Erectile Dysfunction Treatment

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The outlook for men with erectile dysfunction (ED) has improved enormously in the last few years – so much so that almost all the patients whom we see nowadays can be assured of a return to successful intercourse. Many of these males feel that the new treatments for erection difficulty (formerly known as ‘impotence’ or ‘impotency’) have completely transformed their lives.

What is erectile dysfunction?

Term watch

Many people confuse erectile dysfunction with:
premature ejaculation which is 'coming too quickly'.
retarded ejaculation (delayed ejaculation) which is an inability of the man to reach a climax.

First, let’s define the problem. ED means inability to get a good enough erection to achieve satisfactory intercourse.

Some sufferers can’t get a ‘hard-on’ at all; others get one but it isn’t firm enough to penetrate the partner; and others can manage penetration for a bit – but then lose it.

Why does ED occur?

ED is very common, and it occurs for a variety of reasons and at different ages.

Teenagers and young men

In younger males, the commonest cause is anxiety – particularly nervousness about having sex, about causing a pregnancy, or about using a condom. (A lot of people in this age group complain that they ‘can’t get on with a condom’ – because as soon as they try to put it on, they lose their ‘stiffy'.)

Middle age

Common causes in this age group are overwork, stress, bereavement (ED often happens when a widowed man tries to form a new sexual relationship), and guilt. A few cases are due to diabetes.

Post-middle age

In this group of men, ED gets commoner with increasing age. (Nonetheless, 70 per cent of all 70-year-olds are sexually potent.)

It is now clear that in a very high proportion of cases, the problem is due to deterioration in the blood vessels that carry blood into the penis.

You may be surprised to see that I have not listed ‘lack of hormones’ as a common cause of ED. In fact, lack of male hormone is pretty rare. If you are tempted to go to one of the many private clinics which make a habit of diagnosing ‘male hormone deficiency', and then charging huge sums of money for testosterone treatment …we suggest you think twice!

What is an erection?

An erection (a ‘hard-on’ or ‘stiffy’) occurs when blood is pumped into the penis and stays there – making it hard. It generally happens because a guy is thinking about sex, or because his penis is being stimulated – or both.

The result is that signals go down the nerves which lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to ‘open up'. So blood flows in – and the organ ‘blows up’ like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again – a least, until sex is over.

So you can see that getting an erection is is a very complex process. It’s awfully easy for various factors to interfere with it - for instance, worry, tiredness, too much alcohol, or (in later life) narrowing of the blood vessels.

Very importantly, nicotine is now known to narrow those vital blood vessels – which is why ED is much commoner in smokers.

But often, there is nothing physically wrong with men who develop ED.

So are a lot of cases of ED due to psychological causes?

Yes – particularly in the young. In general, erectile dysfunction is quite likely to be psychological, rather than physical, if the man:

is still waking with ‘morning erections'.

can still get a good erection by masturbation.

Common psychological causes of erection difficulties include:

nerves - especially about ‘performing'.

guilt – notably if you’re trying to have sex with somebody else’s wife.

relationship problems - especially if you’re no longer keen on your partner.

latent gayness – for instance, if you’re a basically gay guy, trying to have sex with a woman.

depression.

exhaustion.

But in a lot of cases, ED turns out to be due to a mixture of psychological and physical causes.

What physical causes are there?

Common physical causes include:

deterioration of the arteries – this is a physical change which is common in older men, including those with high blood pressure.

diabetes .

smoking (see above).

excessive drinking (hence the phrase ‘Brewer’s droop’).

being obese and out-of-condition.

side-effects of certain drugs, notably ones for blood pressure and depression.

effects of ‘recreational’ drugs, like cocaine.

Less common physical causes include:

excessive drainage of blood from the penis (‘venous leak’).

diseases of the nervous system.

injury to the spinal cord.

major surgery in the abdomen – particularly prostate operations.

hormone problems – including excess production of a pituitary hormone called ‘prolactin'.

What should a man do if he has potency problems?

If you have difficulty getting an erection, seek help. Don’t suffer in silence – as so many men do!

Also, don’t hide it from your partner. A lot of guys behave like this, and very often the result is that the other person decides that she is being scorned, or that ‘he doesn’t love me any more'.

Your first move should be to consult your GP.

If for any reason you don’t want to do that, then contact some other medical/relationships agency, such as the ones listed at the end of this article.

Please don’t do daft things like:

buying yourself some pills and potion off the Internet.

signing up with some clinic that asks you for £1,000 deposit.

going to a prostitute to see if she can cure you.

deciding that your life is over (it isn’t).

What happens when you see a doctor or therapist?

If you go to a doctor, he should take a full ‘history’ of your problem, and then examine you to see if there are any physical causes for your ED. (Please note that a therapist or counsellor isn’t able to do physical examinations – nor can they prescribe drugs.)

He should also do a test for diabetes – and possibly other lab tests as well.

After that, he may well be able to give you some indication of the likely causes (or causes) of your ED. If he can’t, then ask if can refer you to someone who can give you further help.

Once the cause(s) of your erectile dysfunction has been identified, then you can get treatment.

What treatments are now available?

Obviously, treatment depends on the cause of the ED. For instance, psychological causes may require:

commonsense advice to one or both partners.

counselling

psychotherapy

relationship counselling.

Personally, I feel that in some cases of psychologically-induced ED, it’s worth trying the effect of erection-inducing drugs – to help ‘kick-start’ the man back into action, and boost his confidence. Not all doctors agree with me.

Treatments for ED which is of physical origin are listed below.

Erection-inducing drugs

Oral drugs which induce erection have absolutely revolutionised the treatment of ED over the last seven years. They don’t work for everybody, but they do work for the majority – even in diabetes. They can also help people with neurological and spinal problems.

Also, the increasing choice of available drugs means that if one particular drug doesn’t suit you, it’s well worth trying one of the others.

As of 2005, there are four orally-administered drugs available in the UK. Most important: please note that they all have side-effects, only a few of which we can list here. For more information, read the package insert leaflet, and if in doubt ask your doctor.

Also, it is not safe for some people to use these drugs. Furthermore, some medications interact dangerously with them. Therefore, before going on any of these pills you should always see a doctor, talk things over with him, and have a physical check-up.

Do not buy erection drugs by mail-order, or from chaps you meet in pubs!

The oral drugs currently available are:

Cialis tablets (tadalafil)

Levitra tablets (vardenafil)

Uprima sublingual tablets (apomorphine)

Viagra tablets (sildenafil).

Cialis (tadalafil)

Works in the same way as Viagra. Now popular with a lot of men, because its effects last so long – at least 12 hours in most cases. Manufacturers claim it is not ‘blocked’ by food.

Side-effects similar to those of Viagra, but also causes back pain and muscle pain. Interactions with other drugs and with grapefruit juice are similar to those of Viagra, but also clashes with the antibiotic clarithromycin and the sedative phenobarbitone.

Levitra (vardenafil)

Works in same way. Side-effects and interactions are similar to those of Viagra. Not as long-lasting as Cialis.

Uprima (apomorphine)

Different from the other three pills, as it works on nerve centres in the brain. Also, you dissolve it in your mouth, rather than swallowing it. If successful, it will take effect within about 20 minutes. Common side-effects include nausea, yawning, headache, dizziness, taste disturbance and sleepiness. Interacts with heart and BP drugs, among others. Avoid alcohol.

Viagra (sildenafil)

Widens the bloods vessels, so giving an erection - provided the penis is rubbed. In most men, works within an hour. Effect lasts for about four hours. Easily ‘blocked’ by food in the stomach.

Commonest side-effects are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. Viagra is very dangerous with certain heart drugs. Interacts with many medications. Do not drink grapefruit juice on day of use.

At the beginning of April 2005, a report from the University of Minnesota suggested that a small group of men have suffered blindness as a result of Viagra use. It claimed that the drug may rarely cause a serious eye condition called ‘non-arteritic ischaemic optic atrophy.’ If you are taking Viagra, you should ask your doctor to keep you informed of any further research on this development.

What other drug treatments for ED are there?

It’s also possible to give erection-inducing agents by:

injections into the penis.

pellets inserted down the urinary pipe.

These methods have become less popular since the increasing availability of oral drugs, but they suit a minority of men. You have to be quite brave to give yourself a jab in the penis. For details of side-effects, consult your practitioner.

What mechanical aids are there for ED?

There are a number of devices which can help men to achieve a better erection and to have successful sex.

Vacuum pumps.

A pump is a cylinder which you put over your penis. You then pump out the air. That should ‘suck’ your penis into an erection – which, however, tends to be a bit cold and blue-looking.

Rings

Specially-designed rings which fit round the base of the male organ are often used with vacuum pumps. However, they can be tried on their own. The idea is that the ring helps stop the blood from flowing out of the penis.

External splints

These are supposed to prop the penis up during sex. Not awfully successful, in my view.

Vibrators

Although vibrators aren’t often prescribed by doctors (and certainly not on the National Health), I have found that they can be quite useful in urging a lethargic penis into life. Some vibrating devices (such as the Penisator) actually clip round the male organ.

What about surgery?

Back in the 1990s, there was great hope that surgery would cure a lot of men who had ED. Unfortunately, it hasn’t worked out like that, and it is fairly rare to see a man whose erection problems have been put right by a surgical operation. The types of surgery which are available for ED are:

Curing a venous leak. As we’ve indicated above, a few men lose their erections because blood leaks out of the penis through a leakage in the veins. Occasionally, this leak only occurs in certain sex positions. Where a leak can be clearly pin-pointed by special x-rays, a urologist (urological surgeon) may be able to operate in order to improve matters.

Insertion of internal splints. A skilled urologist can insert artificial splints inside the body of the penis. With the simplest type of splint (which is just a firm rod), the man merely lifts the organ into a vertical position when he wants to have intercourse. There are more sophisticated (and much more expensive) internal splints which you or your partner can inflate when you wish to make love. Some couples report being very pleased with these. But if anything goes wrong with the surgery – for instance, infection or bleeding – you could be in some trouble.

Summing up

Erectile dysfunction is usually treatable these days. However, it’s important to first establish what the cause is.

Very often, there are several causes, including both physical and psychological factors.

Commonsense measures will often help – for instance, cutting down on stress, alcohol or smoking, getting more sleep, or stopping any medications which interfere with erection. Your GP can assist you in these areas.

But where expert help is needed, you can find it – if you try hard enough!

Further help

The following can be helpful in various ways to ED sufferers and their partners:

The Sexual Dysfunction Association (formerly The Impotence Association) Tel: 0870 7743571.

Institute of Psychosexual Medicine Tel: 020 7580 0631. Website: www.ipm.org.uk.

Family Planning Association (fpa)/Sexual Health Direct Tel: 0845 310 1334.

Brook Advisory Centres For Young People Tel: 08000 185 023. Website: http://www.brook.org.uk.

Relate Tel:01788 573 241.

Couple Counselling Scotland Tel: 0131 55 61 52 7. Website: www.couplecounselling.org

British Association for Sexual and Relationship Therapy (BASRT) Tel:020 8543 2707.

Erectile Dysfunction

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