💊 Men's Health

Erectile Dysfunction (Nigeria Guide)

Understanding, investigating, and treating erection problems — beyond herbal remedies

Erectile dysfunction (ED) — the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity — affects a significant proportion of Nigerian men, particularly those over 40. ED is a major cardiovascular risk marker: 40% of men with ED will have a cardiovascular event within 5 years if the underlying cause is not addressed. In Nigeria, ED is heavily stigmatised and most men seek help from patent medicine stores, herbalists, or online sources rather than doctors, missing the important cardiovascular and psychological evaluation that ED warrants.

Signs and Symptoms

✓ Inability to achieve an erection when desired

✓ Inability to maintain an erection throughout sexual activity

✓ Reduced sexual desire (libido) — may coexist or be the primary issue

✓ Anxiety and avoidance of sexual activity

✓ Relationship strain and loss of confidence

Risk Factors

Hypertension and antihypertensive medications — particularly beta-blockers and thiazides
Diabetes mellitus — damages blood vessels and nerves supplying the penis
Cardiovascular disease — ED shares the same pathophysiology as coronary artery disease
Obesity and metabolic syndrome
Smoking — causes endothelial dysfunction and reduces penile blood flow
Excessive alcohol — acute and chronic effects on erection
Psychological causes — anxiety, depression, relationship problems, performance anxiety
Low testosterone (hypogonadism) — reduces libido and contributes to ED
Medications — antidepressants (SSRIs), antipsychotics, beta-blockers, anti-androgens

When to Seek Help

SoonED in a man under 40 — cardiovascular evaluation essential; young-onset ED is a strong cardiac risk marker

SoonED with chest pain, exertional breathlessness, or leg claudication — possible significant cardiovascular disease

RoutineED with reduced libido and other hypogonadism symptoms — testosterone assessment needed

RoutineED not responding to PDE5 inhibitors — specialist assessment for psychogenic, hormonal, or vascular causes

UrgentPriapism — painful erection lasting >4 hours, especially in sickle cell disease — urological emergency

Tests & Diagnosis

🧪 Fasting blood glucose and HbA1c

Diabetes is the most common treatable cause of ED in Nigerian men

🧪 Lipid profile

Dyslipidaemia is both a cause of ED and a cardiovascular risk factor

🧪 Blood pressure measurement

Hypertension contributes to ED; antihypertensives may cause ED

🧪 Morning serum testosterone and LH

Hypogonadism — low testosterone. If low, check LH and prolactin to differentiate primary (testicular) from secondary (pituitary) hypogonadism

🧪 Full blood count and thyroid function

Anaemia and hypothyroidism both cause ED and fatigue

🧪 International Index of Erectile Function (IIEF) questionnaire

Standardised questionnaire classifying ED severity — mild, moderate, or severe

Treatment Options

Lifestyle modification — address underlying causes

Stop smoking, reduce alcohol, lose weight, increase physical activity. These alone can significantly improve erectile function in 30–50% of men with mild-moderate ED. Cardiovascular fitness directly improves ED

Treat underlying conditions

Optimise blood pressure control (switch from beta-blocker to ACE inhibitor if possible). Control blood glucose in diabetics. Treat depression with an SSRI with lower sexual side effects (bupropion, mirtazapine)

PDE5 inhibitors — first-line medical treatment

Sildenafil (Viagra) 50–100 mg taken 30–60 minutes before sex. Tadalafil (Cialis) 10–20 mg on-demand or 5 mg daily. Vardenafil 10 mg. Highly effective in 70–80% of men. Contraindicated with nitrates (e.g., isosorbide dinitrate for angina) — potentially fatal hypotension. Available as generic (much cheaper) in Nigerian pharmacies

Testosterone replacement (if hypogonadal)

For low testosterone: intramuscular testosterone undecanoate (Nebido) or enanthate injections. Normalises testosterone, improves libido and contributes to erection recovery. Check haematocrit and PSA before and during treatment

Psychosexual therapy

For predominantly psychogenic ED — performance anxiety, relationship issues, prior sexual trauma. Cognitive behavioural therapy (CBT) and couples therapy. Often combined with PDE5 inhibitors initially

Vacuum erection device (VED)

A mechanical device that draws blood into the penis — no medication required. Useful for men in whom PDE5 inhibitors are contraindicated. Available from specialist pharmacies

Penile injections (intracavernosal alprostadil)

Prostaglandin E1 injected directly into the side of the penis — highly effective even when oral medications fail. Available at urology centres. The patient self-injects after training

Penile implant (prosthesis)

Surgical placement of a penile implant — for refractory ED not responding to all other treatments. Available at specialist urology centres in Nigeria. High patient satisfaction rates

Avoid unregulated 'herbal' preparations

Many herbal ED preparations sold in Nigerian markets contain unlabelled sildenafil or other PDE5 inhibitors — dangerous if taken with nitrates. They may also contain aphrodisiacs with cardiac toxicity. See a doctor for safe, appropriate treatment

Frequently Asked Questions

Is erectile dysfunction a normal part of ageing?

ED becomes more common with age but is not an inevitable or untreatable part of ageing. Many older men have satisfying sexual function. ED often reflects treatable underlying conditions — diabetes, hypertension, cardiovascular disease — as much as ageing itself.

Can antihypertensive medication cause erectile dysfunction?

Yes. Beta-blockers (atenolol, propranolol) and thiazide diuretics are the most likely antihypertensives to cause ED. ACE inhibitors, ARBs, and calcium channel blockers have much less effect on erectile function. Tell your doctor if a medication is affecting your sexual function — switching is usually possible.

Is Viagra safe for men with heart disease?

PDE5 inhibitors are safe for men with stable heart disease who can tolerate moderate exercise. They are absolutely contraindicated with nitrates (e.g., GTN spray, isosorbide mononitrate) — a potentially fatal combination causing severe hypotension. Always disclose all medications to your doctor.

Do aphrodisiac herbs work for ED?

Most herbal aphrodisiacs sold in Nigeria have no robust clinical evidence of benefit. Some are contaminated with unlabelled pharmaceutical drugs. Others have cardiac toxicity. The most effective and safe treatments for ED are the established medications (PDE5 inhibitors) prescribed after proper evaluation of the underlying cause.