Erectile dysfunction (ED) is an inability to obtain or maintain an erection that is suitable for intercourse. It is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.
When a man becomes sexually excited (aroused), his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden.
Anything that interferes with the nervous system or the blood circulation to the penis can lead to erectile dysfunction. Low testosterone can affect the level of sexual desire (libido) and can also cause erectile dysfunction. Psychological conditions, such as depression, can also impact significantly on erectile function.
Alcohol and recreational drugs also affect erectile function and should be avoided to try and improve the situation.
There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:
Examples of vasculogenic conditions that cause erectile dysfunction include:
Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.
Examples of neurogenic conditions that cause erectile dysfunction include:
Examples of hormonal conditions that cause erectile dysfunction include:
Medication can also cause erectile dysfunction and these include:
Psychological causes are an extremely important cause of erectile dysfunction, they include:
Erectile dysfunction usually has a mixture of both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and the anxiety may lead to even more problems.
Diagnosing erectile dysfunction
Erectile dysfunction (ED) requires a thorough history to be taken as well as a physical examination and blood tests.
Treating erectile dysfunction
If you have erectile dysfunction (ED), treatment will depend on what is causing it.
Treating underlying conditions
If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also help to resolve the problem.
If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so.
If your testosterone is low then I will refer you to an endocrinologist (a doctor who specialises in hormones) to replace it to a normal level before other treatment is started.
Lifestyle changes can have a significant impact on erectile dysfunction. These include:
As well as helping to improve your erectile dysfunction, these changes can also improve your general health and may help to reduce your risk of cardiovascular disease (conditions that affect your heart and blood vessels).
Phosphodiesterase-5 (PDE-5) inhibitors
Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating erectile dysfunction. They work by temporarily increasing the blood flow to the penis.
In England, three PDE-5 inhibitors are most commonly used for treating erectile dysfunction. They are:
Depending on the type of PDE-5 inhibitor you are prescribed, it should take about 30-60 minutes before it starts to work. It may take longer to notice the effects if the tablet is taken with fatty food. Sexual stimulation is required for the tablets to help achieve an erection.
There have been many studies to test the effectiveness of these medications. In general, at least two-thirds of men report having improved erections after taking one of these medicines.
PDE-5 inhibitors should be used with caution in men who have significant cardiovascular disease. They should not be taken in patients who are prescribed long acting nitrates. They can also cause low blood pressure and therefore should not be taken at the same time as alpha blockers as this can potentiate the effect.
Side effects include:
A vacuum pump consists of a clear plastic tube that is connected to a pump, which is either hand or battery operated.
You place the penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill the penis, making it erect. You then place a rubber ring around the base of the penis to keep the blood in place, allowing you to maintain an erection for around 30 minutes.
It may take several attempts to learn how to use the pump correctly but they are usually effective. After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.
You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.
Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men.
Intracavernosal / intraurethral injection of prostaglandins
Alprostadil is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis
Alprostadil is available as:
We will teach you how to use these devices in the clinic.
If your partner is pregnant, use a condom during sex if you are inserting Alprostadil into your urethra.
Alprostadil will usually produce an erection after five to 15 minutes. How long the erection lasts will depend on the dose.
In men who did not respond to PDE-5 inhibitors, Alprostadil injections are successful in 85 out of 100 men. Alprostadil inserted into the urethra is successful for up to two-thirds of men.
Alprostadil should not be used:
Side effects include:
Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed.
Penile implants are avaliable in two forms:
Complications can include:
If the surgical option became necessary as all other treatemnts had failed I would refer you on to an Andrologist who specialises in this procedure. I do not offer this operation as it is extremely specialist.