The effects of erectile dysfunction on men and the impact of treatment of erectile dysfunction with sildenafil (Viagra).
The two authors of the study described below interviewed men with erectile dysfunction in a men’s health clinic in a British NHS hospital. They talked to forty men who had erectile dysfunction and who had been to the clinic in the year preceding the interview.
The objectives were to assess the impact of erectile dysfunction on these men, to discover what they expected of Viagra, and to enquire into the ways the treatment impacted on men and what effect it had on their relationships.
Not surprisingly, erectile dysfunction had a serious effect on the men who experienced it, in particular on their self esteem and their relationships. Viagra, in those cases where it worked, greatly improved the men’s well-being. Unfortunately, the men for whom it proved less effective experienced severe distress and feelings of low self-worth.
You, Erectile Dysfunction, and Your Partner
Erectile dysfunction is very common, but little is known about how it impacts on men and what effect the treatment of erectile dysfunction can have on life quality.
For a long time – indeed, until the 1970s – many workers in this field thought that the causes of erectile dysfunction were primarily psychogenic (that is to say, based in the mind).
One of the reasons for this was an authoritative study by Masters and Johnson, in which they stated that only one case of erectile dysfunction in twenty was of physical origin.
In addition, there has been little study of the emotional and psychological impact of erectile dysfunction and its treatment, both in general and in particular with Viagra.
However, one study of male ageing in the late 1980’s remarked in passing that a man with erectile dysfunction “may be expected to be anxious, depressed and lacking self-esteem and self-confidence.”
We now know erectile dysfunction has a major psychological, emotional and social effect.
For example, the Sexual Dysfunction Association reported that three men in five taking part in an online survey regarded erectile dysfunction as a factor in their low self-esteem; one in three reported that his relationship had been adversely affected; and one in five said that his relationship had come to an end as a direct consequence of erectile dysfunction.
There is a lot of shame attached to erectile dysfunction, which stops men with erectile dysfunction confiding in other men or looking for treatment from health care professionals.
Viagra: A Breakthrough In Treatment?
The first simple treatment for erectile dysfunction, a phosphodiesterase inhibitor called sildenafil (Viagra), taken orally, became available in 1998.
The media hype around Viagra led a lot of men to think that it was an infallible cure, but the truth is that for a lot of men, Viagra does not work, and this can compound the emotional problems caused by the erectile dysfunction in the first place.
The authors of this study looked at the impact that erectile dysfunction had on forty men attending a clinic. They investigated the men’s self-esteem, and looked at how their erection problems impacted on the men’s relationships and welfare.
They also examined the men’s expectations of Viagra as a treatment for erectile problems, and investigated how its success or failure affected their mental and emotional state.
There were almost exactly 300 referrals to the clinic in one year, and they were divided into two groups: men for whom Viagra was successful in resolving erectile dysfunction, and the others, on whom it had no impact.
“Success” was defined by the patient being able to have penetrative intercourse. “Failure”, as you’d expect, meant no erection, or at least one that was not hard enough to penetrate the man’s partner. Twenty men were selected from each group.
The age range of the men was twenty two to seventy two years and the average was fifty two. All these men had Viagra prescribed at the clinic in a consultation which was neutral in tone, so as to ensure the man’s expectations were not changed during the consultation.
Given the men’s emotional distress and sensitivity around erectile dysfunction, the authors aimed to identify and explore as many issues relating to the men’s experiences as possible.
The data obtained were subjected to thematic analysis, which broadly showed up as follows.
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Partner’s reaction
Let’s face facts. Women love men openly and affectionately, and show their love in many ways, some of which men seem unable to reciprocate. But it looks very much as if women regard sex as one way in which their man can demonstrate his love in return. And they use that fact to get it….
Having a man who can make love to her is fundamental to a woman’s self esteem and sense of love. It’s not going too far to say that a woman may use physical love – i.e. sex – as a means to make a man love her. Ask any woman. She’ll tell you that as a woman, if you want some quick ways to make a man fall in love with you, showing him a good time in bed is one of the best!
But sex is fundamental not only to a woman’s sense of self-esteem but also to her sense of having a man love her. So for any man who wishes to ensure that his woman continues to love him, dealing with erectile dysfunction is essential. It’s not just about you. It’s about your relationship too.
Reaction to erectile dysfunction
Most men felt emasculated by erectile dysfunction. It is unsurprising that the ability to have penetrative sexual intercourse and to satisfy one’s partner sexually is regarded by most if not all men as an important and defining element of their masculinity.
In some cases the man’s reaction was so bad that depression followed and his relationship was seriously affected.
And erectile dysfunction can also impact on a man’s ability of participants to enter into new relationships: the reasoning being, if you can’t have sex with a woman, “if you can’t get a hard-on”, why approach her in the first place?
This reduction in self-confidence affected the men’s sexual relationships as well as their everyday relationships with friends and work colleagues.
One observed that his impotence knocked his confidence so much that he didn’t feel that he was matching up to his colleagues as a man – he reported that he “didn’t feel as good as them”.
Other men reported feeling isolated and despondent because they believed that erectile dysfunction was a problem only for older men: for them it was an indicator of “feeling old before their time”.
What made this worse was that some men thought their erectile dysfunction was irreversible and they would never have sex again.
Erectile dysfunction affected the men’s relationships with their partners. One in four thought they were “letting down their partners” because they could not engage in intercourse or “satisfy them sexually”.
[Editor’s note: since when did a woman’s sexual satisfaction depend on penetrative intercourse?! What a patriarchal view of relationships!]
The impact of the erectile dysfunction on the men’s self-esteem was clear from remarks like this: “if I can’t keep an erection, I’m not going to keep a woman.” Fifteen men did not or could not talk about erectile dysfunction with their partners. In their terms, they felt “belittled” by their erectile dysfunction.
This page is based on the report of a research study originally published here: www.bmj.com where the supporting references can be found.