A Word with the DOCTOR
by Dr John Winsor
The Sunday Times of Malta

WHEN LADS get problems with their sexual performance it is usually temporary and due to the stress of the moment or excessive alcohol.

Alcohol breaks down the barriers of sexual taboos and reticence, thereby increasing desire. But there is another side to the increase in desire - namely a decrease in performance, which is sometimes referred to as "brewer's droop".

In all cases of impotence, the main difficulty is failure to sustain an erection. Premature ejaculation is another complication of the problem.

The reasons for this are mixed - about 40 per cent of cases have physical causes, such as diseases, drugs and injury, and 30 per cent have psychological causes. Another 30 per cent have a mixture of both physical and psychological precipitating factors. It is also more common among men over the age of 45.

I find that fear is a potent cause of impotence, such as the fear of doing damage to oneself after an operation or heart attack. Your sex life can continue - after a coronary thrombosis - get advice from your doctor.

Drugs causing impotence include anti-depressant chemicals and those used to lower blood pressure - as an erection is due to the amount and pressure of blood diverted into the penis.

Diseases affecting impotence include diabetes, high blood pressure, depression and anxiety. Recurrent failure brings its own spiral of lack of confidence and increasing tension, leading to more disastrous consequences when making love.

Nervous system diseases, such as multiple sclerosis, affect performance in the male. Those who have suffered nerve damage in accidents where, for example, the pelvis has been crushed in a road traffic accident are liable to sustain sexual difficulties. Any disturbances of the circulation below the waist can contribute to impotence.

Fortunately, these are unusual situations and the majority of blame lies in the psyche - fear, anxiety and tension, with a degree of depression thrown in for good measure.

Ladies can also lose interest in sex. Loss of libido is more common in women than men and the culprit is usually depression, especially the post-natal type after having a baby.
The sex act can also become painful for the female because of stitches following childbirth or other gynaecological conditions and these are a strong 'turn-off’. Cure the problem and sex life improves dramatically.

Some men blame impotence on their operation if they have had the large prostate gland, which affects the passage of urine, removed. This is known as trans urethral resection of the prostate or TURP for short.

The old-fashioned operation carried a risk but if you have the modern operation today, there is no chance of the nerves involved in the sex act being damaged.

Fortunately, most patients respond to treatment these days. Drugs can be injected into the patient or special mechanical aids can bring about and sustain an erection.

However, hormones are, useless in the treatment of impotence as they do not attack the cause of the problem. Surgery is sometimes successful where there is arterial disease.

How you treat your partner is very important. Physical humiliation, failure to satisfy a partner in the past or attempted rape can adversely affect sexual performance and interest in sex. Much patience and understanding must be used to support someone who has had a traumatic sexual past.