by his side
Being overweight, cardiovascular disease and high blood pressure are bad for virilityImage: picture-alliance/D. Lipinski

The penis: An early-warning system

"An erectile dysfunction can be an early indication of cardiovascular disease, such as a heart attack," says Atiqullah Aziz. "Sick heart, sick penis!"

So, if you visit Aziz in his clinic, the doctor won't just check you between your legs.

"Often we find the erectile dysfunction is linked to something else," he says — and that can be diabetes, obesity, nicotine addiction, or consuming too much alcohol.

Aziz regularly recommends his patients change their lifestyles.

A study in the US has been able to show an association between healthy diets and a lower risk of erectile dysfunction.

An article published by the Harvard Medical School lists five measures that can help men prevent erectile dysfunction and even treat an existing one.

Those measures include regular exercise, a good diet, a healthy cardiovascular system, not getting overweight and training your pelvic floor.

Packaging for the medication Viagra and two blue pills
You may ask: Why change your lifestyle when there is Viagra?Image: picture-alliance/dpa/U.Deck

"Unfortunately, many men prefer to take a pill rather than fix the problem," says Aziz, resigned to the fact.

When it comes to pills, Viagra is possibly the best-known brand. But they all tend to be based on a Phosphodiesterase-5 (PDE-5) Inhibitor. PDE-5 inhibitors encourage blood flow to the penis, which you need to get an erection.

But pills don't always help and when they don't, Aziz says, there are more "invasive options," involving cavernous nerves and penile implants.

Most penile implants need a pump to function. The pump is inserted into the man's scrotum. And when the pump is pumped, liquid flows into the penile implant and that produces the erection.

Whatever the fix, however, it pays to consult a doctor if you think you've got erectile dysfunction. Because neither the dysfunction nor the shame will disappear if you ignore the problem. On the contrary, the problem can get worse.

'Performance, performance, performance'

"Mental health issues can lead to erectile dysfunction, as well, especially among young men," says Aziz. That can be because of pressure at work, relationship issues or depression.

"We live in meritocratic societies, where often the only thing that counts is performance, performance, performance," says the urologist.

As such, your penis may be an early warning of a stressed psyche.  

Is online porn putting a damper on sex?

Feelings of pressure and depression can be reinforced when your sex life suffers.

It can become a vicious circle, but the only way out is to get over those feelings of shame and confront the problem.

And sometimes, a doctor may conclude that it's not the organ that's broken, but the psyche. In such cases, Aziz recommends his patients consult a sex therapist.

Silent treatment worse than impotence

In early 2021, researchers published a study in which they proposed the best recovery rates could be achieved by combining a drug therapy with a talking psychotherapy.

And there is one other reason why men should talk about their impotence, especially if they live in a relationship.

That German self-help group we mentioned as the start writes our partners "suffer more when we withdraw into silence" than they do when our penises fail to perform.

This piece has been translated from German.

DW journalist Julia Vergin
Julia Vergin Senior editor and team lead for Science online