Men are generally not known for taking care of their health, unless something they really care about takes a hit – their penis.

It’s a tricky subject and a lot of guys are not comfortable owning up to performance problems in the bedroom, which makes addressing and treating erectile dysfunction (ED) a minefield of sorts. It can cause stress, shatter a man’s self-confidence and contribute to the breakdown of a relationship.

The subject is made even more difficult to address because when men do talk to a doctor about their problem, the reality is that ED has many causes and presents in many guises.

So what is ED? It’s usually defined as the inability to get and keep an erection that’s satisfying enough for sex.

For Gary* (52), finally admitting to suffering ED was something of a relief. “I was dying inside for a while and of course, the more it happened, the more pressure I felt. I would say it took a year before I had to accept it would not go away on it’s own.”

A visit to the GP was “mortifying” he says, but a dual path of medication and counselling helped him treat the issue.

The pressure was not just on him, says Gary. It also created problems in his relationship at the time. “I kept telling my wife that it was not her, but I think she was thinking there was something wrong with her and it made me feel even worse.”

There are several features to ED: some men have problems getting erections in the first place, while others have difficulty maintaining an erection that lasts long enough for sex.

Lifestyle and mind

General lifestyle and, more especially your mind, play a big role in how your penis functions.

Ireland's only clinical sexologist, Emily Power Smith, believes the penis, and how it works, needs a major education drive.

For a start, men (and women) need to understand that as a man ages, he can expect different types of erections, she says. “All men, after they hit 40 years old, will find some difference in the quality of their erections, and for drinkers and smokers, this can start earlier,” says Power Smith.

There is very poor education regarding the penis and penises are very sensitive to pressure, criticism and doubt, she says. “The man and his partner need to work on more physical stimulation to keep the blood flowing and a lot of people don’t get this and panic sets in, which then becomes a vicious circle.”

It’s something that Tony* (59) can relate to. “I felt less of a man when the problem started. I had never had a problem and it happened the one time and I explained it away as not feeling well. When it happened the second time, I did start panicking. I felt rubbish about it and very panicked about having sex again.”

When Tony went to the doctor, an underlying medical problem was discovered and this is why medics always suggest a visit to the GP rather than suffering it out.

Tony had high blood pressure and ED can be a marker for heart disease, so it’s very worthwhile getting a blood test to rule out any potential health issues. In fact, causes of heart disease and erectile dysfunction are very similar.

ED symptoms may occur earlier than those of heart disease due to cardiovascular issues such atherosclerosis – the narrowing of blood vessels throughout parts of the body – which is believed to be the most common cause of erectile dysfunction and a warning sign of a future heart attack or stroke.

Psychology

For most men, it’s a physical and a mental issue and Power Smith believes that’s when the psychology sets in and the pattern of worry starts. A man’s identity is hugely connected to his erection – more than is healthy, she says. “A lot of women are overinvested in an erect penis too – there’s a real lack of education around sex generally and we need to remember that penetrative sex is a tapas on a whole table of tapas and we are very, very focused on the penis and how hard it is. Once pressure is introduced, it creates a vicious circle of anxiety and stress in a man.”

Depression and anxiety are common in men with ED and can affect not only the sexual relationship but social and work activities as well.

Men also need to take a look at testosterone levels if they are having problems. Power Smith advises to check on the levels of free testosterone: “You can be within the normal range for testosterone at the GP but when you look at levels of free testosterone, they may be too low for sex function and libido so it’s worth looking at.”

Whether erectile dysfunction rates are increasing is difficult to tell. It’s different for everyone and a unique experience and can strike at any age. Following a bad breakup, Tom* found it impossible to relax during sex and developed ED at the age of 29. He bought Viagra off the internet and tried to push through the problem. It didn’t work and he ended up going for counselling. “I had to take a look at my anxiety and why I was thinking about sex a certain way and the expectations I had.”

Pattern

Emily Power Smith says most men going to the GP will be offered Viagra or Cialis Viagra to break the pattern of erectile dysfunction and the expectation is that it will be grand and sorted.

Unfortunately, the little blue tablet isn’t a magic pill and as erectile dysfunction is different for man; sometimes it’s worth taking a look at the deeper problems behind the issue. Power Smith says that medication process will only give a hard erection, it won’t sort any interpersonal issues or other issues caused by partner problems.

“Often men think they can willpower through it, but mostly they can’t . . .”

Always visit your GP to get help or get referred to someone who can help, she advises. *Names have been changed for confidentiality. You can contact Emily Power Smith through her website, Empowersme.com