For generations, men didn't talk about it if they were having problems in the bedroom, not even with their doctors. If a man's sexual performance was inhibited, he suffered in silence and shame.
In recent years, this stigma has faded somewhat, thanks largely to the advent of new treatments. But many men, feeling that their masculinity is in question, still hesitate to bring such problems to the attention of their doctors. This is a mistake, said a Seattle urologist — not only because of the relief and happiness that men experience when the problem is corrected, but also because problems getting and maintaining an erection can indicate a larger, more serious medical condition.
"Erectile dysfunction is a more common complaint among men than most men would think," said Erik Torgerson, M.D. "It's estimated than about 50 percent of men in their 40s and 50s are already experiencing some degree of erectile dysfunction.
"The reason that it plays into a man's general health is that erectile dysfunction can be the presenting symptom for some more serious conditions, like diabetes, elevated blood pressure and depression."
In other words, the state of a man's erection can be an early warning for the state of his general health — a visible sign of a still-invisible ailment.
"It's something that's out there; it's something that we can see," Torgerson said, "whereas you don't always feel elevated blood pressure, you don't always feel the effects of early-onset diabetes."
For African American men, this warning rings particularly true. While there is no racial component for the frequency of erectile dysfunction — it affects men of all races equally — African American men in general suffer from diabetes, high blood pressure, heart disease, obesity and stroke at a higher rate than White men. Thus, Torgerson said, there is all the more reason for Black men to mention erectile dysfunction to their doctors.
"African Americans as a race are not directly associated with erectile dysfunction," Torgerson said, "except for the fact that African Americans are at a higher risk for these other conditions, which are associated with erectile dysfunction."
Although these serious conditions can be the cause of erectile dysfunction, Torgerson said, the usual causes are much more simple. Everything from fatigue to depression to plain nervousness can lead to trouble. The use of alcohol, drugs and tobacco can also be factors.
Depression can be an especially common factor, he added. If a man is down on his luck, if he's feeling less than confident or successful, that anxiety can manifest itself in the bedroom. Often, Torgerson said, this leads to a chicken-or-the-egg situation where a man can't see his way out.
"Is a man having trouble sexually because he is depressed, or is he depressed because he's having trouble sexually?" Torgerson asked rhetorically. "We don't really know the answer. Interestingly, though, treatment of men with medications to improve erectile dysfunction has been shown to increase the likelihood of overcoming major depression."
Torgerson emphasized that having trouble getting an erection doesn't mean that you're less of a man, or that you are one of the few men with such a problem. As the subject has become less taboo, it has become clear that erectile dysfunction is far more common than once thought. The direct benefit to quality of life that arises from treatment, Torgerson said, far outweighs the shame or embarrassment a man might feel at mentioning erectile dysfunction to his doctor.
"Men used to feel that … if they were beginning to feel some decrease in their sexual function, that there was an unusual problem with them, something that set them apart," Torgerson said. "What we've learned over the years is that it is a very prevalent condition. But still, patients are sometimes embarrassed to ask for help."
Taking the first step toward getting help, though, remains the key. With the highly effective remedies developed in recent years, Torgerson said, erectile dysfunction can almost always be treated effectively.
"If you're having problems with your sexual function, there is help out there," Torgerson said. "You're not alone, and we can help you."