Dear Dr G,I’m a troubled housewife and writing to you with some concerns I have with my husband. I am 48 and my husband is a year older.My husband and I have been married for almost 20 years.I feel somewhat guilty our earlier years of marriage were over-indulged in very active bedroom activities.In the first decade of our marriage, we were enjoying each other’s sexual company mostly on a daily basis.Just like any other married couple, raising children became our priorities, and sexual activities took a backseat.In recent months, my husband and I both decided to reignite the passion.However, I noticed my husband could only manage to get an erection for penetration, but the rigidity very quickly diminished half way.In the first three months, we both thought it was stress-induced.As erectile dysfunction persisted, we both began to get worried.My husband spoke to his mates and they blamed that too much sex in the past might have “damaged” the penis. In other words, we have finished using the “quota”.I would like to find out what constitutes an ED? Does my husband have ED?Can excessive sexual intercourse in earlier days cause ED?Is there any scientific evidence to support such claims?Lastly, what will be the impact on my husband if he continues to avoid medical attention for his condition?Eagerly awaiting your response,Excessive Esther Erectile Dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. ED is more common than many people realise. ED is believed to affect one in five Malaysian men and is listed as one of the most common sexual health problems in Malaysia. Naturally, ED is considered to be affecting men of advancing age. In fact, some studies revealed ED affects 69.5% of Malaysian men above 40 years of age, but it’s an issue men find very difficult to discuss, regardless of age. Erection Hardness Score (EHS) is generally used as the barometer for penile rigidity. The optimal erection that men should strive to achieve to enjoy sex thoroughly is when the penis is completely hard (EHS 4), with the rigidity comparable to the cucumber. Any deficiency in the rigidity technically is ED, ranging from the suboptimal erection comparable to unpeeled banana (EHS 3) and peeled banana (EHS 2) that is just adequate for penetration. Lastly, the softness of tofu-like (EHS 1) penile rigidity is simply impossible for penetrative intercourse. Over the years, many factors have been blamed for causing erectile dysfunction in men. This can range from voodoo curse to tight underpants. One study looked at men’s view on causes of ED, revealing many men relating their erectile insufficiency to excessive indulgence in sex in their youth. This prompted a study in Finland examining the effects of coital frequency on subsequent risk of erectile dysfunction. The study sampled 989 men aged 55 to 75 years (mean 59.2 years).The data was analysed from this population-based 5-year follow-up. The result demonstrated the overall incidence of moderate or complete erectile dysfunction was 32 cases per 1000 person-years. After adjustment for comorbidity and other major risk factors, men reporting intercourse less than once per week at baseline had twice the incidence of erectile dysfunction compared with those reporting intercourse once per week. In fact, regular intercourse protects against the development of erectile dysfunction among men aged 55 to 75 years. Although many view ED as “just” a sexual health problem, ED is often associated with other comorbid conditions including cardiovascular disease, hypertension, diabetes, prostate diseases and depression, many of which have a number of the same vascular risk factors. Study has even proven that ED is a strong indicator of premature mortality, and precursors to cardiovascular events such as heart attacks and strokes. Therefore, seeking medical attention and ceasing the opportunity to examine all risk factors is the key in tackling unexplained ED. In the fast-paced urban lifestyle, it is not uncommon for men who face the challenges of work and family pressure, to encounter occasional obstacles to “rise to the occasion” in the bedroom. When the occasional failures turn out to be the regular norm, it is crucial to examine the hard facts of the causes and impact of the deficiency. Men facing the problems of sexual dysfunction often find it comforting to blame other factors such as stress and tiredness. It is also not uncommon for couples feeling guilty to blame past sex indulgence on current erectile insufficiency. In fact, many studies have shown the protective effect rather than damaging impact of frequent sex.
