Mr. Tang was my new patient for this office visit. He is in his forties and in apparent good health. His chief complain was fatigue and insomnia. After a detailed questioning and exams, I decided that the root of his problem is his insomnia, probably related to stress at work. Then I ordered some tests and asked him to follow up in one month. Before I walked out of the room, he asked: “By the way,……”

I knew right there that I was going to spend another 10, 15 minutes answering some of his less-than-straight-forward questions. To nobody’s surprise, he said that he was losing his sexual drive recently and even when he actually had sex, he just could not maintain his erection long enough for his satisfaction. At the insistence of his wife, he was in for a check-up. But he was just too shy to offer his main reason for the visit at the beginning of our conversation.

Mr. Tang is not alone. The prevalence of male sexual dysfunction in new patients seen by general internists is approximately 50 percent. One survey of healthy married couples noted sexual dysfunction complaints in 40 percent of men and 63 percent of women. Sexual dysfunction diminishes the quality of life and can be an indication of serious medical problems, including diabetes, thyroid disease, atherosclerosis, pituitary tumors, depression, and chronic renal or cardiac disease.

Sexual dysfunction may be consequence of psychological or emotional factors, hormonal abnormality, autonomic neuropathy, vascular insufficiency, or drug side effects. Hormonal abnormality includes low testosterone level (male hormone), which may to low sexual drive and poor sexual performance. The most common cause of low testosterone is pituitary tumor, a growth inside the brain that affects the five major hormones of the body. When untreated, pituitary tumor can impinge on the optic nerve and cause blindness. Diabetes is a usual culprit for male sexual dysfunction. Diabetics can lead to damage in the nerves that control erection and can also cause narrowing of the arteries inside the penis. High blood pressure, if long standing or not under control, can also lead to damage to the arteries inside the penis and a less-than-full erection. Disease of the heart and kidney can also lead to damage to blood vessels.

The mind itself also plays important role in normal sexual health. It is the mind that activates the nerves that control erections and leads to rushing of blood into the shaft of the penis. People, when under a lot of stress, may have their mind on completely different objects, and even when aroused, may not fully achieve a normal erection. Depression, characterized by feeling of hopelessly and sadness and loss of interest, can significantly dampen the sexual desire and performance.

So I sent off some more blood tests. This time I checked for diabetes, thyroid disease, kidney function, and testosterone level. I also screened him for depression, which he did not have. The main problem was that he was under a lot of stress recently at work, with multiple deadlines to meet. He worked more than 10 hours in the office per day without much time for relaxation or exercise.

Tests came back negative for all the major diseases I screened for. So I discussed with him methods of relaxation during his long work hours, such as scheduled break every hour. I also advised him on sleep hygiene and light exercise during the day time. To overcome his fear about inability to perform, I prescribed Viagra on an as needed basis, as “crutches”, I said.

Mr. Tang came back to see me a month later. He said that with scheduled break and good sleep hygiene, he slept much better. With light exercise for 5 to 10 minutes after getting home from work, he actually felt more energetic. Except at the first few times of intercourse, when he needed the help of Viagra, he no longer needed the extra help. “I got rid of the crutched, doc!”, he exclaimed happily. “My wife wants to thank you too.”

For other persons who are not helped by Viagra, but no correctable disease is found, I usually refer them to herbal treatment. According to the Chinese Herbal theory, the causes are classified as kidney yang deficiency (treatment with You4 Gui1 Wan2), damage to the heart and spleen (treatment with Gui1 Pi2 Tang1), damage to the kidney by anxiety and fear (treatment with Da4Bu3Yuan2Jian1), liver chi stagnation (treatment with Xiao1Yao2Shan3), or damp heat (treatment with Long2Dan3Xie4Gan1Tang1). If the diagnosis is correctly made, results can be dramatic.

Mr. Tang and his wife are both very happy now. I certainly hope that other people with similar problem get check up and medical help and be happy again. As one song goes, “Don’t worry, be happy now.”

Note:

Viagra is a medication that slows down the break-down of a chemical called c-GMP that is mainly involved in achieving and maintaining erection. After taking Viagra, there is much more c-GMP around to maintain erection. But the body has to be aroused to produce the chemical first. Also, it takes time for Viagra to be absorbed and get into the circulation. The manufacturer advises patient to take the pill about one hour prior to intercourse. Also, Viagra should not be taken after a big-fatty meal because that may interfere with the absorption of the medication. So best effort is achieved if Viagra is taken at least two hours after a normal meal.

However, the newest study presented at the recent meeting of European Society for Sexual and Impotence Research, Over half of men taking Viagra achieve an erection that results in successful sexual intercourse within 20 minutes. Researchers from the University of Southern California followed 220 men with averaged 60 years of age, and Erectile Dysfunction for an average of 7 years, and most had moderate to severe dysfunction. Within 14minutes of taking Viagra, 35% of men achieved at least 1 erection that resulted in successful sexual intercourse. Fifty-one percent of men achieved this response within 20 minutes. Treatment was well tolerated, and no patient stopped treatment because of side effects.