Andy and Sheila's erection problem (2)

Sheila came along to our second appointment and we discussed her views of the couple's sexual problem. I said I thought it was as psychological problem because Andy could sometimes get good spontaneous erections  - but Sheila corrected me and said that was only when Andy used Viagra! This wasn't what Andy had said to me first time, and shows the value of getting information from both partners. So suddenly there was the possibility that Andy's ED might again have a physical background, despite some other aspects of his history suggesting psychological. How do you sort this out? If there are both physical and psychological factors in erectile dysfunction, how do you decide which is the main cause? And you need to do this because that information will usually decide the treatment plan; very generally physical problems are best treated with drugs and psychological problems best with therapy.

One of the ways we use in our clinic is to test a man's erections when he is asleep! I know it sounds a bit weird. Men have erections in their sleep, usually three or four per night. Nobody really knows why they do but it’s thought it might be an exercise mechanism for the penis, get blood pumped into the tissues and keep them healthy. I give a man a small(ish) machine to take home and wear for two nights. It’s called a RigiScan (unfortunately) and it measures the rigidity of nocturnal erections. If the results show someone gets good firm erections in their sleep then that is a strong indicator the physical processes for erection are intact, and therefore the man’s erectile dysfunction is psychological. If there is no evidence of good nocturnal erections it doesn’t necessarily confirm a physical problem, but further investigations may be required.

I discussed this with Andy and Sheila (she thought the device was hilarious, Andy just looked scared) and I’ve given them the equipment to use at home. Hopefully it’ll give us a better insight into the main reason for their problem.