That little problem a man won't talk about - even if he's your doctor

Millions of men suffer from impotence, but

a new survey suggests that even those who summon up the courage to see their

GP may receive no help. Phillip Hodson reports.

The poet John Betjeman suffered: "My sex is no longer rampant." Sir Anthony Buck apparently suffered: "It took two years for the marriage to be consummated to wife Bienvenida." Even James Bond has suffered: "For an hour in that room alone with Le Chiffre the certainty of impotence had been beaten into him and a scar had been left that could only be healed by experience."

A pity they didn't live to see the current trend of impotence research and development.

This should be an exciting time for erections. There is a range of new products - at least one of them available on the NHS - or in the pipeline, to help most men. However, the conclusion of a survey of 432 patients and 194 partners, published on behalf of the Impotence Association, is significantly deflating.

The chairman of the association, Dr Alan J Riley, has estimated that up to 5 million British men suffer from some form of "erectile dysfunction" yet only 10 per cent receive any form of treatment.

We now learn that of those seeking help, one in four neglects to visit their doctor, preferring to trust to commercial alternatives such as sprays, herbs and "energy rings". Of those who do visit the surgery, 23 per cent get no treatment whatsoever. Of those who do visit the doctor and get treatment, a massive 58 per cent come away dissatisfied.

Does this matter? Well, 62 per cent of sufferers reported lowered self- esteem and some feelings of depression; 15 per cent had trouble making new relationships; 14 per cent said impotence had damaged their long-term partnerships; 10 per cent thought it had even spoiled their relationship with the doctor, while a quarter of the respondents said impotence reduced their overall quality of life by up to 80 per cent.

Allan Bennet - in his 50s - wrote to me last year to express frustration with the system: "I have had sexual difficulties for more than two years. Reluctantly, I went to see my GP having finally plucked up the courage. He asked me what I expected at my age, and did it really matter any more? I'd got my family, hadn't I? And with a magisterial wave he dismissed my concerns.

"I was so flabbergasted, I remained speechless. The doctor in question, I may add, is a Roman Catholic.

"It was only when I got home that my brain jogged back into gear. I sent him the following note:

`Dear Doctor,

`I know that you have indicated that the virility problem is not of fundamental importance to the continuation of my marriage but I can assure you that it most definitely is vital to the continued existence of my peace of mind as a man. I thought you should be informed I shall be seeing a sexual consultant in London ...' "

When you consider that good sex adds years to the life of middle-aged men such as Allan, cutting the risk of premature death by as much as 36 per cent ("The truth about sex; more of it makes you live longer", The Independent, 19 December 1997), this does amount to a legitimate health concern.

Yet time and again, for reasons of embarrassment or lack of empathy, GPs seem reluctant to be proactive or to prescribe. And as the survey suggests, patients are equally slow to face up to their difficulties, often suffering in silence as only "real" men can.

In fact, if the male sex were quoted on the stock exchange, today's price would be in trouble again. Poor educational attainments and falling sperm counts are one thing. But to pass up a National Health aphrodisiac when it is lawful and licensed seems more than perverse.

As men live longer, compete with women harder and consume more health and grooming products, impotence is, in any case, set to spread rather than diminish. Up to a third of men over the age of 45 experience some symptoms of impotence, and up to two-thirds of those aged 75 and over. Longer life span usually means more heart and hypertension problems. These may cause impotence directly, or as a result of taking medication for the conditions. The same is true of depression - a common enough feature of mid-life crisis. Both the illness, and remedies such as Prozac, can reduce libido and affect sexual performance. New drugs to counteract baldness, such as Propecia, also carry some risk of impotence.

Nor do "old" drugs such as alcohol and nicotine help. Men who consume more than 40 units of booze a week are likely to deliver little or no sexual thrill. It has been shown that smoking two high-tar cigarettes, one after the other, reduces blood-flow in the penis by about a third. And the Independent on Sunday's campaign to promote cannabis has to answer concerns that up to 20 per cent of long-term cannabis users may become impotent.

