Don't Come Crying to Me When You're the Lonely One

Women have done a grand job making breast cancer okay to discuss, driving increased awareness, earlier diagnosis, and better treatment protocols. Similarly, colon cancer is now discussed in polite society, resulting in more people setting embarrassment aside and getting screened. 

Today, we are going to push the boundary just a little bit to keep you happy, help your relationships and maybe keep you alive. We are going to talk about sex.

In 1979, Cliff Richard, a very popular British singer, had a huge hit called “We Don’t Talk Anymore.” Although the song speaks of emotional disconnection, sexual issues often cause communication failures, relationship fragmentation and a spin into oblivion.

Just like any complex pursuit, aviation has a lexicon; nouns such as empennage, verbs like rotate and phrases like cleared for the option that would mean little to non-pilots. Words matter. Words unspoken matter a great deal. The issue today is just that; a subject that is often brushed under the carpet. Or, should I say, bedclothes. Erectile dysfunction, or ED. Failure to launch, if you want to apply an aviator’s vocabulary. And it is actually a very serious matter with many implications for aviators. If you heard an odd sound when you cranked your starter motor, gentlemen, you might assume your engine could feasibly fail in flight. The similarity to ED is quite stark, and given that I receive many distressed emails about this problem, I thought it merited attention.

I once broached this topic at a live AOPA event, and noticing some audience discomfort, I asked how many of those present had children, and of course, many hands were raised so it was a simple segue to suggest that sex was a shared experience for all of us there. To have sex to induce a pregnancy, or as part of a loving and intimate relationship, a man has to be able to achieve and maintain an erection sufficient to enable satisfactory intercourse. Failure to do so is called ED, a term that came into common parlance after a campaign to raise awareness a number of years ago, and a consensus conference at the National Institutes of Health. The problem can also be sub-clinical, a term coined in 2006, meaning the man may have intermittent problems, which can also imply underlying problems.

An erection occurs when there is appropriate stimulation of some or all of the senses – I am not going into that here – and relies on a functional nervous and cardiovascular system, but simply put, nerve impulses cause blood to flow into the penis faster than it can flow out.

ED is actually very common, occurring to some degree in over 50% of men age 40–70. And if any degree of ED occurs, psychological overlay follows, damaging self-esteem, worsening the problem and impairing a relationship. To “numb the pain,” alcohol consumption increases and lethargy follows, leading to further negative consequences. Overcoming embarrassment is key; this is a symptom that impacts the partner as well as the man with ED.

Given the mechanism I explained, it follows that several medical situations can induce ED, and I want to credit Professor Emmanuele Janini from Rome, who explained this beautifully. There are several physiological villains that can trigger ED. First, the problematic plumber; as above, blood needs to flow in and out of the penis in an orchestrated manner and blood vessel problems, such as hypertension or narrowed arteries, can lead to ED. In fact, the vessels in the penis are similar to those in the heart, so ED may be a warning sign of impending problems with your ticker and merit urgent diagnosis. Please read that again: if you have ED it is imperative you be checked out by your doctor. The next villain Professor Janini references is the evil electrician; the nervous wiring system may be faulty due multiple sclerosis, Parkinson’s disease or after surgery for prostate cancer that may have necessitated severing nerves to remove the malignancy.

The next fiend is the criminal chemist who may mess with your body chemistry – and here too much sugar (diabetes) is far and away the biggest culprit, but there are plenty of others. Fancy that super big soda now? Or those body-building supplements that might damage your testicles? Next up is the dastardly doctor who has prescribed one or more medicines that interfere with sexual function such as certain blood pressure medicines and others to address mood disorders.

However, the biggest villain causing ED is oneself; lifestyle decisions have a massive effect! Giving up smoking, losing weight, exercising regularly, reducing alcohol intake and minimizing stress with tools like yoga, mindfulness training or just going for a walk in the country certainly help. And help to a degree that has been shown in well-conducted clinical trials.

If ED is an unwelcome visitor to your life, please see a doctor to exclude a serious underlying cause which can then be addressed. Please do not just seek to acquire cures over the internet or, worse yet, from a friend.

Assuming there is nothing life-threatening, and after adopting a healthier lifestyle and de-stressing, one would have to be a hermit to not know that there are medicines that can now help men and their sexual partner enjoy a satisfying sex life. These medicines function in similar ways and are administered as pills with varying times to take and retain effect, strips that dissolve under the tongue or as rapidly absorbed oral pastes. Taking tablets on an empty stomach increases speed of action and, as with all medicines, there are side effects including heartburn, nausea and headache. One might also experience changes in color perception, specifically seeing a blue tinge to objects for a period of time which may be hugely significant for pilots; taxiing onto an active runway at night could end very badly. Some of these medicines are also used to address troublesome symptoms of an enlarged prostate, benign prostatic hyperplasia or BPH, and while FAA may allow sporadic use for ED, your AME may turn his or her nose up if you are using it for BPH.

The first such medication, Sildenafil citrate (Viagra), was approved by the FDA on March 27, 1998, but the drug was first developed by UK scientists 9 years before to treat cardiovascular issues like hypertension and angina. Although the clinical trials for heart disease were not promising, men noticed that other blood flow was changing and the drug found a new indication! As famous people like Senator Bob Dole and Michael Douglas opened up about using Viagra, popularity grew, but it became apparent – and it made sense – that men with heart disease should not use it.

There are other options such as intermittent injections into the penile blood vessels and a surgical procedure to insert a device that can be inflated to support an erection. With many other medications on the market possessing slightly different attributes, men with ED, and ideally their partners, should have an open and honest conversation with their doctor about what is best for them.

A mutually satisfying physical relationship is good for general wellbeing and will ensure that while certain things are truly better left unsaid, ED is not one of them.

If you have ED, please speak to your doctor. It may save more than your sex life or relationship life. It may save your life, life. Fly well!

You can hear Dr. Sackier’s weekly podcasts on matters medical at or wherever you get your podcasts. And you can write to him at [email protected] and he will endeavor to respond. However, he asks that if you take issue with his opinions, please be courteous, as some recent correspondents have been highly disrespectful, rude and even threatening – we can disagree, but let’s not be disagreeable!

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification

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