“I can’t get it up”: A conversation about Erectile Dysfunction

Erectile Dysfunction, the inability of a man to obtain and/or maintain an erection during sexual intercourse, is more common in Nigeria than folks would like to admit. 

Laolu had his first episode when he was 33. For most of his adult life leading up to that moment, he had a decent sex life. However, on this day – one he swears he will never forget, things got awkward. “I remember just lying there wishing the mattress would swallow me whole. To be honest, that would have been a much better option than the look on her face as she struggled to get me hard. Because the more effort she put in, the more embarrassed I was,” he tells Love Matters Naija. 

Impotence is not a word Nigerians take lightly – even a casual lighthearted allusion to a case of Erectile Dysfunction (ED), commonly known as impotence, is often met with defensiveness, followed by several religious incantations meant to shield the person in question from said “spiritual attack”. While the world has evolved to the point where sexual inadequacies and quick fixes are shown in ads on the radio and TV. In Nigeria, talking about your inability to have or maintain an erection is pretty much taboo. The fear of impotence still thrives on the same pitch as another “cursed” word, barren. “There is a lot of stigma attached to ED. A man is not seen as complete when he suffers from it,” says Dr. Cletus Akpayak. 

The internet, as it always does, offers a myriad of answers to questions about Erectile Dysfunction. From pet transmission to tips on how to deal with the issue at home, answers abound on the World Wide Web. However, vetting and filtering this information remains a constant struggle, especially when articles often time than not, contradict each other. To this end, we sat down with Urologists, Dr. Cletus Akpayek from the University of Jos Teaching Hospital, Jos, and Dr. Nnamdi Nwachukwu of the Nigerian Institute of Human Virology, Abuja for a conversation on all things Erectile Dysfunction. 


What is Erectile Dysfunction (ED)? 

Dr. Akpayek: Erectile Dysfunction, commonly known as impotence, is the inability of a man to obtain and/or maintain an erection during sexual intercourse. 

Dr. Nwachukwu: It is important to note that while the man desires sex, he still can’t get or sustain a full erection to engage in sex. 


Is it true that ED can be medical or psychological? If so, does it play out differently depending on the category it falls? 

Dr. Akpayek: ED can be classified into Primary or Secondary. Cases of Primary Ed are usually psychogenic, and with this, counselling is often used in the treatment process as opposed to drugs. Secondary on the other hand stems from various underlying medical issues such as Hypertension – affecting the blood supply to the penis, hormonal disorders, injury to the penis, ingestion of certain drugs, etc. While some cases of secondary ED are not reversible, it may require treatment of the underlying disease or withdrawal of the offending drug. 

Dr. Nwachukwu: It could be medical or psychological. The root cause tells which one it is. ED can be caused by an untreated infection and in this case, it becomes a medical issue. Or, it could be a lack of connection to your sexual partner and in this case, it is psychological. 


Does age have anything to do with it? 

Dr. Akpayek: Age is not always a factor but age-related problems may result in ED. 

Dr. Nwachukwu: As a man advances in age, his testosterone reduces. Testosterone is responsible for sexual drive and performance so it is not uncommon for a man’s sexual performance to reduce. He may even begin to occasionally experience ED. Life, occupational, and financial pressures also affect a man’s body cum performance. 


What are the common misconceptions people seem to have about ED? 

Dr. Akpayek: The common misconception is that it is not treatable and that the person may not be able to father a child. This is incorrect. 

Dr. Nwachukwu: Many men think that when this happens, their sexual partner is no longer attractive. Some also associate it with “Voodoo.”


What are some of the treatment options available in Nigeria? 

Dr. Akpayek: As I said before, it depends on the cause. Psychogenic ED requires counselling/psychotherapy, while Secondary ED requires treatment of underlying problems. Where these do not work, then the patient needs to see a Urologist if he wasn’t seeing one from the beginning. The Urologist upon further investigations can either prescribe drugs appropriate for the patient or in extreme cases, carry out surgery. 


How common is it in Nigeria? 

Dr. Nnamdi: ED is very common in Nigeria. Statistics indicate that over 40% of Nigerian men experience it. 


What are your thoughts on the stigma attached to ED? 

Dr. Akpayek: There’s a lot of stigma attached to it. The man is viewed as incomplete and there’s often agitation on the side of his spouse. This has led to the end of relationships and marriages. 

Dr. Nwachukwu: The average man has a lot of ego and most times, they express it in sexual performance. When a man can’t perform, he is ashamed and tries to hide it. 


How do we prevent ED? 

Dr. Akpayek: Education on male genital function is key to prevention. Education also removes stigma, reduces societal pressure, and encourages men to seek help. For Secondary ED specifically, prompt identification and treatment of problems that might lead to ED, avoidance of alcohol and cigarettes, as well as abuse of recreational drugs. 

Dr. Nwachukwu: When you experience ED, seek help. There’s nothing to be ashamed of. The professional will help you diagnose the cause and come up with a solution. Prevention also includes avoiding stress, having adequate sleep and rest, as well as rich meals that boost testosterone. 



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