It was a normal day at the OPD and yours truly was poised to save lives💪🏾. Then entered a young man, who sat across from me gently and looked shyly into my face. After the initial buildup of rapport, the patient gave his presenting complaint as headache. I asked him a series of questions to try and make a diagnosis but I only got more confused the longer we spoke. As I engaged him in conversation, my confusion got worse🙃 but the Holy Spirit was at work… hallelujah!!! 😆 I suddenly had a “light-bulb moment” 💡(brofo) which led me to ask, “young man, your headache, is it headache? Pointing to my forehead, “or it is headache” pointing this time to my groin.
With a look of relief, the young man smiled and exclaimed “Oh Dr., how did you know? 🤩 Apparently, he had been experiencing poor erection for the past 6 months but was shy to bring it up. He kept referring to it as headache in the hopes that we would read in between the lines🧐 Thank God I did🤓.

What is erectile dysfunction?
Erectile dysfunction(ED), also known as impotence, is the inability of a man to attain and/or sustain penile erection sufficient for sexual satisfaction. ED is quite a common health challenge among men. In some settings, it’s reported to be about 15% among men (Askarian & Malekmakan, 2006) while a higher prevalence of about 52% is reported in other settings (Muneer, Kalsi, Nazareth, & Arya, 2014). ED causes great psychological stress with ego taking a major hit thus causing low esteem in most sufferers😒.

How does a man get a normal erection?
Erection is achieved through a complex interplay of blood flow to and from the penis as well as nerve supply. During sexual arousal, signals are sent from the brain to the penis to stimulate the muscles of the penis to help in relaxation. As the muscles relax, blood flows to the penis resulting in an erection. In order to sustain the erection, blood flow out of the penis is cut off.

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What are the causes of ED?
There are multiple causes of ED including the structure of the penis, changes in certain integral hormones as well as anything that will affect blood flow to or from the penis. Psychological causes due to stress (work, relationship, the pressure to impress, or depression) also play a major role in ED.
The causes are protean but in line with the vision of this blog, I will concentrate on causes related to non-communicable diseases.

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Hypertension: persistently raised blood pressure may lead to blockage of arteries which may result in ED
Diabetes mellitus: Uncontrolled diabetes can result in the destruction of nerve and blood supply to the penis (Muneer et al., 2014).
Hypercholesterolemia: raised cholesterol in blood results in blockage of blood vessels including the penile artery
Obesity/Sedentary lifestyle: morbid obesity, as well as lack of exercise, is significantly associated with erectile dysfunction (Ahmed, Alnaama, Shams, & Salem, n.d.)
Chronic use of medications: some drugs including prescription drugs (eg: benzodiazepines, beta-blockers, antidepressants) and recreational drugs( such as excessive alcohol, cocaine) increases the risk of ED.

Diagnoses
A delicate conversation to have thus privacy must be provided to allow for full disclosure.
Remember, “wo tɔn wo yareɛ a na wo nya ano ɛduro”😉 (It is when you sell your disease, that you find a cure).
All patients with ED must receive a complete physical examination including weight, height, and body mass index. These will help in knowing whether the person is obese or not.
Furthermore, laboratory workup including fasting blood sugar and lipid profile may be done to rule out some of the courses as stated above.

Management of ED
Management includes
1. Lifestyle modification such as cessation of smoking and abuse of alcohol, weight management.
2. Management/ treatment of underlying chronic disease
3. Medications
4. Penile prosthesis surgery

Prevention of ED
1. Get active guys… don’t be a couch potato!!🤪 check my article http://www.heactoriaawekeya.com/keep-moving// for more
2. Avoid the use of recreational drugs such as alcohol and wee. Let’s face it too many of our young men are drinking too much alcohol in the name of bitters.. please don’t be deceived☹️
3. Get help to manage your weight. Start by cutting down excess food. Boys dey chop too much la😡
4. A good diet rich in vegetables and fruits. You don’t like fruits? Get help on http://www.hectoriaawekeya.com/rainbow/

5. Stop pressurizing yourself to impress women in bed. How much sex can a man have in this life kraaa that we are under so much pressure? Life is simple my guy😁

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The role of the healthcare worker
Like the young man in my story, many men will not volunteer information on their ED to their caregiver. It is therefore up to us as health workers to actively ask about sexual health so that the patients are comfortable to open up. I’m sure someone is reading this and thinking, “Ah, if they won’t disclose, it’s their pun cup of tea“. Adopting a devil-may-care attitude in this situation will affect all of us eventually.

The WHO states that “Sexual health is fundamental to the physical and emotional health and wellbeing of individuals, couples, and families, and to the social and economic development of communities and countries”. This implies that sexual health cannot be overlooked if we want to provide holistic healthcare. ✅
All men seeking care for diabetes, hypertension, hyperlipidemia, and other chronic diseases must be screened for ED, examined and referred appropriately.

Finally, sexual health contributes to the total health of a man. A lot of people feel embarrassed but you need to get past this and seek help.
If little Jack is acting up for some reason, don’t be shy to bring it up🤩 (pun unintended) with your healthcare provider. OPD consultations can be tiring sometimes and wrapping our heads around coded languages may be the last thing on our minds.
Until I come your way again next week, Speak up and get help!!💪🏾

XoXo
Hectoria

40 COMMENTS

  1. “For lack of knowledge my people perish”…thank you Doc for this great writing on one of the most important pressing issues of men..may the waves of your writings blow more towards the matters of men😃

  2. Stop pressurizing yourself to impress women in bed. How much sex can a man have in this life kraaa that we are under so much pressure? Life is simple my guy😁….:)

    This one koraaa finished me 🙂

  3. Nice one. I remember man in his late 50s came to the consuting room and told me, “Pls my problem i need a male doc”. Eiii, i got a bit infuriated but had to come back to my senses. I got the drift that it was related to sexual health. Made him comfortable, pushed him more and voila, erectile dysfunction.

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