The impact of impotence Performance problems might be solved if men were willing to discuss them TO YOUR HEALTH

THE BALTIMORE SUN

After recapping a day's murder, mayhem and mischief, late-night newscasters like to send their viewers off to bed with something to chuckle into their pillows about and discuss over coffee the next morning.

Before signing off one night recently, Detroit anchorman Bill Bonds gave viewers a tongue-in-cheek peek into the private life of an unassuming Akron, Ohio, man named Eugene Donald Terrell. Mr. Terrell, 60, was considered newsworthy for losing a $350,000 malpractice lawsuit.

His suit accused Dr. Jack Summers of negligently implanting a defective device that was supposed to have helped Mr. Terrell achieve an erection. But jurors decided in favor of the doctor, who had successfully performed hundreds of such operations and said the penile implant Mr. Terrell received had probably sprung a leak.

Good night, everyone, and thanks for looking in.

Undoubtedly, many viewers drifted off to sleep that night still musing over "that poor impotent man in Ohio." And it's just as likely that many men who saw that telecast empathized with Mr. Terrell and slept fitfully.

Impotence is no laughing matter to the millions of men suffering from it, or the sexual partners who suffer right along with them -- and whose reactions may determine how successfully impotent men cope and recover.

Impotence strikes men of all ages and all colors. In response to their plight, researchers attending the American Urological Association's annual convention in May in San Antonio, Texas, discussed the sudden proliferation of drugs and treatment methods under development. Currently, no drugs are federally approved for treating impotence. But scientists predict one within two years because pharmaceutical companies recognize the immense profits to be made.

Emotional turmoil

Men who have repeatedly endured the humiliation of failing in bed, reluctantly consulted doctors to diagnose their problems and undergone all sorts of invasive procedures to restore their potency say that being impotent is enough to make a grown man cry. Among the most painful things, they say, is keeping all the emotional turmoil it causes bottled up inside.

"There doesn't seem to be anyone among my friends or family that I can talk to about this," says Vernon, a 70-year-old Oak Park, Mich., man who had a successful surgical implant six years ago.

Echoing the sentiments of many impotent men, Vernon says, "If I told anyone about my problem, I'd open myself up to ridicule."

We ridicule what we do not understand.

Because of men's reluctance to admit to being impotent, quantifying just how many suffer from this condition has never been easy. Five years ago, it was estimated that 10 million to 20 million American men suffered chronic or situational impotence. But last year's Massachusetts Male Aging Study -- the first comprehensive examination of sexual dysfunction and impotence -- puts that number as high as 30 million.

Answers that explain a physical inability to achieve an erection are readily available. But the vast majority of impotent men suffer in silence rather than seek help.

"At most, 5 percent of the men who have this problem seek treatment," says Dr. Irwin Goldstein, professor of urology at Boston University and a pre-eminent scholar on impotence's causes and treatments. "For better or for worse, the majority decide that this is simply a part of aging and live with it."

Physicians now know the primary causes of impotence, as well as the appropriate remedies for nearly every case. But psychotherapists are still learning to gauge the emotional damage that losing so basic a human function does to male self-esteem.

By definition, impotence is the inability to achieve or maintain enough of an erection to engage in mutually satisfying sexual intercourse. For some men, impotence is a situational condition that can be attributed to excessive stress or heavy drinking. But in most cases, impotence is a continuing or chronic problem caused by anything from cardiovascular disease to prescription drugs.

"Impotence is always a symptom of a more serious medical condition and, at times, a psychological problem," says Edward Shilling III, executive director of a Washington information clearinghouse called the Impotence Institute of America.

For men who suspect they're impotent -- or those who know they're impotent but aren't sure which treatment option is best FTC for them -- it may be helpful to go to support-group meetings.

"The first one you attend is always the worst," says Vernon, who attended sessions for a full year before deciding to have a penile prosthesis surgically implanted.

"But once you realize every man there is in the same boat you are, it becomes easier to speak freely."

And speak freely they do.

At a recent gathering in Southfield, Mich., a nurse was describing to three elderly men the varying degrees of firmness achievable by injecting muscle relaxants into the penis. On a scale of 1 to 10, a 3 registered semisoft and a 7 registered semihard.

