Opting for poor lifestyles, Mumbai lies low by impotence

Impotence is on the rise in Mumbai, ignited by the pressures of urban existence and poor lifestyle choices. Sanghamitra Bhowmik reports on the toll every man’s nightmare is taking, and how those affected are coping 

Thirty-something Vinod and Nisha Sharma have everything going for them: well-paying jobs, a brand new home, friends to party with. But when night falls and the time arrives to get into bed, they are consumed by worry and despair. It has been months since the Sharmas have had sex. The reason: Vinod is battling impotence, or — to be medically precise — erectile dysfunction.

It was over a year ago that Vinod heard the diagnosis. He was shocked. “I thought impotence affected only old people,” he says. “I kept thinking, ‘How could I get it?’”

Vinod has plenty of company. An estimated 90 million Indian men are impotent. Erectile dysfunction — which occurs when blood vessels harden, hampering the flow of blood to the penis — affects men of all age groups, across societies, communities and races.

What’s new, in the Indian context, is that it is on the rise among a younger age group of men in cities such as Mumbai, fuelled by a host of lifestyle-related factors and the everyday pressures of urban existence.

The culprits causing impotence are the usual suspects: stress, obesity, sedentary lifestyles, alcohol and smoking, all also implicated in life-threatening conditions such as heart disease and hypertension. Performance anxiety and false expectations compound the problem, and Mumbai provides the perfect breeding ground for these issues to come to a head.

Dr Rupin Shah, an expert in andrology, the branch of medicine that deals with the male reproductive system and urological problems, says his clinic in Santacruz has registered a three-fold rise in men coming in with erectile dysfunction over the last five years. “Impotence caused by stress or unhealthy lifestyles is becoming increasingly common among younger people today,” he says.

“Urban life not only causes stress-related illnesses, but also paralyses a person’s sexual response,” says sexologist Dr Prakash Kothari. “Couples who come to me are often too tired or too busy to have sex.”

That’s the story of the Sharmas, both of whom work at call centres, often at different times. So when Vinod gets home, Nisha is asleep; when Nisha is awake and at home, Vinod is at work. Sex soon ends up moving down in the list of priorities. It gets worse when you add the common Mumbaikar complaints — lack of space and long, tiring commutes — to the equation.

Impotence can happen due to medical and psychological reasons, and both are sparked by the lifestyle choices modern men make. “Diabetes, cardiovascular problems, hypertension and the like can also trigger erectile dysfunction,” says andrologist and urologist Dr Ajit Vaze, who says he has seen an increase of about 25 per cent over five years in the number of men coming to his clinic with impotence problems. “And many of these men are below 40.”

Also, doctors now believe that the inability to have sex may be an indicator of other, more serious diseases. There is a view in the global medical community that argues for making sexual habits an integral part of diagnosis and clinical examinations. “This is especially relevant to India, which has the largest number of men with diabetes,” says Dr Shah. “That’s why there is a need to include sexual history in medical evaluation.”

Though men are the exclusive target of impotence, the issue affects entire families, and many women are no longer willing to remain spectators in the drama.

When 35-year-old BPO executive Sukesh Mehta, a father of two, suffered a mild heart attack three years ago he gave up sex. “He was scared that sexual activity would give him another attack,” says sexologist Dr Rajan Bhonsle. “But then his wife started getting agitated.” A combination of counselling and medication has ensured a successful treatment for Mehta.

“There is a new breed of woman out there. They are open-minded and willing to help their partners,” says Dr Bhonsle. “Many a time it’s the woman who asks the questions. This sort of thing did not happen 10 years ago.”

All said and done, erectile dysfunction continues to be seen largely as a man’s ‘shortcoming’ rather than a health problem. The frustration and humiliation arising from this lack of ‘manliness’ can ruin the lives of the man and the woman he is with. But experts agree that, by and large, people are more willing to talk about the condition.

Despite all the treatment and support available, doctors prescribe a lifestyle overhaul to spice up your sex life. Says sexologist Dr Kothari: “Sexual potency is inseparable from the body’s vitality and mental well-being. Take care of your health and your sex life will take care of itself.”

