This Valentine’s Day, when it comes to being ‘hard’, the choice is easy

10 February 2015: “Are you happy with your sex life?” That’s probably not a question you get asked every day! However, for most people, whether they talk about it or not, it is an important one. The answer may impact not only relationships, self-confidence and quality of life, but also on long-term health as well! 

According to a recent survey, which included over 12 500 men and women in 27 countries, more than half of the respondents reported that they were not fully satisfied with their sex lives. Furthermore, almost 50% of the men reported problems with getting or keeping an erection.1,2 Despite erectile dysfunction (ED) being so common, many men (and their partners) suffer in silence and never seek treatment. In fact, it is estimated that only 1 out of every 3 men with ED seek professional help and as few as 1 in 10 receive treatment.3

Why is it so important to seek professional help for ED?

“Sexual problems can have a profound effect on a man’s self-esteem, self-confidence and relationships”, says Dr Leon Ehlers, a family doctor in Umhlanga, who has a special interest in sexual health. “Women partners are also affected, especially if there is a lack of communication. She may not understand why their relationship now lacks intimacy. She may feel concerned that he is withdrawing from her, or worried that he is not communicating like he used to. Is she less attractive than she used to be? Is he having an affair? Furthermore, women partners of men with ED are themselves more likely to have less sexual desire, lower sexual satisfaction, and to cease sexual activity entirely.”4

A large international study of men who were mainly married or living with a partner, showed that around the world, the concerns of men with ED are very similar.3 The majority agreed that their erection problem was a source of great sadness to them and their partner, and half of the respondents said that they would do ‘nearly anything’ to cure their ED.3

Even men with mild ED, and their partners, report reduced sexual satisfaction despite normal frequency of sex.1 For many men the ability to achieve a hard erection defines their masculinity and erection hardness directly affects the way they feel about themselves and their sexual satisfaction.Researchers grade erection hardness in 4 categories; Grade 1 is a partial erection that is not hard, whereas Grade 4 describes a completely hard and fully rigid erection.Being able to achieve a Grade 4 erection is a key factor in improving relationship satisfaction, satisfaction with sex, self-esteem and self-confidence.1 With simple oral medications, available in tablets, men can regain the ability to achieve a Grade 4 erection and this has become the primary aim of treatment for ED.1,5

Erection Hardness Score (EHS)6

“How would you rate the hardness of your erection?”

0: Penis does not enlarge.

1: Penis is larger but not hard.

2: Penis is hard but not hard enough for penetration.

3: Penis is hard enough for penetration but not completely hard.

4: Penis is completely hard and fully rigid.

ED can be a symptom of serious illness

There are other important reasons to seek professional help. “ED may be the first symptom of something more sinister”, says Ehlers. “ED occurs commonly with other health problems that require treatment, including depression, high cholesterol, diabetes and high blood pressure. It can also be the first symptom of arterial disease, in which case there may be significant risk of having a heart attack within the next 3 to 5 years. We can help to prevent that if men come to us early enough. But you must tell your doctor about your ED. It’s unfortunate, but a lot of the time a doctor will not specifically ask about it. That doesn’t mean that it’s not important”, say Ehlers.4

Start with your GP

“There is a class of medicines called PDE-5 inhibitors which is still one of the most effective treatments for ED”, says Ehlers. “With sexual stimulation, it works quickly and can make it possible to achieve a firm and lasting Grade 4 erection. That means feeling better about yourself. It helps restore confidence and definitely improves the sexual relationship for both men and women partners. However, you need to make sure you are receiving the real thing and that you get a full health check before taking anything for ED. And that means starting with your GP, telling them you have ED and asking for treatment,” says Ehlers.4


Beware of counterfeit medicines

Buying medicines online appears to offer a number of advantages. It is quick and convenient and enables access to treatment for conditions that we might feel too embarrassed to discuss with a pharmacist or doctor. Sometimes, online medicines are perceived to be inexpensive. However, there are considerable risks associated with using the internet to obtain medicines, because fraudulent, unlicensed and potentially lethal counterfeit drugs are common.

Counterfeit medicines may contain too much, too little, or no active ingredient at all. They may also contain toxic chemicals, such as other drugs, road paint, floor wax, chalk, talcum powder or shoe polish. Not surprisingly, using counterfeit drugs can seriously damage your health and even cause death.7

Although it is impossible to determine the true scope of the problem of internet medicine counterfeiting, online pharmacy accreditors in the USA recently surveyed 10 000 online sites selling prescription medications and found that 97% were operating illegally or not following pharmacy laws and standards.8



  1. Mulhall J, Althof S, Brock G, Goldstein I, Junemann K-P, Kirby M. Erectile Dysfunction: Monitoring Response to Treatment in Clinical Practice – Recommendations of an International Study Panel. J Sex Med2007;4:448-464.
  2. Mulhall J, King R, Glina S, Hvidsten K. Importance of and Satisfaction with Sex Among Men and Women Worldwide: Results of the Global Better Sex Survey. J Sex Med2008;5:788-795.
  3. Perelman M, Shabsigh R, Seftel A, Althof S, Lockhart D. Attitudes Of Men With Erectile Dysfunction: A Cross-National Survey. J Sex Med2005;2:397-406.
  4. Interview with Dr Ehlers; 3 December 2014.
  5. Kadioglu A, Grohmann W, Depko A, Levinson IP, Sun F, Collins S. Quality of Erections in Men Treated with Flexible-Dose Sildenafil for Erectile Dysfunction: Multicenter Trial with a Double-Blind, Randomized, Placebo-Controlled Phase and an Open-Label Phase. J Sex Med2008;5:726-734.
  6. Mulhall JP, Goldstein I, Bushmakin AG, Cappelleri JC, Hvidsten K. Validation of the Erection Hardness Score. J Sex Med2007;4:1626-1634.
  7. European Alliance for Access to Safe Medicines (2008). The Counterfeiting Superhighway. Medicom Group Ltd, Surrey, UK. Available at: Accessed 2 December 2014.
  8. National Association of Boards of Pharmacy (NABP). Internet Drug Outlet Identification Program

Progress Report for State and Federal Regulators: July 2013. Available at: Accessed 2 December 2014.


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