Photo: Flickr/Creative Commons, oh_debby.

Michael Russer, now 66, developed erectile dysfunction after surgery for prostate cancer in 2011. “I never really experienced depression, which is a state in which far too many men find themselves stuck,” says the Santa Barbara, CA-based CEO of Russer Communication and cofounder of CancerIntimacyHelp.com. While depression can cause erectile dysfunction, it’s often the result of it, too. Many men define their manhood by the length and strength of their penis. “Our phallic-centred culture has been shaped by the porn and pharmaceutical industry,” he adds.

About one third of men over the age of 40 years old have experienced erectile dysfunction. Photo: Flickr/Creative Commons, Vinoth Chandar.

Erectile dysfunction is a man’s inability to get and sustain an erection that is hard enough for sexual intercourse. Erectile dysfunction is more common than one might think. In a recent study, one third of men over the age of 40 had experienced ED. The prevalence of ED rises with age. While fewer than 20 per cent of men under the age of 50 experience ED., more than one-third of men between the ages of 50-59 years have. And, for men 70 years of age and older, over 80 percent have experienced ED.

Common cases of ED

Erectile dysfunction can be caused by many factors. It can be mild, which is the case for the majority of men. Or it can be severe. Depending on the cause, it can be temporary or permanent.

As in Russer’s case, some men with prostate cancer develop ED. While the cancer does not cause ED, subsequent surgery to remove the prostate gland and other treatments can lead to this outcome. Other health conditions can lead to ED as well. For example, it is significantly more common for men with heart disease and diabetes.

Smoking, high cholesterol and high blood sugar can be causes, as well as being overweight. There are psychological reasons, relationship issues, including the proverbial “performance anxiety.” And, drugs, such as those used to treat depression, can affect both a man’s libido and the quality of his erection.

Despite erectile dysfunction, couples can enjoy an intimate, happy relationship. Photo: Flickr/Creative Commons, Donald Ogg.

Treatment options for erectile dysfunction

There are as many treatment options as there are causes of ED. The treatment must be customized to the underlying cause, on the advice of a doctor. Some treatments have side effects so the costs and benefits must be weighed.

Lifestyle can make a difference in some cases. Exercise has been found to improve erectile function and reduce the risk of dysfunction. Aerobic activity increases blood flow, reduces stress and helps to maintain a healthy weight. Other lifestyle choices can help too including quitting (or not starting) smoking, drinking in moderation and avoiding recreational drugs.

Sexual partners have a number of options available to help with intimacy in the face of ED. Photo: Flickr/Creative Commons, Nannydaddy.

Many men respond to oral medications that increase blood flow to the penis. Popular brands include Viagra, Cialis and Levitra, which work in conjunction with sexual stimulation. Other medications are self-injected directly into the penis via a small needle, such as Alprostadil, creating an erection that may last as long as an hour. There are suppository options and also testosterone replacement therapies for men whose ED is linked to low hormone levels.

There are lesser known options too. Hand-powered or battery-powered penis pumps that pull blood into the penis so that a tension ring can be placed at the penis’ base to hold the erection is one. Another is penile implants to keep the penis firm but malleable, so it can be positioned for sexual intercourse.

ED Can Improve Sex Lives

Russer tried various orthodox protocols that did not work. He turned to a cornucopia of alternative treatments as well. “I tried acupressure, acupuncture, Watsu water massage, Reiki, upper and lower colonics…” he says. His personal favourite? “A shaman who danced around my prone body in a dimly-lit incensed filled room while beating a drum that made my body jump every time he hit the damn thing.” 

“Most men feel their greatest sexual fulfillment when they please their partner in the way she wants.”

Rather than continuing to try to fix his condition, he embraced it. Michael now helps other cancer survivors and their partners create even greater intimacy in their relationship without penetration. “Bigger, harder, faster is a fallacy,” he explains.

ED can create greater equality in a sexual relationship. “Most men feel their greatest sexual fulfillment when they please their partner in the way [the partner] wants,” Russer points out. “And direct clitoral stimulation trumps penetration.”

His own relationship with his long-time romantic and business partner Jacqueline Lopez is thriving. He has heard other women describe their partners, who have accepted their condition, as “the world’s greatest lover.” As he discovered, sometimes the best treatment option is no treatment at all.