Erectile dysfunction – What can you do about it?

What is erectile dysfunction?

Erectile dysfunction, also known as impotence, is defined as the inability to get or keep an erection, meaning that you are unable to have sexual intercourse. Sometimes, your penis may become partly erect or it may not get hard at all. Erectile dysfunction is a common problem, with 10% of men experiencing it at some point in their lives. Men aged over 40 are particularly affected, as are those who suffer from diabetes.

What causes erectile dysfunction?

An erection normally occurs following arousal when your brain sends signals to the penis. These signals are carried by nerves and they trigger the relaxation of smooth muscle, which allows the penis to fill with blood and become swollen. As it fills, the veins are compressed, preventing blood from leaving the penis and sustaining your erection.

For your penis to work properly, you must have adequate levels of hormones, a sexual desire, sufficient blood supply and intact nerves that supply it. If you have a problem with any of these mechanisms, it can result in erectile dysfunction.

The causes of erectile dysfunction can be grouped into physical and psychological causes. Physical causes account for up to 80% of cases and include the following:

Blood vessel disease – 

This reduces blood flow to the penis and prevents an erection. It is the most common cause of erectile dysfunction and can be due to high blood pressure, smoking, high cholesterol or diabetes

Nerve damage –

Loss of sensation or an interrupted nerve supply from the brain to the penis can be to blame. Parkinson’s disease, a stroke, diabetes or multiple sclerosis can all cause nerve damage. Spinal surgery, pelvic surgery or an injury to your spine can occasionally injure the nerves supplying your penis as well

Hormone imbalance –

Reduced levels of testosterone can lead to erectile dysfunction, although this is not very common

Medications –

Erectile dysfunction can be a side effect of antidepressants and drugs for high blood pressure. You should continue to take your medications until you speak to your doctor if you think this may be the cause

Alcohol, smoking and recreational drugs –

These all increase the risk of suffering erectile dysfunction

Psychological problems can also have an impact on your ability to get an erection. Stress, anxiety, depression and relationship difficulties can all cause erectile dysfunction. This can all be made worse by feelings of guilt or embarrassment if you are unable to get an erection, known as performance anxiety. If you notice that sometimes you are able to get a full erection and at other times you cannot, then psychological issues are likely to be a factor.

What can I do about it?

Many men feel reluctant to discuss erectile dysfunction with their partner or a doctor, but it is important that you do so as it will enable you to get the right treatment. Your doctor may perform some tests to check your cholesterol, blood sugar and hormone levels to help identify the cause and treat it if necessary. If these are not found to be the cause of your erectile dysfunction, then other investigations and treatment options are available.

Can erectile dysfunction be treated?

There are a number of options for treating erectile dysfunction, depending on whether the cause is physical or psychological.

Lifestyle changes

As mentioned earlier, erectile dysfunction can be caused by high levels of cholesterol, high blood pressure or raised blood sugars. Switching to a healthier diet and trying to increase your levels of exercise can have a positive impact on these and may help you to regain your ability to get an erection. Quitting smoking and cutting down on alcohol are also likely to be beneficial.

Medications

A commonly used tablet, called sildenafil (Viagra), is often successful at helping you to achieve an erection. These medications commonly work by dilating the blood vessels in your penis and can be taken just before sexual intercourse. You should check with your doctor that it is safe for you to take them, as there are some people for whom these are not safe

Alternatively, medication in the form of a cream can be applied to the tip of your penis. An injection to the base of the penis is also available, and you can be taught how to do this for yourself. These methods work in the same way as the tablet. Although medications are quite successful, they do not work for everyone.
In the rare instance that you find that your erection does not go down four hours after using one of the above medications, you may need to have it reversed in hospital.

If you are found to have low levels of testosterone, hormone replacement may be recommended to correct the imbalance, although this may not necessarily restore your ability to get an erection.

Devices

Vacuum pumps are a non-invasive method of achieving an erection and can be used as an alternative when medication isn’t suitable. They work by inserting your penis into a cylindrical tube and creating negative pressure with a pump to encourage blood flow to your penis.

If all other treatments have failed, then penile implants are an option. This involves surgically placing a device into your penis that allows you to achieve an erection.

Counselling

If a psychological issue is contributing to your erectile dysfunction, there are various options for counselling and therapy. Cognitive behavioural therapy can be used to treat anxiety and depression. Sex therapy or couple counselling can also be useful for helping you to regain your erectile function.

Summary

Erectile dysfunction is a problem commonly experienced by men, especially those of older age. It can be due to physical or psychological factors, and it is quite often a combination of both. Erectile dysfunction can feel embarrassing to talk about, but if you speak your doctor they will be able to help you address the problem. A variety of effective treatment options are available, and they are often successful at helping you restore your sexual function and regain your confidence