I cannot rise to the occasion, am I bewitched?

I met Julius and his wife Leah two years ago. They came to the Sexology Clinic to seek help for erection failure. They had not been intimate for close to a year. When they reached the clinic reception, however, they disagreed. Julius insisted on leaving immediately while Leah stayed put. An argument ensued and degenerated into a shouting match.

"This is not what I expected," Julius said, "we were not coming to a hospital. We must leave."

Leah shouted back that since they were already in the clinic they should seek help. I pleaded with the couple to go into my office for a more civil discussion.

"Leah is my second wife," Julius explained once they sat in the consultation room, "my first wife is evil, she has bewitched me and I cannot perform."

Incidentally, Julius had a serious conflict with his first wife because he decided to be polygamous. Attempts to reconcile them failed and Ann, the first wife, walked out of the marriage. She was not ready to live in a polygamous marriage.

"She said that I will regret my actions and that I will never be happy married to Leah," Julius lamented, "Six months later my erections began to weaken and the problem advanced till my manhood became completely feeble."

"Erectile dysfunction is a common medical problem and I would suggest that we give it a medical approach instead of concluding that it is the result of witchcraft," I explained to which Julius got furious. He fired back at me saying that I was not qualified to distinguish between medical and witchcraft-related dysfunctions.

Julius was representing a common view: that erectile dysfunction, and in fact that all other sexual problems are the result of witchcraft or some evil powers descending on someone. As such people with sex problems do not always go to a hospital. In one case I came across a 40-year-old single man with severe premature ejaculation which stopped him from marrying and yet for a long time he would not seek medical help. He had used all manner of herbs, slaughtered a black goat for sacrifice to appease the spirits, and even cut and applied some ash to his private parts as the traditional healer had advised, but nothing changed. His breaking point came when he was told to get the saliva of a lion and apply it on his private part. It was impossible to get the saliva. He came to the clinic desperate, having run out of non-medical options.

"I suggest that we give the doctor a try," Leah pleaded, interrupting my monologue. Julius remained quiet for a minute as he threw his arms in the air.

"I have struggled with this problem for close to a year anyway so taking your medicine for a few days will not be a big deal," he said.

I examined Julius. His blood pressure was quite high. I also ordered several blood tests. His blood sugar was found to be high as well. His cholesterol was similarly deranged. Fortunately, all his sex hormones were normal.

The combination of high blood pressure, high sugars, and abnormal cholesterol levels conspire to kill erections in most middle-aged and elderly men. Julius had entered the bracket of people with this dangerous triad. Because most people are not in the habit of annual medical check-ups, failure to erect may be the first sign that you have these diseases. The blood vessels of the penis which are responsible for causing erections are quite sensitive to these diseases and clog up resulting initially in weak erections which slowly progress to complete inability to erect.

"So what can we do to reverse this situation?" Leah asked. Julius was lost in his thoughts. He fixed his gaze on the floor and avoided eye contact with me.

"You can go ahead and prescribe whatever you want, who knows, maybe it will work."

I prescribed a mixture of diet, exercises, and medicines. I pleaded with Julius to stick to my advice. I wondered if he was getting convinced at all with my line of treatment.

A few months later, the couple reported progress in their sex life.

Prof. Osur is a Kenya-based reproductive and sexual health expert and a reproductive rights advocate

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