Dear Doctor, 

I have an erectile dysfunction. I have always wanted to have a child but my condition hasn’t helped matters. Help!

Allan

Dear Allan,

It is indeed a very stressful situation. Weak penetration is one, where a man is unable to hold an erection for sufficient time while making love. Erection is a function depending on the blood supply and nervous network of genital parts and surrounding structures. It is a problem affecting about a million men world over. Once in a while, any man can have weak penetration. But if it is consistently present for about 2 months, it needs attention.

Diseases like diabetes and hypertension, if uncontrolled, can produce weak penetration over time. Diseases of the spinal cord, blood vessels can also lead to erectile dysfunction. Similarly surgery or trauma of the spinal cord, pelvic organs can cause sexual impotence. Use of abusive substances like alcohol and tobacco is also responsible for this predicament. One can also develop erectile dysfunction due to much weight. Advancing age, diseases of the prostate, also lead to erectile dysfunction. Some drugs such as those used to treat hypertension, allergy, dyspepsia and depression among others can cause erectile dysfunction. It can also be due to decreased levels of testosterone.

This problem can be solved in many cases by good counseling for the partners and good cooperation between them. Both should be relaxed totally, during love making. More foreplay and slight changes in technique and postures can be helpful. Reducing excess weight, avoiding alcohol and tobacco is beneficial. Injections of testosterone are also helpful.

Good control of high blood pressure, diabetes, avoiding obesity, helps to prevent and improve this condition.

Clinical examination and investigations to assess the nerve and blood supply of genital parts helps to identify an underlying physical cause. Drugs are available to improve erectile function but can produce serious side effects.

Use of vacuum pumps, penile implant, and surgery of blood vessels are other options available.

Conceiving a child depends on the quantity and quality of semen, timing of coitus (should coincide with time of ovulation), and another condition being both should be relaxed. Artifical insemination,i.e pushing semen of the partner in uterine cervix can also help a man with erectile dysfunction to have a child.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital