Erectile Dysfunction Treatment

The Erectile Dysfunction directory contains links and articles relating to various authority websites on the subject of male impotence on the internet today. Mens health matters are not associated with any of these websites in any way, or the content you may find on them. We hope you find these resources useful.

Erectile dysfunction (ED), or impotence, occurs when a man has difficulty with either getting an erection or with keeping an erection for long enough to allow satisfactory sexual activity.

It is one of the most common sexual problems and affects around half of all men over 40 at some point. It becomes more common and severe as men get older. However, only a fraction of affected men seek help.

Erections
The shaft of the penis has two chambers that fill up with blood during sexual arousal. These are known as the corpora cavernosa. When a man has sexual thoughts or feelings, the brain communicates this sexual excitement through the nerves and these eventually reach the genitals. In turn, the nerves bring about a relaxation of the muscle cells in the walls of the blood vessels entering the penis. This increased flow of blood fills up the two corpora cavernosa resulting in an erection.

Cause of erection problems
There are a number of causes of ED. In around two thirds of cases, there are physical problems affecting the blood supply. However, there is a complex relationship between physical and psychological aspects of sexual function. For instance, physical health problems can cause psychological distress that can have an additional effect on erection problems.

Physical health
Several conditions prevent sufficient blood getting into the penis and so cause ED. These include diabetes and vascular disease (furred-up blood vessels). There can also be problems with keeping the blood within the penis (veno-occlusive disease), resulting in erections that are quickly lost. Problems with the nervous system can affect the transmission of signals from the brain to the blood vessels in the penis. This occurs in conditions including multiple sclerosis, spinal cord injury and Parkinson's disease. The nerves involved in sexual arousal can also be damaged in surgery to the pelvic area, such as removal of the prostate. In a small number of cases, problems with hormone levels, can also affect erection.

Psychological aspects
Psychological problems can also influence the ability to get and maintain erections. Anxiety and guilt are common causes of ED. Unsatisfactory sexual and relationship experiences may lie behind these issues. Stress at work, depression, boredom with current sexual practices, partner conflicts, and unresolved issues about sexual orientation may all cause problems.

Medicines
The side-effects of medicines such as some treatments for high blood pressure can cause ED.

Medicines can also affect sexual drive and desire (libido), or cause problems with ejaculation and orgasm. These can have a knock-on effect on erections.

Lifestyle
Drinking too much alcohol commonly affects the ability to get and maintain an erection (brewer's droop). In the longer term, it interferes with the production of the male hormone testosterone, which can reduce libido. Nicotine damages the circulation, so smoking increases the risk of erection problems. Similarly, being physically inactive, which contributes to poor cardiovascular fitness, may increase the risk of ED.

What's normal?
In younger men who consult the doctor, the initial problem is often anxiety over the reliability of an erection. However, occasional episodes of ED are common and do not mean there will be persistent problems in the future.

As men get older, its common for them to need greater tactile stimulation, by themselves or their partner. A change in sexual foreplay and technique may be necessary to ensure a good, sustained erection.

The diagnosis of ED
Many men feel embarrassed when they first discuss the issue with their doctor or practice nurse. But, particularly since the launch of the drug sildenafil (Viagra), awareness and understanding from health professionals is high and the consultation will almost certainly be less embarrassing than feared.

The doctor will ask about your general health and about your erections. This will include whether or not you wake up with an erection in the morning and the strength of the erection compared with the past. The doctor will ask about any medicines you are on, and about any changes in your life that may be having an influence on your sexual health.

Your doctor may also want to talk with you and your partner together about any physical or psychological factors that may be contributing to the problem. For example, around the menopause, women may experience pain or discomfort during intercourse. When the man has a faltering erection this may lead to further discomfort for both partners.

A physical examination includes taking the blood pressure and checking the pulses in the legs - an indicator of how healthy the circulation is. The penis and scrotum will be examined. The doctor may request blood tests to look for medical problems, such as anaemia, diabetes, high cholesterol or hormone abnormalities, that might be a contributory factor.

More specialised tests to assess blood flow and the way the nerves are working can be done in specialist hospital clinics.

Treatment
In around 95% of the cases, a suitable treatment can be found. If necessary, referral to a hospital ED clinic may be possible. The simplest treatments are "talking" therapies, and tablets.

If the cause is mainly worry, other psychological problems or relationship difficulties - such as arguments and disagreements about sex - then talking to a counsellor or psychosexual therapist will be most helpful.

Lifestyle changes & prevention
A healthier lifestyle can often be beneficial and can help prevent any further deterioration caused by underlying medical conditions.

If you smoke, make a plan to stop.
Take moderate-intensity exercise (so you feel warm and slightly out of breath - brisk walking for instance - for half an hour on most days of the week.
Eat a balanced diet rich in fruit and vegetables and low in fat.
Drink alcohol in moderation. Other recreational drugs can cause ED.
Aim to reduce stresses in your life by looking at the balance between your work and your home/leisure time. Relaxation techniques may be helpful.
Medicines
If prescription medicines are thought to be causing or contributing to ED, it may be possible to switch to an alternative treatment. If hormone levels are found to be low, then replacement therapy with testosterone is possible.

In most other circumstances, a trial with a medicine that helps men obtain and keep an erection is the next step. However, these medicine are only available on the NHS for people with specific medical conditions such as diabetes, multiple sclerosis and Parkinson's disease, or men who have had major pelvic surgery, spinal injury or who have kidney failure. A private consultation and prescription may be required for other men.

There are now three different brands of tablets known as phosphodiesterase type-5 (PDTE5) inhibitors. The two newer drugs tadalafil (Cialis) and vardenafil (Levitra) work in a similar way to sildenafil (Viagra), the first drug of this type, but take effect more quickly. Men taking nitrate drugs (eg glyceryl trinitrate) for angina must not use PDTE5 inhibitors at the same time as it can dangerously lower the blood pressure. A fourth drug, apomorphine (Uprima), comes as a tablet to be dissolved under the tongue. It brings about an erection in about 20 minutes.

For all four medicines, sexual foreplay is needed to start the arousal process. The ability to have erections can last for several hours or with tadalafil and vardenafil for up to 24 hours.

Side-effects with these treatments tend to be minor and include headaches, nausea, indigestion and a stuffy nose. However they are prescription-only drugs, that are not suitable for everyone. There have been rare but serious complications.

The cost varies, depending on the dose, from about £4-£6 per tablet.

In more severe cases of ED, medicines such as alprostadil (contained in Caverject, Viridal Duo and MUSE) can be injected directly into the side of the penis or inserted, as a pellet, into the penis tip. These treatments require instruction by a specialist nurse or doctor and are usually only prescribed at specialist hospital clinics.

All of these medicines are only legally approved for use in men and have not been officially shown to be safe for women.

Alternatives
External vacuum pump devices may be available from hospital ED clinics or purchased privately. Constriction rings (which trap blood in the penis) are useful where there is no problem with the flow of blood back from the penis. In a small number of cases, surgery to correct blood supply to the penis or to insert a penile implant may be options.

Further information
The Impotence Association
http://www.impotence.org.uk
020 8767 7791

British Association for Sexual and Relationship Therapy
http://www.basrt.org.uk
020 8543 2707

Erectile Dysfunction

Can't find what you are looking for?
Use our site search facility...

Home I Search Site I Site map I Conditions I Symptoms I News Archive I Forum I Contact us I About us I Access Keys

All information published on this web site is for information purposes only. The content of this web site should not be used for a conclusive diagnosis or for choosing a treatment. The content on this site has been provided as a guideline and general information it is not intended to replace professional medical care. In all serious cases it is advisable to recieve attention from a qualified medical practitioner.