"You mean a 10 is the best that stuff will give you?" one man interjected.

"Well, look," the nurse said, arching an eyebrow for emphasis. "We're not trying to drive nails into a wall, are we?"

The sessions are more informative than confessional in nature. Guest lecturers discuss different treatment options, and those attending are invited to watch videotapes of implant surgeries or other treatment techniques.

For a youthful man, it's difficult enough to accept impotence, let alone consider treatment options as extreme as injecting medication into your penis every time you want to have sex. Or having penile tissue removed to make room for a surgical implant.

Stan, a 37-year-old civil servant was only 28 when he first experienced impotence.

"I had no confidence around women because I knew I wouldn't be able to perform if I had to," Stan says. "The few times that I could get it to work -- maybe once out of every 10 tries -- it wouldn't last long enough. I went through at least three or four decent relationships that ended because Icouldn't perform. One of the women understood my problem -- or so she said -- but it wasn't long before she faded out of the picture.

"None of them said directly that my impotence was the reason for our breakup, but I have to assume that's what it was. I guess women are looking for more than just a platonic relationship. Sex matters; love and sex both have to be there."

Hardening of the arteries

It wasn't until after he suffered a heart attack and underwent quadruple bypass surgery at age 32 that Stan discovered the root cause of his sexual failures: a hereditary hardening of the arteries that restricted the flow of blood both to his heart and to his penis.

In his case, the only viable treatment option was a penile implant. Still, he couldn't bring himself to have the surgery until two years ago.

"Now I wish I'd had it done sooner," Stan says. "I'm enjoying single life the way I was meant to. Not long after receiving the implant, I got into a steady relationship with a woman that lasted four months. We only broke up because she suspected me of sleeping with someone else, which wasn't true."

Vernon, who is retired, says he can't conceive of calling it quits sexually because the women in his age group won't let him.

"I only date women my own age, and even they have expectations," Vernon says. "Since I got the implant six years ago, I've lost my reluctance to attend dances or other events where single women go. Ladies my age are still quite interested, and they're ready to discuss it, too. I've found that if you tell women about the problems you've had, most will say they understand. They've probably experienced it with their own husbands."

Others suffer too

Impotence doesn't affect only men; for each of the 30 million men suffering from the condition, there's at least one partner who's dissatisfied sexually and disturbed emotionally as well.

Boston University's Dr. Goldstein says impotence merits more scientific attention because its effects reach far beyond the bedroom.

"When his level of potency changes, how does a man handle that?" Dr. Goldstein asks. "Is he less motivated at work? Does he work harder and longer to avoid sexual activity when he gets home? Does he avoid touching his wife, or abuse alcohol so he has an excuse for not performing? Does he turn off his libido altogether?"

During the late 1970s, when her husband first showed signs of impotence, Eileen MacKenzie, 68, knew no way of helping him overcome the problem and had nowhere to turn for advice. The tribulations Ms. MacKenzie and her husband, Bruce, endured inspired them to devote their lives to assisting impotent men and their partners.

"The partners suffer just as much as the impotent man," Ms. MacKenzie says. "It's important for the partners of impotent men to know that they don't cause impotence and that they alone cannot cure it."

In 1988, seven years after Mr. MacKenzie received a surgical implant, the MacKenzies co-authored a book titled "It's Not All in Your Head: A Couple's Guide to Overcoming Impotence" (Holt, $10).

In 1982, the MacKenzies founded the men's support group Impotents Anonymous and the partners' support group I-ANON. In 1983, the MacKenzies founded the Impotence Institute of America in Washington and today oversee the distribution of resource material through Impotence World Services in Maryville, Tenn.

"Impotence puts the partners in a very stressful situation," Ms. MacKenzie says. "Before we got treatment to solve my husband's problem, I had this wonderful habit of starting a discussion over something trivial at around 9 p.m. every night. I knew it would ignite a big argument that would keep my husband from approaching me sexually. I was sick and tired of dealing with his failures."

In hindsight, Ms. MacKenzie says she's learned this lesson: "It's important for the partner to get as much information as possible, and let the impotent man know that they're doing it in order to be a better partner."

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