Erectile Dysfunction
What is it?
Erectile dysfunction (ED) is the persistent or recurrent inability to achieve or maintain an erection sufficient for sexual activity. It is also sometimes known as 'impotence'. The cause of ED can either be psychological (depression, stress, relationship difficulties, etc) or physical (e.g. heart disease, diabetes) and is very common, affecting at least one in ten men. Some medications can also cause ED. In about 75% of cases of ED, the cause is physical, although most men with ED will have a combination of physical and psychological causes. The number of men with ED increases with age.
What are the symptoms?
If you have ED you will notice that you are either unable to get an erection in the first place, or you are able to get an erection but cannot keep it long enough to penetrate your partner or achieve climax. Some men are unable to get a desired erection for sexual activity, but notice that they still wake up with an erection.
How is it diagnosed?
As ED is a condition that is not usually detected as part of a routine medical examination, often the only way that the doctor will discover your problem is if you tell him. ED can be a complex medical condition with many possible causes, but it can be effectively treated. The type of treatment that will be most effective for you depends on the underlying cause of your ED, so your doctor will need to take a detailed history of the problem from you to try to get to the root of the problem. You should therefore be prepared for questions that may be of a very personal nature, concerning your sex life. The doctor will also conduct a physical examination, looking at your genitals, pulses, and your reflexes. Your blood sugar, cholesterol, blood pressure, hormonal levels and your nerves may all be tested to try and establish the underlying cause of your ED.
If your doctor is unsure of the cause of your ED, or does not have the necessary facilities to treat the condition at the surgery, you may be referred to a urologist. Further investigations may be carried out that measure the blood flow and pressure in your penis.
What is the treatment?
There are many different types of treatments for ED, and once the doctor has established the cause of your ED, these treatments will be discussed with you so that a decision can made on which treatment will be most suitable and effective for you.
Oral treatments
Usually this is the first line of treatment. A pill is taken up to an hour before you are planning on having sex. Often the erection will not simply ‘happen' after you take the pill, you will still need some form of sexual stimulation in order for the pill to work. Once you have got an erection, you should be able to have sex as normal, on that occasion. The next time you wish to have sex, you will have to take another pill, although there is one pill that works for 24 hours.
Vacuum constriction device
This is a mechanical way of getting an erection. You place your penis into an empty cylinder and then a pump removes the air from the cylinder creating a vacuum. This vacuum makes blood move into the penis, giving you an erection. To keep the erection once you take your penis out of the cylinder, a rubber ring is slipped around the base of your penis. This ring can stay on for up to 30 minutes, while you have sex.
Intracavernosal injection therapy
The patient or partner is taught to inject a special drug into the shaft of the penis when an erection is required. Erection usually automatically follows15 minutes after the injection.
Transurethral therapy
This is a needle-free form of the injection treatment. A small pellet of the drug is placed in the urethra using a special applicator. The drug is then absorbed through the wall of the urethra and an erection follows in five to ten minutes. This form of treatment has a lower success rate than the treatments above.
Hormone treatment
Only a small number of ED cases are caused by hormone problems. The most common hormone disturbance causing ED is low testosterone levels, which can be restored with testosterone replacement therapy.
Penile prosthesis
A penile prosthesis is when a rod is inserted into the penis so that an erection can be manually achieved. This is usually a last resort, if all other treatments have not worked. There are two types of rod. There is an inflatable one, where a small pump inflates a small bag in the penis to achieve an erection. Or there is a flexible, semi-rigid rod which means the penis is in a state of semi-rigidity at all times.
Surgical treatments
In a few isolated cases, surgery can be performed to correct abnormalities of blood vessels affecting blood flow.
Further information
Your local GP surgery is the best place for you to find information on ED, especially if you have specific concerns about your symptoms or treatment. Charities can also be useful sources of information and support.
Impotence Association http://www.impotence.org.uk/
