Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction, frequently referred to as impotence, is the persistent or recurrent inability to attain or maintain an erection sufficient to complete sexual intercourse or another chosen sexual activity.

How common is erectile dysfunction?

It is a common problem which affects at least one in every ten men. Regrettably, only about 10% of sufferers actually receive treatment. The number of men suffering erectile dysfunction increases with age.

What causes erectile dysfunction?

Few men go throughout life without experiencing occasional failure to attain or maintain an erection. This usually results from stress, tiredness, anxiety, or excessive alcohol consumption. This is nothing to worry about. However, worrying about it may set the scene for a more persistent problem due to "fear of failure". The man becomes so preoccupied with previous erectile failure that he is unable to enjoy the arousal feelings associated with sexual stimulation. This in turn, decreases his sexual arousal and stops erection from occurring.

Until about 20 years ago, erectile dysfunction was considered to be caused almost entirely by psychological factors but we now know that physical conditions are present in about 75% of male sufferers. However, the majority of men with erectile dysfunction experience a combination of psychological and physical causes.

Men whose erectile dysfunction is of a physical origin often experience a gradual onset of erectile failure which tends to occur with all sexual activities.
Physical causes of erectile dysfunction include:

  • Deficient blood flow to the penis such as resulting from blocked arteries
  • Excessive drainage of blood from the penis ("venous leak")
  • Damage or diseases affecting the nerves that go to or from the penis
  • Hormone abnormalities
  • Side effect of prescribed drugs
  • Alcoholism and drug abuse
  • Diabetes
  • Heavy smoking
  • High cholesterol
  • Diseases affecting the erectile tissue of the penis
  • Neurological diseases, stroke
  • Severe chronic diseases such as kidney and liver failure

An erectile dysfunction with a sudden onset in men who can achieve erections under some circumstances but not others suggest a psychological cause. Sometimes the triggering factor can be easily identified such as a serious disagreement with the partner; being interrupted while making love or excessive worry at work.

Psychological causes of erectile dysfunction include:

  • Stress and anxiety from work or home
  • Marital conflicts and dissatisfaction (as can also occur with premature ejaculation)
  • Depression
  • Sexual boredom
  • Unresolved sexual orientation

It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively. Some lifestyle changes are worth considering before medical advice is sought. These include quitting smoking, reducing alcohol intake and trying to reduce stress and anxiety. If such changes do not solve the problem, then the man should seek medical advice.

In the first instance the man with erectile dysfunction should consult his general practitioner. GP's differ in the services they offer men with erectile dysfunction. At one end of the scale there are some general practitioners who have set up clinics within their surgeries and are able to offer a full range of treatments. Others will not treat erectile dysfunction themselves and will refer patients to specialists. If matters fail to improve, it would be reasonable to ask to see a specialist.

It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively. Some lifestyle changes are worth considering before medical advice is sought. These include quitting smoking, reducing alcohol intake and trying to reduce stress and anxiety. If such changes do not solve the problem, then the man should seek medical advice.

In the first instance the man with erectile dysfunction should consult his general practitioner. GP's differ in the services they offer men with erectile dysfunction. At one end of the scale there are some general practitioners who have set up clinics within their surgeries and are able to offer a full range of treatments. Others will not treat erectile dysfunction themselves and will refer patients to specialists. If matters fail to improve, it would be reasonable to ask to see a specialist.

Sex and/or couple's therapy

When psychological factors or difficulties in the man's relationship with his partner are considered an important cause for erectile dysfunction, a course of sex or couple's therapy might be recommended. It is very useful in helping couples re-establish a sexual relationship when there has been a long period without sexual interaction because of erectile dysfunction. Sex therapy is sometimes advocated in combination with other forms of treatment.

Oral Treatments

There are currently four oral drugs licensed for the treatment of erectile dysfunction. Three of these tablets are taken 30 minutes to one hour before sexual activity and are effective for varying amounts of time. The other is taken sublingually (under the tongue) twenty minutes before sexual activity. All four drugs are effective and do not cause an erection unless the man is sexually stimulated.

Transurethral therapy

This is an effective needle-free form of treatment. A small pellet of drug is introduced into the urethra (the tube through which urine is passed) using a special disposable applicator. The drug is then absorbed  through the wall of the urethra and passes into the erectile tissue, giving an erection within 5 to 10  minutes.

Intracavernosal injection therapy

This is a highly effective form of treatment. The patient (or his partner) is taught to inject a drug directly into the shaft of the penis when he wants an erection. Erection usually follows within fifteen minutes of the injection. The procedure is easy to learn. Several different products are available.

Vacuum constriction devices

Several different designs of constriction devices are available. Essentially the device consists of a plastic cylinder connected to a pump, which may be either hand or battery driven, and one or more tension rings. The penis is inserted in to the cylinder and activation of the pump removes the air from within the cylinder so creating a vacuum. This results in blood being drawn into the penis, which immediately enlarges in a similar way to a natural erection. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection. The vacuum within the cylinder is then released and the cylinder removed from the penis. It is important that the tension ring is also removed within 30 minutes.

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) which can be restored by appropriate testosterone replacement. It is unwise to take testosterone preparations unless laboratory investigations confirm deficiency.

Penile prosthesis

Essentially these are splints which are inserted surgically in to the penis.
There are two main types:  semi-rigid rods which maintain the penis in a state of rigidity all the time but which allow the penis to be bent downwards out of the way when not required. The second type is more  ophisticated and involves insertion of a hydraulic device which causes stiffening of the penis when a pump  implanted in the scrotum) is activated. As implantation of penile prosthesis causes destruction of erectile  issue, they should never be considered until other forms of treatment have been tried. Watch video (1.4  b).

Surgical treatments

A few cases of erectile dysfunction that are caused by abnormalities in blood-flow into and out of the penis  an be treated by surgery.

Yes.

There is the old adage that a "problem shared is a problem halved" and this is certainly true in the case of erectile dysfunction. Sometimes partners, unintentionally, put a lot of pressure on men to "perform". If the man has difficulty with his erections this pressure can cause erectile dysfunction. Discussing the problem with his partner may relieve this pressure and restore normal erectile function. It is often helpful for the partner to accompany the man to the general practitioner and specialist.

Ageing increases the risk of developing erectile dysfunction but it is attitude, not age, that is the biggest barrier in treating the condition. While some older men and their partners accept loss of erectile function as a part of ageing and do not want treatment, others are unhappy about losing such an important part of their lives. It is now considered acceptable for men and women to continue an active sex life way into old age and no one should be denied treatment for erectile dysfunction solely because they are too old. Men in their 90s are now seeking treatment for erectile dysfunction and generally respond to the types of treatment offered to younger men.