Erectile Dysfunction (ED), originally from the Latin Impotentia coeundi, is one of the major diseases of mankind, and can be loosely defined as an inability to achieve an erection for successful penetration.

In normal populations, the incidence of major Erectile Dysfunction (ED) is 5 to 20%. Even in the young, ED occurs in around 13%, according to a study on boys between 18 and 25 years. This is remarkable, because ED is known to be seen in older, not younger men, as a rule.

One of the most respected and cited studies on the epidemiology of erectile dysfunction is the Massachusetts Male Aging Study. The study showed that 52% of 1,290 men aged 40 to 70 years had some degree of dysfunction, and almost 10% had total absence of erectile function.


A new article in The International Journal of Impotence Research has some interesting things to say, based on a large study on the sexual habits of more than four thousand men, both gay and straight.

Most men in the prime of their sexual lives (18 to 44 years) use no drugs for sex, while some do it for recreational use, and fewer because they need to use them medically.

The recreational use of ED drugs is increasing, and seems to have a negative effect. The study says that, on surveying the participants’ perceptions and self assessments after taking ED drugs, their confidence and performance suffered unless they took drugs again.

As lack of confidence in one’s ability to gain and hold erections has been identified as an important psychogenic risk factor for ED, the findings have important implications. Recreational users of ED medications may be vulnerable to becoming psychologically dependent on pharmacologically induced erection.

Therefore, the young kids out for a trip on Viagra are rooting for trouble!


ED is now more than an andrologist’s way of making bread. It is now a sentinel for a variety of diseases. What are they?

* ED may be the first symptom of coronary heart disease in a young man. In fact, ED is now considered a strong indicator of heart disease, with strong correlation as to severity. In other words, the more severe the heart disease, the greater the liability to be having ED. Men who have less than expected degree of erection, or have it only to lose it midway (lazy erections) are likely to have a cardiovascular cause of ED.

* ED may present in an undetected diabetic.

* It is seen in long-standing smokers, alcoholics (whiskey dick or brewers’ droop), and those with lipid disorders, prostatic diseases, etc.

* Evidence has linked hypertension to ED.

* Drugs used in the treatment of various diseases can also cause ED.



India has been called the country of unconsummated marriages because of the phenomenon of ‘honeymoon impotence’, when ED manifests on the first attempt. Impotence in India is mainly psychogenic, unlike the rest of the world, where three-fourths of cases are said to be due to organic, not psychological causes. Of course, once a man becomes impotent, he suffers enormous loss of confidence and self-image, leading to further performance anxiety. So the psychological overlay (no pun intended, for once) is also visible here.


If you are a man facing ED, the sensible thing is not to hide it, but come out with it to a physician. Screening for hypertension, diabetes and heart disease will follow. Smoking should stop, as should excessive boozing.
Then what?
Based on what is wrong with the patient, the treatment is commenced.
Usually, drugs like Cialis (tadalafil) are the first line of treatment. Among the ED drugs, a lot has changed since Pfizer came out with Viagra. Leftist limpos: please note that Viagra was not invented by a Government pharma company.
Cialis (Tadalafil) is now a preferred drug for ED patients. It works for 36 hours, can be taken irrespective of food, and one does not need to time the drug intake with sex, thereby making for a better experience. In contrast, Viagra (sildenafil) works for only four hours and needs to be taken half an hour or so before sex.
In some cases, the doctor may advise the patient to inject a substance like papaverine or a prostaglandin (Alprostadil) into the penis just before sex. Rigidity is best achieved with injections.
In psychological cases (performance anxiety, depression, schizophrenia, etc.), counselling and appropriate treatment is advised.
Specific cases where the penis loses rigidity due to blood leaking from the veins respond well to vacuum suction devices.


In a small percentage of cases, where there is no response to any of the above, the andrologist might consider implants. These are devices that are implanted inside the penis (and partly in the scrotum). One device (essentially a semi-rigid rod of silicone with metal wires), called the AMS prosthesis, may lead to a permanent semi-erect state. In India, it costs around 60,000 rupees (around 1150 USD). A local version has been made by andrologist Rupin Shah and costs only Rs. 10,000 ($250). The better prostheses (e.g., the three-part inflatable AMS prosthesis) enable erection only during sex (on demand). A pump (implanted in the scrotum) needs to be activated to push in fluid inside an implant in the penis. The implant fills with water, and the penis becomes hard. This costs around Rs.220,000 ($5050).

