Which is more important? The plumbing or emotions?

Modern medical textbooks have all become so much more informative. A simple statement reflecting the vast amount of knowledge that has been accumulated through research over the last one hundred years. Yet, when you look at these books, you are confronted by mountains of facts about increasingly minute processes within the body. Students are expected to be impressed by the depth of knowledge because instead of one sentence approximating how a muscle works, there are now whole chapters devoted to the thin muscle filaments containing multiple proteins. Instead of simple engineering analogies of muscles and cables, human knowledge has become obsessed by the identification of ever more complex chemical and molecular processes. This is my wood-for-the-trees moment.

Erectile dysfunction can now be described in terms of complex chemical interactions and illustrated with wonderful diagrams. There are still all kinds of analogies with hydraulic engineering, but the sophistication of the functional analysis is breathtaking. However, it is not a part of the medical books to observe and describe the entirely human context in which the erection is supposed to operate. A single male may masturbate. A heterosexual couple may engage in sexual intercourse. A homosexual couple may offer mutual manual satisfaction, oral or anal intercourse. Multiple partners may engage in group sex. Many different social taboos would potentially be breached in any more detailed explanation. The common denominators are that the party or parties are expressing their sexuality in the ways that give them the most pleasure. The greater the pleasure, the greater the incentive to engage in the activity and the greater the disappointment if success is not achieved.

Will medical treatment be asked for and a success? In part, this will be determined by the nature of the relationship. Where the relationship is socially disapproved, the man may well not seek treatment at all because of fear. A physical examination might reveal different types of sexual activity, or a chance remark in the consultation might expose the forbidden practices. This is ironic. If the parties to the relationship have a strong mutual commitment and lovingly support each other, the likelihood is that the co-operation between all involved would produce excellent medical outcomes. Well-established sexual intimacy and commitment preserve the right level of desire and motivate everyone to getting a solution that works well. Were it not for online pharmacies and their willingness to supply medications like cialis without prescription, many partnerships might never be able to get appropriate treatment of any kind.

Unfortunately, many partnerships do not get treatment for the underlying causes of the dysfunction. Although most will know that the dysfunction can be a symptom of diabetes and cardiovascular diseases, fear of exposure may force the couples or groups to ignore or deny the problem until it is too late for the easy treatment represented by cialis to continue on its own. By then, the chances of an effective treatment for the underlying cause may be remote.

This is two completely different cultural imperatives in conflict. Men are socially conditioned to believe that they will always be able to have an erection. Any publicly acknowledged failure means shame. Yet they are only allowed to have erections in certain very carefully defined social situations. Step outside those situations and you are into potentially disapproved or even criminal territory. In theory, doctors are bound by duties of confidentiality, but the fear of exposure means that many men and their partners do not get treatment when the research shows that couples who are in love and share a strong commitment to their relationship are the ones who would most benefit from that treatment.