It was a usual busy day in the Sexology Clinic.
The queue was long and it was getting late in the day. The nurse would not, however, let me be.
She walked into the consultation room for the third time in one hour, this time around with Diana, the wife to the patient who had just been admitted and whom she was asking me to review in the ward.
The patient, according to the nurse, had been admitted with a diagnosis of erectile dysfunction.
I was hesitant; traditionally, erectile dysfunction is not a reason for admission. The patient, James, was a 34-year-old foreman in a construction company.
He had been brought to the hospital by Diana, his wife, a school teacher. The couple had two children.
James was admitted complaining of persistent headache, weakness and generalised body pains. “My troubles started six months ago when my erection failed; I could not rise to the occasion,” James explained. “I have suffered ever since!”
From the time he suffered erection failure, James rarely slept. He spent hours on end in their sitting room pretending to watch TV or to work on his laptop well into the wee hours of the morning.
Many times he went to bed at 2am. Even then he would not fall asleep immediately. He slept for two to three hours.
“I dread getting my wife awake in bed; I fear disappointing her; I always think the erection will fail,” he explained.
Erection failure is not a thing that a man faces and remains in the right state of mind.
But many times it is not the incidental erection failure that is a problem. When erection fails, one slides into performance anxiety.
“And what is that exactly?” James asked, interrupting my explanation.
You see, erection failure can make you dread sex.
When you think of your erection failing, a reaction happens in the body akin to what happens when you are faced with a life-threatening situation.
Imagine coming face to face with a lion, or with a killer snake; your body immediately goes into a fight and flight mode!
This mode gives you high energy; you will not get sleep. Your heart rate goes up and you can feel your heart racing.
You feel sweaty even when the weather is cold. You can get a throbbing headache and lose concentration.
Most people with erectile dysfunction face this very scary reaction. This makes them use every reason to stay away from their wives to avoid being intimate since every erection failure escalates the reaction.
While some may keep off the bed until the wife falls asleep, other men immerse themselves in alcohol.
There have also been cases of people seeking transfer to work away from home. In some unfortunate cases, the man may get violent to keep the wife off.
Performance anxiety can happen in any sexual dysfunction: men with premature ejaculation face it.
Women who have lost the desire for sex or who have pain during sex or any other sex problem can similarly face it.
“So what do we do to help James?” Diana, who had been quietly listening, asks. “I would rather have him alive even if we are unable to have sex.”
Having a supportive partner when a sex problem happens limits the effects of performance anxiety.
Back to Diana’s question on how to help James: performance anxiety of over six months had drained him. He was fatigued.
He was sleep-deprived. He had not been eating well. His mind was clogged. He needed medicine to treat anxiety and help him sleep and rest. That was the first immediate line of care.
It took a few days to stabilise James. Once his mind was clear, I took a longer medical interview to find possible leads to the cause of his erectile dysfunction.
I also ordered tests to further confirm the diagnosis. Everything pointed to a stressful lifestyle combined with stresses in the relationship and reduced intimacy. All of these factors led to erection failure.
The ultimate treatment, however, was sex therapy. Although James was discharged three days after admission, it was only after two months of therapy that he got back on his feet.
“Once again I can stand to the occasion!” James proclaimed on his last day of visit to the clinic, his words interrupted by bouts of staccato laughter.