Erectile Dysfunction

What is Erectile Dysfunction?

The medical term for problems with penile erections is erectile dysfunction or ‘ED’ for short. Some men also call this impotence.

Erectile Dysfunction is difficulty in getting and/or keeping an erection that is good enough for sexual intercourse.

Getting an erection is a complicated process that involves the muscles, nerves (cells that send messages round the body) and blood vessels (tubes that carry blood) in the penis. In order for a man to get an erection blood is pumped into the penis to make it firm. This usually happens when a man thinks about sex and/or when they are stimulated (touched).

Sexual stimulation causes messages to travel down the nerves that lead from the spinal cord to the genitals (penis and testicles). The blood vessels that supply the penis then open wider so that more blood can get into the penis and it enlarges and becomes erect (hard). 

Why Can’t I get an erection?

There are many reasons why men can have difficulty in getting or keeping an erection. Some of the reasons may be due to a physical cause; some may be due to a psychological (mental/ emotional) cause.

Physical causes include:

  • Cardiovascular disease; a disease of the heart or blood vessels, such as atherosclerosis - narrowing/hardening of the arteries (tubes which carry blood around the body)
  • Hypertension; a condition where the blood pressure is too high
  • Diabetes; a condition that is caused by too much glucose (sugar) in the blood. This can affect both the blood supply and the nerves in your penis
  • Stroke; a serious medical condition that occurs when the blood supply to the brain is interrupted
  • Multiple Sclerosis ; a condition that affects the body's actions and activities, such as movement and balance
  • Parkinson’s disease; a condition that affects the way that the brain organises body movements, including walking, talking and writing
  • Spinal injury; damage to the back bone.
  • Hormonal problems (hormones arechemicals in the blood), such as a lack of testosterone (male sex hormone) or an overactive/underactive thyroid gland.
  • Medicines; some medicines can cause ED, however DO NOT STOP taking any prescribed medications (medication given to you by a doctor) as this can be dangerous! If you think that a medicine you are taking may be causing your ED speak to your doctor as they will be able to help decide if this is the cause and rule out other causes
  • Smoking.  Chemicals in cigarette smoke cause blood vessels to constrict (narrow), limiting blood flow to the penis. Smoking also causes cholesterol/plaque (fatty substance) to build up in blood vessels which may lead to an ongoing problem. So, the younger you start and the more you smoke, the greater your risk of ED
  • Drinking too much alcohol; as the amount of alcohol in the blood increases, the alcohol stops the brain’s ability to sense sexual stimulation. Alcoholism also has an adverse effect upon libido (sex drive). Men who drink too much for many years can then have hormone problems, such as a drop in testosterone production
  • Obesity (being excessively overweight). Obesity can cause a number of health problems, such as type 2 diabetes  and cardiovascular disease, which are all causes of ED.
  • Hypercholesterolemia; having raised cholesterol (fatty substance in the blood) levels. This is because high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attack and stroke. This can happen when cholesterol builds up in the artery wall restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing
  • Illegal drugs (such as cocaine and cannabis). This is because they interfere with your nerve impulses or the flow of blood to your penis
  • Peyronie's Disease; a condition that affects the tissue of the penis

Psychological causes include:

  • Depression; feelings of extreme sadness that last for a long time
  • Anxiety; a feeling of unease, such as worry or fear

ED can often have 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 anxiety may lead to an episode of ED.

There are a number of emotional issues that may also affect your physical ability to get or maintain an erection. These include:

  • Relationship problems, such as being unable to talk openly about any problems that you have
  • Lack of sexual knowledge
  • Past sexual problems
  • Being in a new relationship

How common is ED?

ED is extremely common, and studies now show that approximately half of ALL men aged 40 to 70 years old will have some degree of ED!

Studies also show that it takes the average man 2 years from the start of ED before he gets help from a health professional.

Seek medical advice

DO NOT DELAY!  You may feel embarrassed to talk to your nurse or doctor about ED; however they are used to talking to people about ED.

You should see your GP or nurse if ED persists for more than a few weeks.

It is important that they assess your health because studies have shown that ED can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).

Many websites offer tablet treatment for ED (such as Viagra or herbal supplements) but their use is not recommended. The medications that are offered by these sites could be fake and may be dangerous. Even if the medications are genuine, they may not be suitable for you.

What will my GP do?

Before diagnosing ED your GP will ask you about:

  • your symptoms
  • your overall physical and mental health
  • your alcohol consumption
  • whether you take drugs
  • whether you are currently taking any medication

Sexual history

Your GP will also need to ask you detailed questions about your sexual history. Try not to be embarrassed because ED is a common problem.  It should be possible to request a male GP at your doctor’s surgery if you prefer.

