Doctor, is long Covid to blame for my impotence?

Hi doctor,
I am 32 years old and I have a serious problem in my sex life. I have been sexually active until late last year when I started experiencing ejaculation before penetration, and sometimes I have a weak erection. I have tried using some drugs but I'm not getting out of it. I rarely take alcohol. What could be causing this? Could this be an effect of Covid-19? How can I get help so that I can go back to the normal me?

Dear reader,
Normally, the male sexual response cycle takes an average of five minutes from desire to ejaculation. This is an average so it means that there will be instances of having a much shorter cycle (like two minutes) and this would still be normal, as well as much longer cycles. If ejaculation happens earlier than you would like, this is called premature ejaculation, and it is normal for it to occur every once in a while. It is also normal to have occasional episodes of failure to achieve or maintain an erection.

However, if the challenge of premature ejaculation and/or maintaining an erection persists, then there is need for further evaluation.

Some possible causes include:
•Psychological factors – stress, anxiety, depression, problems with self-image, guilt, performance anxiety and relationship challenges. Some people also experience challenges with sexual performance as a result of excessive masturbation.

•Physical factors – reduced testosterone levels; problems with blood flow; problems with the nerves; conditions affecting the prostrate; obesity; high cholesterol levels; other chronic illnesses; some medications; smoking; excessive alcohol intake; and use of other drugs.

There are medications that are used to achieve and maintain an erection, but they should be used when necessary and only under medical advice because of the potential side effects. In addition, the underlying cause of the problem needs to be identified and treated, following evaluation by a urologist. There are also other treatments, creams or devices that may be used to help sustain an erection. Review by a mental health professional would also be beneficial, especially to handle any associated psychological concerns. It is also vital to have a supportive partner through the process.

Other beneficial measures include having a healthy diet, getting adequate sleep, regular exercise, and good stress management. Pelvic floor exercises help to strengthen the pelvic muscles, which may be helpful in maintaining an erection and delaying ejaculation. Another option is to use a numbing agent or a condom to reduce sensitivity, and therefore delay ejaculation.

Some techniques to assist with delaying ejaculation are:

1) Sensate focus exercises – these are usually guided by a therapist. The couple focuses on non-sexual physical touch to build intimacy in the relationship, while avoiding sexual intercourse for some time, thus reducing the pressure to perform

2) Stop-start technique – when there is the urge to ejaculate during intercourse, stop all activity until it passes, then continue. With repeated practice, delaying ejaculation becomes a habit.

3) Pause and squeeze technique – when there is the urge to ejaculate during intercourse, squeeze the penis where the head joins the shaft for several seconds, until the urge passes, then continue.

Several studies have shown that some men may experience challenges in their sexual health, including erectile dysfunction, after contracting Covid-19. The theorised possible causes for this include persistent low testosterone levels in some men; testicular damage from the infection; long-standing inflammation affecting blood flow; worsening of any underlying illnesses especially heart conditions, and psychological factors. Since this is a concern for you, it is advisable for you to be reviewed by a physician and an urologist. 

Dear Doc,

What is Laryngitis?  Please shed light on this.  ADW

Dear ADW,

Laryngitis refers to inflammation of the larynx, also known as the voice box. The larynx is located in the neck, as part of the upper airway. When the larynx is inflamed, the vocal cords get swollen, causing hoarseness or muffling of the voice. The throat may feel sore, dry and irritated, and there may also be a cough. Other possible symptoms include fever, running nose, headache and pain when swallowing.

Most of the time, the inflammation of the voice box is as a result of viral infection, though sometimes it may be due to bacterial infection or even fungal infection. Laryngitis may also be due to voice strain or overuse such as from shouting, singing or talking. If laryngitis lasts for more than three weeks, it is called chronic laryngitis, which may develop due to smoking; prolonged exposure to air pollution; excessive alcohol intake; recurrent voice strain such as for singers; vocal cord injury; abnormal growth on the vocal cords; gastro-esophaeal reflux; inhaled medications; chronic respiratory conditions such as allergies and sinusitis.

Most of the time, laryngitis resolves on its own after a few days and without treatment. However, if it lasts for long or if there are other symptoms of concern, it is advisable to be reviewed by a health professional for review and relevant tests. You may also be referred to an ENT (Ear, Nose, Throat) specialist for further evaluation.

To manage laryngitis, rest your voice, take plenty of water and gargle with warm, salty water. Avoid straining your voice by shouting or by whispering, since whispering puts more strain on your voice than normal speech does. Also, avoid alcohol consumption and exposure to cigarette smoke.

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