But most importantly, make time for yourself and your partner and relearn how to enjoy sex. That’s what the Sharmas are doing.

90 million: Indian men estimated to be suffering from varying levels of impotence.

18 million: American men suffering from impotence.

2025: The year by which India will have the largest number of men suffering from erectile dysfunction.

90% : Proportion of men with impotence who carry the risk of developing cardiovascular disease, diabetes and high blood pressure.

Sources: American Journal of Medicine, DNA Research and Archives

What causes it?
Nerve damage from longstanding diabetes.
Cardiovascular disorders (hardening of the arterial walls, high blood pressure, high cholesterol).
Neurological disorders (paraplegia, stroke, multiple sclerosis, Parkinson’s, Alzheimer’s).
Using some prescription drugs (anti-depressants, medication for heart
disease, tranquilisers, sedatives).
Injuries in the pelvic area; radiation therapy; and some surgeries (colon, prostate, bladder, rectum).
Spinal cord fractures.
Testosterone deficiency due to hormonal disorders.
Alcoholism and other forms of drug abuse.
Psychological conditions (depression, stress, anxiety, fatigue).
Negative feelings towards your sexual partner: resentment, hostility, lack of interest.
Peyronie’s disease (a rare inflammatory condition that causes scarring of erectile tissue).

It also reveals…
Diabetes: Men who have diabetes have more problems getting an erection. The problem is partially due to the diabetes-related damage to blood vessels that supply blood to the penis. About 50% of men with diabetes eventually develop erectile dysfunction.

Hypertension: The disease process is the major contributor to impotence, but many of the drugs used to treat hypertension also cause it. Erectile dysfunction is a common problem in men with high blood pressure.

Atherosclerosis: This condition, where the artery walls harden, can prevent blood flow reaching your heart, legs, brain and penis. Erectile dysfunction thus caused is an indicator of heart disease.

Hyperlipidemia: A condition caused by high levels of cholesterol in the bloodstream, it damages the blood vessels in the penis.

Vascular disorders: Erectile dysfunction is most often the manifestation of a blood-flow problem. Many doctors believe impotence could be an indicator of other, more serious diseases; they say sexual habits and history should be an integral part of all diagnosis and clinical examinations.

Cure corner
Oral drugs: Viagra was the first oral medication for erectile dysfunction. Levitra and Cialis have a similar, if reduced, effect. About 90% of impotence cases can be cured with oral medication.

External vacuum devices: Consisting of a plastic cylinder that is placed over the penis, it has tension rings of various sizes and a hand pump.

Hormonal therapy: Testosterone levels are regulated in hormonal therapy through injections given periodically, and through skin patches and gels.

Penile injections: Drugs such as Alprostadil and TriMix are injected into the penis to widen clogged blood vessels.

Intra-urethral pellet therapy: This is used as an alternative for injections and oral medication.

Penile implants: Usually used as a last resort, mostly when oral medication fails. There are semi-rigid and inflatable implants.

Vascular surgery: In this method blood vessels in the penis are restructured to restore natural erections.

The alternative route: Nutritional supplements, acupuncture and ayurveda have helped men with impotence.

V for Viagra
What it is: Viagra, among the most famous of modern-day drugs, is used by many as the first and last line of defence in the battle against erectile dysfunction.

It was patented by Pfizer in 1996, started selling in the US, its home country, in 1998, and came to India in December 2005. A Viagra pill is sold every six seconds in some part of the world.

Discovery: Viagra was, to a large extent, discovered by chance. Its active ingredient, sildenafil citrate, was initially developed to treat patients who had heart disease and high blood pressure. During early clinical trials, an unexpected side effect was discovered: it could improve and maintain a man’s erection. In time it became the first pill approved to treat impotence.

How it works: Viagra promotes erections by relaxing the body’s blood vessels. This increases blood flow in the penis when it is stimulated.

What it costs: A 50-mg Viagra pill costs Rs400 in India. Generic substitutes are available for as little as Rs20.  

Side effects: Sneezing, headaches, flushing and indigestion. Also known to cause continuous erections, a drop in blood pressure and, in rare cases, heart attacks.

Some names have been changed on request