Your GP may ask about:

  • your previous and current sexual relationships
  • what your sexual orientation is
  • how long you have been experiencing ED
  • whether you can get any degree of erection with your partner, on your own or when you wake up in the morning
  • Whether you have been able to ejaculate or orgasm (come)
  • your libido (your level of sexual desire)

ED that happens all the time may suggest an underlying physical cause. If ED only occurs when you are attempting to have sex with your partner it may suggest that there is an underlying psychological (mental/emotional) cause.

Assessing your cardiovascular health

An important cause of ED is narrowed blood vessels. These are also a risk factor for cardiovascular disease (conditions that affect the heart and blood flow).

Your GP may therefore assess your cardiovascular health by seeing if you have any of the risk factors for cardiovascular disease. If you do, it is likely that this is causing your ED.

Your GP may:

  • Measure your blood pressure to see if you have high blood pressure (hypertension)
  • Listen to your heart rate to check for any irregularity
  • Measure your height, weight and waist circumference to see if you are a healthy weight for your height
  • Ask you about your diet and lifestyle, for example, how much exercise you do
  • Test a sample of your blood to test your glucose (sugar) and cholesterol (fatty substance) levels, as high levels can point to conditions affecting your heart or blood vessels which may need treatment

Physical examinations and tests

Your GP may carry out a physical examination of your penis to rule out anatomical causes (conditions that affect the structure of your penis).

If you are over the age of 50, your GP may suggest that you have a digital rectal examination (DRE). This involves your GP wearing gloves and inserting a finger into your anus (back passage).  A DRE can be help to rule out problems with the prostate (the small gland between the penis and the bladder), such asprostate cancer.

Blood tests may also be used to check for other underlying health conditions.  For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).

Further testing

Further testing for ED is usually only required if you are unusually young to be experiencing ED. This is because ED is quite rare in men who are under 40 years old.

Your GP may also recommend further testing to identify the exact cause of your erectile dysfunction, for example, in case of a problem with the blood vessels in your penis.

If the doctor can identify the cause of your ED, these tests will not need to be done.

Nocturnal penile tumescence and rigidity (NPTR)

A nocturnal penile tumescence and rigidity (NPTR) test involves monitoring you over two nights either in hospital or at home to see if you get an erection during the night. Most healthy men have erections when sleeping.

During the test, a special loop will be attached to the base of your penis. If you have an erection during the night, the monitor will record it.

A NPTR test is a useful way of determining whether ED is due to physical or psychological causes.

Intracavernosal injection test

An intracavernosal injection test involves injecting a synthetic (man-made) hormone into your penis to increase the blood flow to your penis. This may be used to assess any abnormalities in your penis to help plan treatment.

If you do not get an erection after the injection this may indicate that there is a problem with the blood supply to your penis. If you do get an erection during an intracavernosal injection test, it is still possible that there is a problem with your blood vessels. You may therefore need an ultrasound scan as well.

Duplex ultrasound scan

A duplex ultrasound scan uses high frequency sound waves to create an image of part of the inside of your body. It can be used to measure blood flow inside your penis.

Arteriography and dynamic infusion cavernosometry or cavernosography

These are special tests that involve injecting dye (a coloured liquid) into the blood vessels of your penis and looking carefully at the dye on a scanner. These are only likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.

Psychological assessment

If there may be an underlying psychological cause for your ED, your GP may refer you for a psychological assessment. This could be with:

  • A psychologist - a healthcare professional that specialises in the assessment and treatment of mental health conditions.
  • A psychiatrist - a qualified medical doctor who has received further training in treating mental health conditions.

Treatments for ED

Treatment for ED often depends on the cause.

If your ED is caused by an underlying health condition, such as heart disease or diabetes, your GP may want to treat that condition first before starting ED treatment.

In some cases, treating the underlying problem may also solve the problem of ED, for example correcting high blood pressure.

Some people may be able to obtain ED treatments on NHS prescription.  Men who are eligible are men with ED who suffer from one of the following conditions:

•     Diabetes
•     Spinal cord injury
•     Single gene neurological disease
•     Poliomyelitis
•     Severe pelvic injury
•     Prostate Cancer
•     Multiple Sclerosis
•     Parkinson’s disease
•     Spina bifida
•     Prostatectomy
•     Renal failure treated by transplant or dialysis

You may also be entitled to a NHS prescription if you were receiving some types of ED medication on or before the 14th September 1998, which was paid for by the NHS. This is because the availability of ED medications on the NHS was changed in 1999.  However, those who had been on ED medication for some time were allowed to continue receiving it on the NHS.

In certain circumstances, some specialist centres may provide a NHS prescription, for example, if ED is causing you severe distress. The healthcare professional who is treating you will consider whether ED is:

  • disrupting your daily life
  • affecting your mood or behaviour
  • affecting your relationships

Vacuum therapy

Vacuum therapy is a cost effective, safe, painless and a very effective method of treating ED.