Even if you are trying to lead a drug-free, well-exercised lifestyle, there is little prospect of escape. The latest significant cause of impotence among younger men turns out to be "bicycle-riding", at least according to Dr Irwin Goldstein of Dallas, Texas (his website: www-bike/BCY/men.bikes. html), who sees six such patients a week. He claims that hard cycle-saddles on sports bikes are responsible for reducing penile blood flow by up to 66 per cent, and even the softer versions reduce blood supply to the region by a third.

So it is just as well that we live in a period replete with remedies. Injectable prostaglandins, (blood-stream messengers) such as Caverject are a special boon for diabetes and stroke patients. Men cross their legs when you mention injections, but the sensation is said to be no more than a "small prick", according to Dr Geoff Hackett of Keele University, who ran tests for five years.

To those critics who say doctors are yet again "interfering with nature", he replied: "Spontaneous intercourse isn't very common in most 20-year- old marriages. My studies show that 39 per cent of patients with diabetes are permanently impotent. Over 50 per cent of stroke patients are impotent. And most of those with spinal damage who can't walk and have sometimes little else to live for are impotent. Not only will many of these sufferers be able to resume sexual activity, the quality of their erections is likely to exceed anything they've experienced since boyhood."

Another version of this compound (called Muse) will be available later this month in pellet form for needle-phobes.

In addition to these treatments, there is a vast array of hard or semi- hard penile rods and implants, some with external bulb-inflators, which may be fitted by a plastic surgeon, in addition to hand-applied pumps, splints and bands.

But in all this discussion of prosthetics and sexual chemistry where is the human touch?

Already we have a consumer-friendly alpha-1 blocker impotence remedy (called Erecnos) which, unlike Caverject and Muse, does not induce erection in the absence of sexual stimulation. We're about to see an orally-active compound (Sildenafil) whose trials are showing great success.

But popping a pill is never going to be the complete answer. Men, after all, are only half the equation. We already know that more than a third of the partners of impotent men have sexual problems of their own. So, despite the problems highlighted in this survey, the future still looks good for talking treatments and Relate; it is also looking good for foreplay.

Phillip Hodson is a trustee of the Impotence Association, a sex therapist and a fellow of the British Association for Counselling. The results of the survey will be published in full on 28 January. To contact the Impotence Association, write to PO Box 10296, London SW17 7ZN.

Suggested Topics
Have you tried new the Independent Digital Edition apps?
Life and Style
ebookA wonderful selection of salads, starters and mains featuring venison, grouse and other game
Life and Style
Arts and Entertainment
Southern charm: Nicolas Cage and Tye Sheridan in ‘Joe’
filmReview: Actor delivers astonishing performance in low budget drama
Arts and Entertainment
While many films were released, few managed to match the success of James Bond blockbuster 'Skyfall'
Arts and Entertainment
Up my street: The residents of the elegant Moray Place in Edinburgh's Georgian New Town
tvBBC's The Secret History of Our Streets reveals a fascinating window into Britain's past
Albus Dumbledore, the headmaster of Hogwarts School of Witchcraft and Wizardry has been the teaching profession's favourite teacher
Luis Suarez looks towards the crowd during the 2-1 victory over England
Life and Style
Cheesecake frozen yoghurt by Constance and Mathilde Lorenzi
food + drinkThink outside the cool box for this summer’s frozen treats
John Barrowman kisses his male “bride” at a mock Gretna Green during the Commonwealth Games opening ceremony
peopleBarrowman's opening ceremony message to Commonwealth countries where he would be sent to prison for being gay
Sir Bradley Wiggins removes his silver medal after the podium ceremony for the men’s 4,000m team pursuit in Glasgow yesterday
Commonwealth games Disappointment for Sir Bradley in team pursuit final as England are forced to settle for silver
Alistair Brownlee (right) celebrates with his gold medal after winning the men’s triathlon alongside brother Jonny (left), who got silver
England's Jodie Stimpson won the women’s triathlon in the morning
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating

By clicking 'Search' you
are agreeing to our
Terms of Use.

