By Joseph Kizza
For Dr. John Baptist Niwagaba, it all started with cryptic messages from his patients.
“Doctor, the grandchild does not wake up to drink milk,” was one of them.
At the time, which is around 13 years ago, Niwagaba took the denotative meaning of what his patients were telling him, considering that most of them communicated with him in Luganda, which was not his strong point.
It was only later that he figured it out. All along, they had been indirectly complaining of erectile issues.
This flow of related complaints inspired him to explore the subject (erectile dysfunction), and he ended up picking it for his master’s thesis.
During his research, Niwagaba, now a physician at Frontline Hospital in Naalya in Wakiso district, discovered that erectile dysfunction was common among diabetic men and that “they would start reporting this fairly too early”.
Many of them – young men in their 40s – reported struggling to get and sustain an erection.
During a webinar on Thursday (August 25), Niwagaba talked of erectile dysfunction as the inability to attain or sustain an erection for satisfactory sexual performance.
And it is not an isolated problem, as it is an end complication to pre-existing conditions, such as diabetes, hypertension and alcoholism.
It could also be a desire problem (low interest in sexual intercourse), added Niwagaba, whose main area of practice is diabetes and non-communicable diseases.
Due to low desire for sex, some people experience challenges with ejaculation – either premature or delayed.
The mental and hormonal state of a person can affect the release of neurotransmitters, which in turn can affect their erectile function.
‘Hogwash!’: To be or not to be long
In his virtual presentation, Niwagaba was keen to dispel some of the myths around erectile dysfunction.
To begin with, the length of one’s penis does not cause erectile dysfunction, he said.
While the standard length of a penis is about 15cm when erect, many men have been pushed into a desperate pursuit of enhancement solutions for their manhood by misleading myths purporting that if it is not big, long or strong, it won’t do the bedroom work.
Niwagaba said that in one study, while a sizeable number of the male respondents felt anxious about the size of their penis, their sexual partners, on the other hand, were satisfied with the manhood dimensions.
He also said race is not a determinant of the length of a penis, and that whether one is a ‘grower’ or a ‘shower’, they should all be able to “enjoy your sexual experience”.
Does penis size correlate with other body parts? For instance, some people compare a man’s fingers, nose or toes with their manhood, believing there is a link.
“This has been tested in a number of researches and there is no correlation. It is hogwash! The size of the penis is independent of other body features,” said Niwagaba.
The myths around the duration of sexual intercourse are also misleading. The average five minutes for sex is just about enough to derive the satisifaction a couple would averagely need.
“There is a lot of lies and confusion out there,” said the physician.
“The whole sexual cycle begins from the brain. Poor sleep time, alcholism and lack of exercise can affect libido [sexual desire].”
The biggest contributors of erectile dysfunction have been found to include diabetes, obesity, hypertension and work-related stress.”
Physicians like Niwagaba use the International Index of Erectile Function (IIEF) – a self-given questionnaire – for people who report to them about sexual function issues.
It is this self-report tool that doctors use to evaluate the severity of the erectile dysfunction – as mild, moderate or severe – and consequently inform the treatment option.
Treatment
Niwagaba said the most common drug they use to treat erectile dysfunction is sildenafil (viagra). The prescription is customized to an individual’s situation.
But in case pills do not work, there are other single-use drugs that can be injected into the penis for instant effect (erection).
Another option is penile implants, which are placed inside the penis to allow men with erectile dysfunction to get an erection. They are either semirigid or inflatable.
Other people have to deal with hyper-sensitivity. Good enough, drugs to reduce this reactivity exist. There are condoms laced with drugs to numb sensation in order for the user to last longer during sexual intercourse.
Sexual dysfuntion can also be treated with testosterone injections for people with low levels of testosterone – the primary sex hormone in males.
Do herbs work?
“Some are well studied and others are not,” said Niwagaba.
“The major challenges with [evaluating the usage of herbs in treating erectile dysfunction] is in the dosing levels. But we know many of them contain active ingredients that can improve sexual function.”
For women whose male partners are experiencing erectile issues, Niwagaba advised them to “create sexual experiences – and not sexual intercourse”.
What does he mean?
Create an environment that can enhance sexual desire. For instance, be selective with the food choice, the ambience (for instance, soft, romantic music) and dress the part (for instance, wear revealing, seductive clothing such as sexy lingerie).
He said men’s sexual hormones are triggered by various senses – sight, touch, smell as well as imagination.
Food for the mood
Yes, there are foods or drinks that may increase one’s desire for sex – also called aphrodisiacs. Chocolate, wine, strawberries and oysters are some of them.
Most of these foods contain nitric oxide, which may aid in erectile function.
Niwagaba said that for aphrodisiacs, the challenge is also with dosage. How much chocolate or wine should one eat or drink to get into an amorous mood?
“They remain variable from person to person,” he said.
Erectile dysfunction in women?
Yes, some women, too, experience erectile dysfunction.
Females erect via their clitoris, which subjects them to potential disorders of erections.
According to Niwagaba, erectile dysfunction manifests itself in women as failure to achieve turgidity of the clitoris and opening up of the vaginal walls for a satisfying sexual experience.
What about masturbation?
One question put to the doctor was whether masturbation contributes to erectile dysfunction. Is it an enabler or an inhibitor?
“This has not been identified as a cause of erectile dysfunction,” he said, adding that if anything, the practice contributes more to self-awareness.
“My take would be: No, masturbation may not lead to erectile dysnfuction.”
Niwagaba, however, was quick to note that because of its convenience as a self-enhacing behaviour, regular masturbation may contribute to reduced desire for sex with a partner.
Another listener wanted to find out whether erectile dysfunction can affect one’s ability to procreate.
“Sexual function does not affect the ability to reproduce,” same Niwagaba’s firm response.
