Before we go on to talk about the physical causes of erectile dysfunction (ED), most of which can be treated successfully with Viagra, Cialis or Levitra, we should talk a little bit about male culture.

Whenever groups of people come together, a society emerges. No matter how primitive or sophisticated, people develop a culture which lays down what patterns of human behavior are acceptable (or not) and establishes a basic system of signs and symbols to allow everyone to judge the importance and significance of what is done (or not done).

So whatever happens, we have a general agreement about what it means. This may be words, gestures, scents, tastes, textures, sounds, images, and so on. The test of acceptability depends on the context. Words or gestures may be acceptable from an individual wearing a particular set of clothes, e.g. a uniform, in a particular place, but offensive from another who does not display the right status to behave in that way.

We will also distinguish between different classes and groups. Whether we become members will depend on our social identity. Do we speak with an accent or speak a dialect, do we write in sentences or in SMS format, where do we live, what work do we do, how do we dress, and so on. More fundamentally come issues of sexual identity and gender which tend to fix the power structures. Most cultures have proved to be patriarchal, i.e. male dominated. From this come the rules of behavior deciding how much private space we should enjoy, whether and where people may touch or stare at each other, and so on. As we grow up we are socialized and learn how to fit into this complex society through our facial expressions, gestures and dress.

Because most cultures are male and men have political and social power, male imagery also tends to dominate. Maleness and male potency is equated with more general access to power and success in society. In its most extreme form, machismo in some cultures applauds obvious displays of masculinity and requires men to demonstrate a strong sense of pride and honor both in themselves and in their roles as leader of the family and father of their children.

So in male dominated cultures, when something goes wrong with a man’s ability to have sexual intercourse, this can have devastating psychological effect. Men affected are likely to feel intense shame and loss. They will change their behavior to conceal their inadequacy, fearing the judgment of their male peers and the loss of respect from women. This extreme defensiveness is often completely unnecessary because, in most cases, Viagra, Cialis or Levitra can quickly resolve the problem. But some men feel so deeply inhibited, that a strong culture of silence prevents them from discussing the matter with anyone.

Research suggests that, at some time during their lives, the majority of men may experience some degree of ED. There are all kinds of reasons for this. It is most usually situational, e.g. some emotionally disturbing event has just occurred and this disturbs the mood and motivation. At other times, there may be a physical injury or some other passing illness that makes sexual intercourse temporarily unavailable or unacceptable. More generally, it is estimated that about 10% of the male population will experience recurring impotence problems at some point in their lives. But a significant number do not seek treatment.

Many men focus on the fact that ED has affected them to the exclusion of the more relevant questions of what the cause might be and whether treatment is available. Had it not been for the publicity surrounding the development and launch of Viagra, it is probable that this omertà (to borrow a words from the mafia) would have persisted in the West. As it is, an increasing number of men affected by ED are prepared to admit the problem and do something about it. The most responsible do go to their doctors to get professional guidance. The remainder are still inhibited and exploit the privacy of the internet to buy Viagra or now Cialis and Levitra online.

No matter how medication is acquired, ED is less of a problem in relationships and, even if men are still silently anxious about how they will perform in the future, their partners are released from their short-term difficulties. For while their men are unable to perform, they are defensive and difficult to live with. Worse, the culture often does not permit partners to ask their men about the problem. Women are therefore condemned to suffer in silence. If men are at least able to resume intimacy and the mood of desperation has lifted, the general quality of life has been improved for their partners.