Many men are suffering in silence as embarrassment prevents them from getting help for erectile dysfunction. Ciarán Brennanreports.
IT'S BECOME a bit of a joke and the great put-down among the lads in locker rooms and in the pub - slagging each other off about not being able to "get it up" or having problems in the bedroom.
But for men suffering from impotence or erectile dysfunction, it's far from a joke.
Men consider erectile dysfunction to be the most embarrassing medical problem to discuss with a doctor - even more embarrassing than hair loss, piles and depression, according to a national survey that was carried out a number of years ago on behalf of the Erectile Dysfunction Information Bureau.
Far from being an isolated ailment, erectile dysfunction is a common and distressing medical condition that is estimated to affect one in 10 men at some stage in their lives. The incidence of erectile dysfunction increases with age, affecting 38 per cent of men aged between 60 and 69, and 57 per cent of men aged over 70.
Impotence or erectile dysfunction is defined as the inability to achieve or sustain an erection that's hard enough or lasts long enough to complete sexual intercourse or another chosen sexual activity.
The problem can have a devastating impact on the lives of those suffering from it.
But the key issue is getting men to talk about it.
"It is part of the problem with men," says Dr Tom Kelly, practitioner in sexual medicine and clinical director of the Everyman centre. "Men never talk intimately about sex with each other, at least not in my experience. I don't get the impression that men would confide in each other on an intimate level about their sexuality so it means that men suffer generally alone."
Dr Stephen Murphy, chairman of the Erectile Dysfunction Information Bureau, agrees that they may be dealing with only a minority of sufferers.
"We probably see the braver ones," says Murphy. "There are probably people out there who have less self confidence, who are likely never to do anything about it."
Part of the problem is the role that sexual performance plays in men's self-image and psyche.
"Men judge themselves or measure themselves as a man particularly by their erectile capacity and their sexual performance," says Kelly.
The bottom line is that most men will experience an occasional failure to get an erection which can be put down to things like tiredness or too much alcohol. But when it becomes more persistent, there can be a problem.
"I divide erectile dysfunction into two main groups," says Murphy. "There are the guys with the more physical problem which would come about as people get older and then there are guys with more of a psychological problem who tend to be younger.
"As a rule of thumb, if it is a problem that has come on gradually, it is likely to be physical. If it is a problem that has come on suddenly, it is likely to be more psychological. That's not a perfect division but it is a good working division."
The physical causes behind erectile dysfunction may include: diabetes; hardening of the arteries, which can lead to high blood pressure, angina or poor circulation; kidney disorders; multiple sclerosis or other neurological diseases; high cholesterol; the side effects of prescribed drugs; heavy smoking; alcoholism and drug abuse.
Psychological causes can include: stress and anxiety from work or home; problems within your relationship; worrying about poor sexual satisfaction; depression; sexual boredom; or performance anxiety.
"The majority of people I see in my clinic are in their 20s, 30s and early 40s and don't have any medical or physical reason for their erectile dysfunction and part of the problem is that they do focus on their penis as the problem whereas the penis is a casualty and the erection is a casualty of other things - they lack confidence, they're afraid of women, they're afraid of making a fool of themselves, they're afraid of being talked about in the pub which seems to be more prevalent now than it used to be where some women might describe the minutiae of the sexual encounter with a man with their friends."
Viagra has been hailed as the saviour for all men suffering from erectile dysfunction, but it should not be regarded as the only solution for the problem, warn doctors.
"Yes, Viagra works; yes, it has revolutionised the treatment of erectile dysfunction in the last 10 years; yes, it is absolutely brilliant; it is not of course the only treatment," says Dr Andrew Rynne from the Sexual Health Clinic.
Often anxiety about one failed erection can play on the mind of a man and lead to a vicious cycle of erectile dysfunction, but medicine is not the answer.
"Whatever has caused the problem initially may have passed but because they get anxious about it and they are fearful about what will happen it will just become a vicious cycle," says Kelly. "It will involve psycho sexual counselling and helping them to gain confidence but probably the most important thing I do for young men in that situation is to help them break the vicious cycle."
It's probably not something that Ross O'Carroll Kelly would be in hurry to admit to - "roysh goys, I'm having a mare in the bedroom department" - so when rugby pundit George Hook fronted a public awareness campaign on erectile dysfunction for Glaxosmithkline for its Levitra drug, it raised a few eyebrows.
Not only did Hook agree to do the campaign, he openly talked about suffering from erectile dysfunction and availing of the drug to help his problem. At the time, many regarded it as a brave move, but Hook didn't see it that way.
"People were surprised not so much that I would partake in a campaign but I would say I actually am a sufferer and I need it," he says.
And while he knows that it is something that can be treated as a joke and for poking fun, Hook says he feels there is an onus on people like himself to get the message across on public awareness and health issues such as erectile dysfunction.
"I'm not stupid and I'm not falsely modest so therefore I knew what I brought to the party," he says. "The very idea of a well-known, hard-drinking, rugby- oving guy to admit this was always going to be more powerful than some actuary in an insurance company.
"Clearly the benefit of somebody like me saying it had an advantage. I also feel passionately and believe that there is a responsibility for well-known people to comment because we can reach people on anything, whether it is Gay Byrne on road safety or anybody else, we have a better chance of getting the message across than not."
Hook says he is often appalled by men's attitude to health and he hopes that his participation in the campaign will have led to some men seeking help about impotency problems.
"If George Hook can come out and say it, I was rather hoping some fella down the country would say, 'If George can do it, I can do it and go to a doctor'.
"It is an insidious thing for men really because instead of the old joke about your wife having a headache, this was a case of men having a headache and men making every excuse not to go to bed.
"And you don't have to be an age pensioner to have this kind of problem."