A word of comfort if you're a man suffering from sexual dysfunction: you're not the only one. The next time you're on the golf course with 10 of your mates, five of them will be suffering similarly.
According to Mr T.E.D. McDermott, an impotence expert, it is a growing problem which affects 50 per cent of men between the ages of 40 and 70 at some time.
The good news from Mr McDermott, a surgeon and urologist, at the Irish Medical Organisation's annual conference is that the problem is common and is treatable, whether medically or psychologically or both.
A Dublin GP, Dr Colm Brady, who has developed expertise in the area, said erectile dysfunction is a taboo subject in society. Because of their egos, men are afraid to discuss it.
"A man on the golf course is far more likely to say, `I did it five times last night', rather than saying `I couldn't do it at all'. Family doctors, he said, would have to learn more about this problem and become more comfortable and knowledgeable about dealing with it.
Ms Mary O'Connor, a psychosexual therapist, said that when patients first visit they are unable to look her in the eye. "I feel terrible for them." The sexual problems experienced by men affected their lives hugely. "I have a young man who suffers from premature ejaculation. He is 6 ft 2 in, blond, handsome and virile, but he never goes near women because he knows what will happen. His mates have labelled him gay. He is actually quite suicidal about it," she said.
Inability to perform, size and embarrassment are the main problems for men seeking help, according to Mr McDermott. Once the initial discomfort of admitting the problem is over they then face the embarrassment of a physical examination. "Every patient that I go to examine says to me, `Excuse me, doctor, but I am very small down there'."
Mr McDermott said there were a number of myths surrounding erectile dysfunction. It was not, he said, a sign of a low sex drive, or a natural consequence of ageing. "I had a 75-year-old patient who complained to me because he could now only have sex three times a night as opposed to the previous four."
The facts about the condition are that it is common, and that disease or injury can often cause it. There is often both a physical and a psychological side.
Smoking, drinking, diabetes and neurological disorders are all contributing factors, as is stress. A long holiday can often help the busy executive in his 50s who has not taken a break for a few years. Treatments include injections, vacuum devices and prostheses, 25 of which are put in annually in Ireland.
Ms O'Connor said that in treating erectile dysfunction there was room for both medical and psychological treatment. "Sometimes they need the injections to get their confidence back and get them going again. But they may not want to take injections for the rest of their lives."