ERECTILE DYSFUNCTION

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

How common is erectile dysfunction?

It is a common problem which affects at least one in every ten men. This means that there are an estimated 2.3 million men in the UK suffering from erectile dysfunction. 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. And this, in turn, decreases his sexual arousal and stops erection from occurring.

The causes of ED are listed below, but in a majority of men a combination of psychological and physical causes are responsible for the problem.

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 – Which in common in old age.
  • Damage or diseases affecting the nerves that go to or from the penis

This can occur following surgery for prostate and bladder cancer

  • Diabetes
  • Excessive drainage of blood from the penis ("venous leak")
  • Hormone abnormalities
  • Side effect of prescribed drugs
  • Alcoholism and drug abuse
  • Heavy smoking
  • High cholesterol
  • Diseases affecting the erectile tissue of the penis
  • Neurological diseases, stroke
  • Severe chronic diseases such as kidney and liver failure

Psychological causes

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

 

Investigations

In men who have a normal desire to have intercourse routine investigations are not recommended. A simple urine test to rule out diabetes is usually carried out. Men over the age of 45 may be counselled about having a PSA test.

  • What treatments are available for erectile dysfunction?

    Oral Treatments

    Oral Medicines for Erectile Dysfunction

    Click on the names above to get specific information about these drugs

    There are currently several oral drugs licensed for the treatment of erectile dysfunction. These are tablets taken up to one hour before sexual activity. For many men these drugs are effective. However they do not cause an erection unless the man is sexually stimulated.

    All these drugs work by inhibiting an enzyme PDE5 which results in a high concentration of a chemical GTP that allows the penis to become erect.

     

    Other oral drug

    Uprima is a drug which works by a different mechanism

    Intracavernosal injection therapy (Direct injections into the penis)

    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. Although many men initially do not like the idea of injection therapy procedure is easy to learn and very effective.

    Caverject

     

     

     

    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.

     

    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 very 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 sophisticated 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 tissue, they should never be considered until other forms of treatment have been tried.

     

    Should a man discuss the problem with his partner?

    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 doctor’s appointments.

     

    Further information

    The Sexual Dysfunction Association
    Windmill Place Business Centre
    2-4 Windmill Lane
    Southall
    Middlesex UB2 4NJ
    Telephone: 0870 7743571


    The Impotence Association
    P O Box 10296
    London
    SW17 7ZN
    Telephone: 020 8767 7791


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