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Urology 2019

Why men need to be more honest about ED

iStock / Getty Images Plus / YakobchukOlena

Michael Moore


Vaibhav Modgil

Consultant Urological Surgeon and Andrologist (Specialist in male Sexual and Reproductive Health)

One patient reveals how erectile dysfunction caused by an underlying condition made his life a misery — and how an implant procedure gave him back his confidence… and his sex life.

Michael Moore was a married man of 28 when he began experiencing issues with erectile dysfunction (ED), which shattered his confidence and affected his mental health. “I began feeling extremely depressed,” he remembers.

When Michael finally went to see his doctor (“It took me six months to find the courage”), he was given various treatments, but none of them worked.

This went on for more than 20 years.

Michael’s erectile dysfunction wasn’t psychological, however. It was being caused by an underlying neurological condition, which he discovered when he was finally diagnosed with multiple sclerosis in 2015/2016.

MS was the cause of my erectile dysfunction

By the time he was referred to Mr Vaibhav Modgil, Consultant Urological Surgeon and Andrologist — a specialist in male sexual and reproductive health — Michael admits he was in a dark place psychologically. “I wanted to get back some control,” he says. “And I wanted normality again for myself and my wife.”

I lost any kind of sex life from my late twenties through to my early fifties.

“It’s far more common than people think, and doesn’t just affect older men,” says Mr Modgil. “The vast majority of cases I see in my clinic are organic, rather than purely psychological; although there is no doubt psychogenic ED is more common among younger men, it can be linked to diabetes, conditions affecting the nerves and even sleep-rated issues, for instance. Cancer treatments such as pelvic surgery, chemotherapy and radiotherapy, can also cause ED.”

Treatment options for erectile dysfunction

First-line therapy tends to be tablet treatment. “If patients don’t respond to tablets, injections into the penis and topical treatments are available to produce erections,” says Mr Modgil. “While these might work for some people, others don’t want to inject into their penis, as it kills spontaneity.” Vacuum pump devices designed to engorge the penis are also available; but, again, these are neither discreet nor spontaneous enough for some patients.

If these solutions don’t work, and all other options have been exhausted, penile implant surgery — a procedure that is available on the NHS in specialised centres — may be a consideration.

“There are two types of penile implants,” says Mr Modgil. “With the semi-rigid or malleable implant, two malleable rods are placed within the penis that can be pulled up into the erect position.

“Then there’s the inflatable penile implant, which involves fitting two cylinders into the body of the penis. A pump sits within the scrotum and a reservoir sits within the abdomen. When the patient squeezes the pump in the scrotum, fluid leaves the reservoir and makes it way to the cylinders to provide an erection. This results in an on-demand erection, when the patient wants, for as long as they want. No part of the device is externally visible with what is usually a very small scar either above or below the base of the penis.”

Return to positive self-worth and body image

Michael, now in early fifties, chose this option and underwent surgery in March. In the vast majority of cases, patients are able to return home a day later. More recently, the team at Manchester Royal Infirmary have started performing ‘day-case’ procedures for selected patients, allowing them to return home the same day as their surgery. “However, people should understand that this, like any operation, is a significant undertaking,” says Mr Modgil.

“The operation must be carried out at a specialist centre under the care of an experienced team. It’s also the point of no return, because surgery eviscerates erectile tissue in the penis — so the only way a patient will get an erection afterwards is with an implantable device.

“It’s a last resort option for most patients, but it works incredibly well.” Its availability is not well-known, however. In fact, Mr Modgil often speaks to healthcare professionals, and even GPs, who are unaware of this type of surgery.

Michael’s been impressed with the results of the surgery, from both a physical and mental standpoint. “My sex life hasn’t been this good since I was 18! Psychologically, it’s boosted me, too, changing my overall mental health. In fact, the procedure has done more than cure my ED. It has also had a positive effect on my feelings of self-worth and body image.”

“Let’s be honest,” says Michael. “Erectile dysfunction isn’t an easy subject for men to talk about with anyone — let alone admit to in the pages of a national newspaper.

“Even though ED was a result of my MS, it doesn’t make it any easier that my friends and family will know about it! That said, there must be hundreds of men who have felt the way I was feeling for years. So, if there’s anything I can do to change that, I will.”

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