One problem with the penile implant is that any infection is disastrous, leads to removal of the device, and permanent impotence. Hard luck!

It should also be remembered that any treatment of ED, like drugs or injections, may cause a persistent, painful, permanent state of erection, called priapism. This condition is an emergency.
Unless treated within four hours, it leads to permanent impotence.

To sum up, a man’s inability to achieve a satisfactory erection is not a laughing matter. It may be a sign of serious underlying disease which can eventually kill him.

Note: pictures are mine!

22 responses to “DEATH BY IMPOTENCE!

  1. Aaahh!
    Don’t give me that crap! I am too old for this!
    But I’ll take it, thanks!

  2. hey i have done a lot of wiking on this subject but i never did know that it could be so risky, expensive and so painful just to err get it up …..

  3. Interesting article, doc. Was not aware of how common ED was in young guys. As a young nurse a while back, I had a patient complain of priapism – caused by one of the meds you cited.
    Had a BF once while blissfully single s/p divorce – the older latin guy I wrote about once in my momma stories.
    Admit it, I encouraged him to get the “blue pill”….but we had a wonderful relationship regardless. Then I created a monster :-)… out he went (for other reasons) – a Joaquin Phoenix lookalike. Anyway, back with BF, who is also ex husband, who I have to hide from! So there, you have it. Guess your readers are all baring all this week 🙂 and embarrassing ourselves.

  4. Wow! I can really have a shady robot penis for only $250? Awesome.

  5. That was quite informative. Thanks Doc!

  6. One of your very good posts. Informative and clear. A good resource for anyone wanting information on ED.
    And congrats on winning the award.

  7. I had some kind of an idea about all this because I remember seeing some kind of a program on Discovery channel years back. Of course it wasn’t in such vivid detail and they didn’t talk about the cures.

    But yeah, I used to think it happened because of organic reasons only, not psychological. I thought that happened after you discovered you had it, you start becoming more reserved and ashamed of yourself that you can’t perform. I also used to think it happens with anybody and has no relation with age. I thought just like people lose their eyesight when they get old, so do they lose erections and that it doesn’t happen to everybody was unknown to me.

    Also I read somewhere about the harmful effects of all these drugs that guarantee erections and all that. They can cause hormonal changes in the body which further causes these mood swings and depressions as you’ve mentioned.

    So great article, thanks for the enlightenment!

  8. Jackie: thanks for speaking easy. I like it that way.
    Bancheese: “$250 for a shady robot penis!” Yes, but first send the money to my Paypal account. The stiff is shippin’ already!
    Prax, Nova, Nita, and Ish: thanks!

  9. Hi Rambodoc, how did they carry out the study on ED? You defined ED as “an inability to achieve an erection for successful penetration.” I know people who can get it up by themselves but when they are with someone the little guy doesn’t cooperate. Maybe its just nervousness or alcohol 🙂 But how do we distinguish?

  10. Priyank,
    The only erection that matters is one where there is a recipient for it. And that (what you describe) is ED, probably psychogenic. Incidentally, there is a clinical test where the patient is shown an erotic movie, and the doc comes in to look at his erection. Objectively, there are four grades of erection. This is the current Phillipines system of grading erection:
    Ripe Banana
    Unripe Banana

    So, the doc identifies the particular fruit/veggie produce that is the mascot of that patient, and this is used as a parameter for judging improvement subsequently. That way, the patient also feels encouraged to know that the quality of his erection is improving with treatment.
    BTW, I am not kidding you here!

  11. a nice informative post…thanks for sharing so many useful facts!

  12. Tofu
    Ripe Banana
    Unripe Banana

    Doc, why go with cucumber when squash is in season? 🙂

  13. Informative post.
    There are a lot of social evils associated with ED too, at least in India. A childhood friend of mine got married to a fellow with an ED, but he would not acknowledge it as a medical problem and her conjugal life was much less than pleasant. The “divorce” counselor would not accept ED as cause enough for divorce and the girl was at her wits end.

  14. Thanks, that was useful info.
    I bet a foodie like you loves these analogies!

  15. The inimitable George Burns was asked once: “Mr. Burns, how is sex in the nineties?” Burns replied, “Great! Only, it’s like shooting pool [Billiards] with a rope!”

    So, you see, it seems possible!

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  17. Potent information.

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  19. During pre-sex foreplay,I get very wet with large quantities of lubricating stuff coming out. Other guys I know don’t ever get wet at all. Why is it so?

  20. The impotence is really a bad decease it also cause several heart problems also .One should be very careful about his sexual health.

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