ES Rentals

    iJobs Job Widget
    iJobs General

    SQL Report Analyst (SSRS, CA, SQL 2012)

    £30000 - £38500 Per Annum + 25 days holiday, pension, subsidised restaurant: C...

    Application Support Analyst (SQL, Incident Management, SLAs)

    £34000 - £37000 Per Annum + excellent benefits: Clearwater People Solutions Lt...

    Embedded Software / Firmware Engineer

    £40000 - £45000 per annum + Pension, Holiday, Flexi-time: Progressive Recruitm...

    Developer - WinForms, C#

    £280 - £320 per day: Progressive Recruitment: C#, WinForms, Desktop Developmen...

    Day In a Page

    Backhanders, bribery and abuses of power have soared in China as economy surges

    Bribery and abuses of power soar in China

    The bribery is fuelled by the surge in China's economy but the rules of corruption are subtle and unspoken, finds Evan Osnos, as he learns the dark arts from a master
    Commonwealth Games 2014: Highland terriers stole the show at the opening ceremony

    Highland terriers steal the show at opening ceremony

    Gillian Orr explores why a dog loved by film stars and presidents is finally having its day
    German art world rocked as artists use renowned fat sculpture to distil schnapps

    Brewing the fat from artwork angers widow of sculptor

    Part of Joseph Beuys' 1982 sculpture 'Fettecke' used to distil schnapps
    BBC's The Secret History of Our Streets reveals a fascinating window into Britain's past

    BBC takes viewers back down memory lane

    The Secret History of Our Streets, which returns with three films looking at Scottish streets, is the inverse of Benefits Street - delivering warmth instead of cynicism
    Joe, film review: Nicolas Cage delivers an astonishing performance in low budget drama

    Nicolas Cage shines in low-budget drama Joe

    Cage plays an ex-con in David Gordon Green's independent drama, which has been adapted from a novel by Larry Brown
    How to make your own gourmet ice lollies, granitas, slushy cocktails and frozen yoghurt

    Make your own ice lollies and frozen yoghurt

    Think outside the cool box for this summer's tempting frozen treats
    Ford Fiesta is UK's most popular car of all-time, with sales topping 4.1 million since 1976

    Fiesta is UK's most popular car of all-time

    Sales have topped 4.1 million since 1976. To celebrate this milestone, four Independent writers recall their Fiestas with pride
    10 best reed diffusers

    Heaven scent: 10 best reed diffusers

    Keep your rooms smelling summery and fresh with one of these subtle but distinctive home fragrances that’ll last you months
    Commonwealth Games 2014: Female boxers set to compete for first time

    Female boxers set to compete at Commonwealth Games for first time

    There’s no favourites and with no headguards anything could happen
    Five things we’ve learned so far about Manchester United under Louis van Gaal

    Five things we’ve learned so far about United under Van Gaal

    It’s impossible to avoid the impression that the Dutch manager is playing to the gallery a little
    Screwing your way to the top? Good for Lana Del Rey for helping kill that myth

    Screwing your way to the top?

    Good for Lana Del Rey for helping kill that myth, says Grace Dent
    Will the young Britons fighting in Syria be allowed to return home and resume their lives?

    Will Britons fighting in Syria be able to resume their lives?

    Tony Blair's Terrorism Act 2006 has made it an offence to take part in military action abroad with a "political, ideological, religious or racial motive"
    Beyoncé poses as Rosie the Riveter, the wartime poster girl who became a feminist pin-up

    Beyoncé poses as Rosie the Riveter

    The wartime poster girl became the ultimate American symbol of female empowerment
    The quest to find the perfect pair of earphones: Are custom, 3D printed earbuds the solution?

    The quest to find the perfect pair of earphones

    Earphones don't fit properly, offer mediocre audio quality and can even be painful. So the quest to design the perfect pair is music to Seth Stevenson's ears
    US Army's shooting star: Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform

    Meet the US Army's shooting star

    Lt-Col Steven Cole is the man Hollywood calls when it wants to borrow a tank or check a military uniform