Prof. Julius Esho, a urologist, is the pioneer Dean of Clinical Sciences, Lagos State University College of Medicine (LASUCOM) and Head of Department of Surgery of Urology Unit at LASUCOM, until recently when he resigned. Trained at the University of Ibadan, Case Western Reserve University, United States, and University of Minnesota Graduate Medical School, Esho, who had worked at King Fahad Specialist Hospital, Saudi Arabia, and Lagos University Teaching Hospital (LUTH)/College of Medicine University of Lagos (CMUL), explains the intricacies of erectile dysfunction, popularly known  as weak erection.

HOW prevalent is erectile dysfunction in Nigeria?

Like many things in Nigeria, it is very difficult to say that this is the incidence of erectile dysfunction. We do not have figures; we do a lot of guessing. But when we apply scientific method to erectile dysfunction, we find out the number of people that have the problem is as large as we have in other parts of the world. We are not any more superior to other races as far as erectile dysfunction is concerned. It is very common. To tell you how common it is, we did a study for a company on a drug that helps alleviate erectile dysfunction. We were exposed to many people as young as 30 years and above. Incidence of erectile dysfunction increases with age. It is like your new six-cylinder engine that operates like gazelle. But if you use the same engine for 10 years, it would begin to grumble. The human body is like that.  Blood supplies to certain parts of the body cannot be as good at 60/70 years of age as they   were at 20. All sorts of things, including diseases, joint pains, diabetes, drugs for the treatment of such conditions, may contribute to diminishing erectile function.

How serious is it?

It is very serious. If it happens, the patient is the one that knows how serious it is. You are not going to see it on his face. But it is very, very serious to the man. Do you know that if a man had erectile dysfunction, he would lose his authority in the home? Erection is what makes a man to know, or feel that he is in charge. And erection is what makes a woman accept a man as her husband. Take away erection, the woman would complain. Erectile dysfunction can affect a man’s performance at work. Aside emotional instability, it can lead to break down of marriage. One of the patients I attended to confided in me that his wife was bringing boyfriends into their bedroom. What can be more serious than that? It places the man in a helpless situation; he has lost control of his family. He cannot guarantee the loyalty of his wife anymore. And he cannot complain because he is seen to be the one at fault.

Aside aging and diabetes, what other factors are responsible for this condition?

There are many other factors: drug abuse, alcohol abuse and renal failure. Some drugs that are used to treat hypertension can dampen erectile function.

But it is a common belief that alcohol increases sexual libido in a man. How come it reduces erectile strength?

Alcohol increases the drive but diminishes the performance. It gives the man the euphoria that he is making waves even though he is doing nothing. Alcohol dampens judgment; it does not enhance performance.

In our environment, some people blame staphylococci for erectile dysfunction? How scientifically correct are they?

Staphylococci are not one of the organisms that cause infections in the urinary tract.  Because staphylococci are common bacteria (they are on your skin right now), even when you send your urine specimen for test, the laboratory scientist will tell you that there are presences of staphylococci. But those are contaminants. Nigerians will jump at it and use it as explanation (for erectile dysfunction). We claim to know everything and make wrong decisions as a result. It is not staphylococci that cause erectile dysfunction.  When you say infection is an issue in erectile dysfunction, you are right. But it is not infection caused by staphylococci. Infections that can interfere with erection are infections   that are more potent and more virulent to make a person sick. We are talking of tuberculosis that silently destroys some systems in the body, among other diseases that can interfere with muscle functions, blood flow and metabolism.

Is malaria not one of the  causes  of erectile dysfunction?

Malaria is an issue in everything because it weakens the body. When you have malaria, even the most attractive girl will not turn you on (sexually) until you get over the malaria.

What is the solution for erectile dysfunction?

There is solution in that you know the things not to do, like obesity, for instance. Can you imagine a man who is so big that even the phallus (penis) cannot reach where he wants it to reach sexually? Abnormality in the external genital of a man if the opening is not in the right place, if the testes do not come down, the man would not have enough of the hormones needed to initiate erection process. After we have ruled out that, we look at drugs he consumes. We also look at psychological aspect (you know that if there is a quarrel between man and woman, erection towards the woman may not be there, whereas, if the same man sees another girl, there may be erection). There are drugs meant to treat erectile dysfunction by doctors.

Some patients consume aphrodisiac drugs on self-prescription basis for the purpose of treating erectile dysfunction.   Is it wise to self-medicate for the purpose of treating erectile dysfunction?

It is not advisable to self-medicate on any drugs; it is too risky. Drugs for erectile dysfunction are high-risk drugs. I have seen a patient who took overdose of recommended drug for erectile dysfunction.  He got into serious trouble.

What trouble?

What happens when erection comes up but does not come down for seven days? Don’t you know that would cause a lot of embarrassments, pain and discomfort for the person? So, self-medication for erectile dysfunction is not nice. Yet, Nigerians patronise herbal drugs in form of opa eyin, jedi-jedi among others for erectile dysfunction.

Does that mean that jedi-jedi does not cause erectile dysfunction?

Maybe I do not know what our people call jedi-jedi. I thought that jedi-jedi has to do with difficulty around the anus like prolapsed and pile. That is not the cause of erectile dysfunction. But the association is so strong that if somebody has hamorrhoid, and the doctor recommends medical treatment, chances are that he will run away because he believes that it will interfere with his sexual potency. But they are not related.  The person who has hamorrhoid may be having it for several reasons that may also cause erectile dysfunction. Supposing that somebody has cancer in the rectum and because the cancer is blocking the passage so that his anus is congested, that person will not remember what erection is all about. But our people will say that it was jedi-jedi that took away his sexual energy. Jedi-jedi is not the pile we doctors know.

Some men boast of having close to 10 sexual rounds per session. Can that be true and how many rounds should a normal man go for in a sexual encounter?

It depends on the age of the man. If the man is the 20s, two or three rounds are normal. But as the man matures, it goes down to two or one and even the one becomes occasional. That is maturity. It is not a competition. That is what misleads some people. Sex is designed basically for procreation.

Most men do not want to discuss about ED even though they boast of their sexual prowess. The higher the figures of sexual rounds claimed, the higher the chances that they are lies. We need to let our people know that erectile dysfunction exists. If it is because of to old age, we can understand. But why should an old man go and marry a teenage girl? He is looking for trouble; he is telling the girl to be prostituting under his roof.