It has been clinically proven to be successful in over 90% of men even when other treatment methods have failed!

The Osbon Erecaid is a device that consists of a plastic cylinder connected to a pump, which may be either hand or battery driven, and includes the use of tension rings.

The Osbon erecaid can be used in 3 ways:

A) To create an erection on demand

B) To boost a natural partial erection within seconds

C) As an exercise to help the penis recover erections naturally by improving blood supply and tissue elasticity (stretchiness). Studies have shown that if the Osbon ErecAid is used for 10 minutes daily as an exerciser it can restore natural erections in up to 50% of men.

It is suitable for use in the majority of men and can be obtained on prescription or privately. Ask your nurse or doctor for more information, or contact one of the Mediplus team on 01494 551200.

There are other Vacuum Pumps available on the market; however it is strongly advised that you buy a pump from a respectable supplier such as MEDIPLUS. Those bought from a sex shop can bemuch cheaper but can be unreliable and are unlikely to come with customer support/helpline.

Tablets

Tablets are often the first treatment given to men even though they are not as successful as the vacuum method. They have many side effects, are expensive (usually costing a minimum of £30 per month for men unable to get their ED treatment on the NHS), and are often unsuitable for men with cardiovascular disease and those taking nitrates (tablets such as Isosorbide mononitrate and GTN).

Tablets are portrayed as being a “convenient” option. However, they have to be taken on an empty stomach, approximately an hour before having sexual intercourse and only work for up to a few hours afterwards.  Also, men will usually only be prescribed 1 tablet per week.

Therefore, sex loses its spontaneity and has to be planned.

There are currently three tablets commonly used for the treatment of erectile dysfunction. Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil).  Your doctor or specialist will discuss with you which of these tablet treatments he or she thinks would suit you.

Injection Therapy

Injection therapy involves you or your partner injecting a drug (Alprostadil) directly into the penis. Alprostadil is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis. You or your partner would be taught to inject a drug directly into the shaft of the penis when you want an erection. Erection usually follows within fifteen minutes of the injection. The product usually used is called Caverject.

Some men find this too painful.  It can also cause side effects such as scarring, which in a small number of men may cause Peyronie’s Disease (a condition affecting the tissue in the penis causing bending/curvature), dizziness, headache, and drop in blood pressure and in a small number of men a priapism.

A priapism is a potentially harmful and painful medical condition in which the erect penis does not return to its flaccid (soft) state, despite stopping sexual intercourse, within four hours. If this happens you must seek help from an A&E department!

MUSE

MUSE is the same type of drug as the injection however it is a needle-free form of treatment. It is an expensive treatment at approximately £10 per dose (£40 per month) and is only successful in up to 50% of attempts.

A small pellet of the drug alprostadilis inserted into the urethra (the water pipe) using a special disposable applicator. The drug is absorbed through the wall of the urethra and passes into the erectile tissue, giving an erection within five to ten minutes.

It can cause side effects, such as a burning sensation in the urethra (water pipe). Partners can also experience a burning sensation, dizziness, headache, drop in blood pressure, and there is also a small risk of priapism.

Hormone Treatment

Only a small proportion of cases of erectile dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of testosterone (male sex hormone) usually in older men, which can be restored after checking at least twice, by appropriate testosterone replacement.  It is unwise to take testosterone preparations unless blood tests taken by a health professional confirm there is a deficiency.

Penile Prosthesis

This is a splint which is inserted in to the penis during a surgical procedure. It is a hydraulic device which causes stiffening of the penis when a pump (implanted in the scrotum) is squeezed.  As implantation of a penile prosthesis causes damage to erectile tissue, they should never be considered until other forms of treatment have been tried.

Sex Therapy/Counselling

Psychological (mental/emotional) factors or difficulties in a man’s relationship with his partner can be an important cause of erectile dysfunction.  Frequently a course of sex or couple’s therapy can be very useful in helping couples re-establish a sexual relationship when there has been a long period without because of erectile dysfunction. Sex therapy can also be used in combination with other forms of treatment.

Lifestyle Modifications

The symptoms of ED can often be improved by making changes to your lifestyle to reduce the impact of known risk factors for ED. These include:

  • Losing weight if you are overweight
  • Giving up smoking if you smoke
  • Reducing your alcohol consumption
  • Not taking illegal drugs
  • Exercising regularly (seek advice from a health professional such as your GP or nurse if you have not exercised for a long time or have any health conditions).
  • Reducing stress levels 





Disclaimer

All content within Mediplus Patient Info pages is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.  Mediplus is not responsible or liable for any diagnosis made by a user based on the content of the Mediplus website.  Mediplus is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites.  Always consult your own GP if you're in any way concerned about your health.

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