Erectile Dysfunction
ED is thought to affect at least one in ten men in the UK.
What is ED?
Erectile dysfunction or ‘impotence’ is the repeated inability to get or keep an erection that is sufficiently firm to achieve the kind of sex desired by a man and his partner. Erectile dysfunction or ED can be the total inability to get an erection, an inconsistent ability to do so or a tendency to sustain only brief erections.
These variations make defining ED and estimating its prevalence difficult.
ED is thought to affect at least one in ten men in the UK. This means that there are an estimated 2.3 million men suffering with erectile dysfunction. In men over 40 years old, more than 50% will experience some form of ED, but despite its prevalence it is estimated that only 10% of men are being treated.
A medical history and recounting of sexual activity may help disclose diseases leading to ED and to distinguish among problems with sexual desire, erection, ejaculation or orgasm.
Causes of ED
An erection involves a precise sequence of events and therefore ED can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column and area around the penis and response in muscles, fibrous tissue, veins and arteries in and near the corpora cavernosa.
One in two men is likely to suffer erection difficulties at some point in their lives. As ageing increases the possibility of experiencing ED, many older men accept the condition as a ‘normal’ part of the ageing process without realising it can be treated effectively and seeking advice about treatment.
- Vascular disease (disease of the blood vessels)
- Diabetes
- Hormone abnormalities imbalances
- Some prostate treatments
- Side effect of prescribed drugs (eg some diuretics)
- Hypercholesterolemia (high cholesterol)
- Diseases affecting the erectile tissue of the penis (eg Peyronies disease)
- Neurological diseases
- Severe chronic diseases such as kidney and liver failure
- Alcoholism and drug abuse
- Surgery (especially radical prostate and bladder surgery)
- Injury to the penis, spinal cord, pelvis, prostate or bladder
- Heavy smoking
- Being overweight
- Pelvic trauma (eg vehicular accidents) resulting in nerve and blood vessel damage
- Alcohol
- Antihypertensives (medication for high blood pressure) e.g. diuretics, beta blockers, methyldopa
- Cimetidine
- Marijuana, heroin, methadone
- Major tranquillisers
- Tricyclic antidepressants
- Digoxin
- Glucocorticosteroids
- Oestrogen, anti-androgens
A sudden onset of ED in men who can normally achieve an erection may indicate there is an underlying psychological problem at the root of their ED. Common psychological causes can include:
- Stress and anxiety from work or home
- Relationship conflicts and dissatisfaction
- Depression and other psychiatric conditions and their medications
- Sexual boredom or unresolved sexual orientation
As ageing increases the possibility of experiencing ED, many older men accept the condition as a ‘normal’ part of the ageing process without realising it can be treated effectively and seeking advice about treatment.
Diagnosis of ED
Treatments for ED
Medical and sexual histories help define the degree and nature of ED. A medical history and recounting of sexual activity may help disclose diseases leading to ED and to distinguish among problems with sexual desire, erection, ejaculation or orgasm.
Drug effects account for 25% of ED cases and using certain prescription or recreational drugs can suggest a chemical cause.
A physical examination can differentiate between nervous system, endocrine system or circulatory system problems or unusual characteristics of the penis itself.
Several laboratory tests can help diagnosis ED and can be used to test for systemic and endocrine problems. (eg serum testosterone, cholesterol, HbA1c)
Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then it is likely to be a physical rather than a psychological cause. Monitoring erections that occur during sleep by nocturnal penile tumescence (measurement of penile engorgement during sleep) can help to rule out certain psychological causes but these tests are not completely reliable. Scientists have not standardised these tests and have not determined when they should be applied for best results.
PDE5 inhibitors Vardenafil (Levitra), Sildenafil (Viagra) and Tadalafil (Cialis)
These are tablets that work by helping the blood vessels in the penis to relax, allowing blood to flow into it causing an erection. They have differing benefits in terms of onset and duration of action. For most ED sufferers oral treatments are the most convenient and simple to use. All of these treatments require sexual stimulation in order to produce an erection, therefore allowing sex to occur naturally.
Men who take nitrate-based drugs (e.g. nitroglycerine) for heart problems should not use these drugs. Men using alpha-blockers may need to take a reduced dose of these drugs as they can cause a sudden drop in blood pressure if taken within 4 hours of each other.
Intracavernosal injections therapy with Alprostadil (Caverject, Invicorp and Viridal)
These medications are self-injected into the erectile tissue of the penis causing the blood vessels feeding blood into the penis to relax allowing the blood flow to increase.
This is a pellet which is inserted into the urethra through the tip of the penis and causes the relaxation of blood vessels in the penis. The result is an increase in blood flow. Topical creams can also be applied to the glans and urethral opening.
There are many vacuum devices available but they all work on the same principle. The penis is inserted into the cylinder and a vacuum is created by a hand or battery pump, causing the penis to fill with blood and harden, which produces an erection. A tension band is then placed around the end of the penis to keep the erection hard and the pump is removed.
Implants may be semi rigid or inflatable. They are inserted surgically under a general anaesthetic. They produce excellent results but are expensive, and spontaneous erection are abolished.
This type of therapy is considered for men whose ED is thought to have a psychological cause or when there is no improvement with the above treatments.
