ED: The problem no one wants to talk about
By Will Hoover
Advertiser Staff Writer
Editors' note: This is second in a two-part series on men's aging. Yesterday's Island Life section looked at how men are increasingly concerned about their appearance as they age, and are more willing than ever to do something about it.
Viagra, made available three years ago, is affordable, safe and works in a natural fashion. Photographs by Deborah Booker • The Honolulu Advertiser
Anyone — male or female — who has ever had a problem with ED does not want to talk about it.
"Everybody's comfort level is different about this," said Geoff Cook, a spokesman for the Pfizer pharmaceutical company, who knows all about ED. "ED is difficult to address."
ED is not some obnoxious neighbor.
ED is worse than that. ED is an euphemistic acronym for "erectile dysfunction," which, bad as that sounds, is preferable to "impotency," the term ED replaced.
Twenty five years ago, the broad assumption was that the dreaded "i" word was the result of a mental condition, and that it
affected only older men. Males who complained about it were referred to a psychologist. Since so few men complained, it wasn't seen as much of a problem.
Then, around the mid-1970s, a second sexual revolution began to manifest itself in the form of enlightened understanding among experts about ED. Studies eventually showed that just about all the previous assumptions on the subject had been wrong.
Now it is known that ED is much more widespread than previously imagined, that its cause is usually physical in nature, and that it can affect men in all age brackets. ED is viewed not as a solitary issue for a few men, but a problem for millions of couples.
With increased understanding has come a succession of medical advances offering an array of solutions. One, Viagra, has been hailed as a miracle drug.
The penile suction device was developed to mechanically cause and maintain male erections.
Yet in spite of so much progress, ED remains a problem that people don't like to talk about — Bob Dole notwithstanding.
In 1994, the Massachusetts Male Aging Study came to the conclusion that 35 percent of men ages 40 to 70 were vexed by ED to some degree. That came to around 30 million American men who didn't want to talk about ED.
And neither did their spouses or partners.
"The female partner can be even more traumatized than the man," said Dr. Craig Robinson, a Honolulu clinical psychologist who has helped many couples work through their concerns about ED.
The subject rates as one of the most trying of all relationship problems, says Robinson, primarily because it is so difficult for couples to broach. Many simply choose to ignore it, which leads to a special dilemma:
The silent man sees the problem as a reflection of failed masculinity. His silent companion sees it as a reflection of his lost desire. Yet, in most cases neither presumption is correct.
ED is commonly the result of medications, excessive lifestyle patterns or something physically wrong with the man that can be medically treated.
"Some wives think that their husbands have lost interest, and that's why they can't perform," said Dr. Albert Mariani, urologist and chief of surgery department for Kaiser Permanente in Hawai'i.
"It's very important to get across to the wife or partner that if the man cannot perform, it is not due to a lack of interest."
But to get that point across means one or both partners must discuss the issue. And among topics that are tough to confront, ED is in a category all its own.
Unfortunately, the result of not talking about ED can be increased frustration, anxiety and anger.
Communication essential
Inflatable and semi-rigid penile implants proved unreliable and often malfunctioned.
Robinson says response patterns for couples generally fall into two pathways: denial and acknowledgement. Couples in denial are either "avoiders" or "alienators," while couples who acknowledge ED are "resigners" or "overcomers."
Denial/avoiders simply shut out the issue and never resolve the problem. As a consequence, the relationship suffers.
In the worst cases, those in denial become so angry they alienate their partners by demeaning them or by seeking intimacy elsewhere. Often, the relationships of denial/alienators are doomed.
Some couples readily admit that ED is a problem in their relationship but choose not to resolve or treat it. Acknowledgment/resigners continue a relationship that no longer includes sexual contact.
Finally, there are couples that acknowledge ED and overcome it by changing their lifestyles or by seeking medical treatment. Sometimes ED can be the manifestation of drug abuse, excessive smoking or drinking. If so, moderation may be the answer. Otherwise, if the problem is physical, couples have medical options.
A key to success is communication, says Robinson. His job is to alleviate the anxieties of both partners by letting both know the problem is common, that neither of them is at "fault," and that there are ways of dealing with ED. The fact that they've chosen to seek help indicates that their relationship is healthy and the chances for success are good.
"The message is that there is now hope," added urologist Mariani. "There is something we can do about this problem."
Viagra breakthrough
Mariani's career began in the mid-1970s, about the same time the revolution in understanding ED got under way. Around this time, Mariani witnessed the development of the penile prosthesis. There were two kinds, inflatable and semi-rigid, and he says they were expensive, cumbersome, required surgery and, in the case of the inflatable versions, tended to break down or malfunction.
More successful than above remedies but required males to stick a needle in one of their most vulnerable parts.
These led to medically approved pump devices and rings that mechanically caused and maintained male erections (Mariani stresses that these should not to be confused with penis enlargement devices seen in magazines which can cause severe, permanent physical damage).
Next came injections that caused an erection by chemical means, but not by stimulation. These were less expensive than other treatments and had a high success rate. The obvious drawback was that they required the male to stick a needle into one of the most sensitive parts of his body.
Then, three years ago this month, came the bombshell breakthrough:
Viagra.
Here was a drug that was affordable, and apparently safe in most cases, had a very high success rate and — most incredible of all — worked in a natural fashion.
"And it works no matter what the basic underlying problem is," said Cook, the Pfizer spokesman for Viagra. "It's not artificial. One of our physicians says, 'We've had men who took Viagra, went out and mowed the lawn and complained it didn't work.'
"Well, that's the point. It requires sexual stimulation."
Cook says heart patients taking nitrate medications cannot take Viagra. In some cases there are mild side effects, such as headaches.
Otherwise, Viagra could be the best thing that has ever happened for couples coping with ED.
"We now had a drug that could be prescribed by primary physicians that was safe and effective," said Mariani. "We could now do something about a problem that had once been written off."
Will Hoover can be reached at whoover@honoluluadvertiser.com
