Erectile dysfunction (or impotence) is quite common with about 15% of patients over the age of 50 experiencing occasional or regular inability to get or maintain an erection.
Erectile dysfunction FAQs
What do you need to create a normal erection?
The correct social and psychological setting is essential. There needs to be adequate blood flowing into the penis but also a mechanism that prevents blood from leaving. This whole process is controlled by a network of very fine nerves and testosterone (the male hormone) is also very important.
What are the causes of erectile dysfunction?
It doesn’t take much to inhibit sexual activity and sometimes even a small amount of anxiety about relationships, jobs, money and health can affect performance.
Insufficient blood flow
This is a common problem particularly in smokers where the blood vessels narrow through a condition called atherosclerosis. It is also common in diabetics.
It is veins that drain the blood away from the penis. Normally there is a mechanism that shuts them down to allow the blood to accumulate in the penis. This can sometimes be deficient so the pressure in the penis can't increase enough for a good erection.
Abnormal nerve function
There are many diseases that affect the way nerves work. Again, a common one is diabetes but patients with multiple sclerosis, spinal cord injuries and a host of other conditions can be affected. Without the nerves to control the blood vessels in the penis, erections are absent or deficient.
Lack of testosterone will prevent erections. There are many causes for this. Testosterone is produced in the testes but is controlled by hormones produced from a gland under the brain called the pituitary. Diseases or tumours of the pituitary can upset the testosterone drive. Low hormone levels can make you feel tired and less energetic. The sex drive (libido) may be reduced so that you have less interest in sex than you used to. The erections are commonly affected, but replacing the testosterone usually helps to put things back to normal.
How is erectile dysfunction diagnosed?
Finding the cause for erection problems can be very difficult and indeed the psychological causes may not be obvious. Often these are subconscious or just simply that you don’t want to even consider it as an issue.
What tests do I need for impotence?
Questionnaires such as the IIEF-5 can help to establish the main problems with your erections. If you are worried you should consult your doctor who will perform a full examination. They will check your urine and blood to see if you have become diabetic and will measure the testosterone in your blood. If this is low you may need to be investigated by a specialist in hormones.
Sometimes, problems with erections can be a sign of other underlying medical problems, and your specialist will be able to organise all the necessary health checks to look for these. Erectile dysfunction can be associated with:
- heart problems
- blood pressure
- metabolic syndrome
- male menopause
How is erectile dysfunction treated
Is there anything I can do to help myself?
Addressing all the stresses in your life and altering your lifestyle may help. You should give up cigarette smoking. There are many herbal remedies that claim significant results but for many there is no scientific evidence of effectiveness.
What else can be done?
Your GP may recommend that you try some anti-depressant drugs. They can be extremely effective. Professional psychosexual counselling is usually available through your GP. You will meet your professional counsellor who will talk through and explore any problems that you have. It is quite a lengthy process and may require quite a few hours of visits.
Testosterone treatment and impotence
If the testosterone is low, then a cause will have been detected. If this can be alleviated, then your natural testosterone levels may rise and your erections will improve. If not, then you can have testosterone replacement therpay and this is given either as a gel that you smear on your body or regular injections. Erection problems and poor libido are common in men with low testosterone levels. Other symptoms include tiredness, low energy and poor concentration. Hormone supplements may be helpful.
Medication for erections
Oral medication with Sildenafil (Viagra), Tadalafil (Cialis) and Vardenafil (Levitra) can be very effective for all types of impotence. They vary slightly in the rapidity of onset of effect and its duration, but usually they are taken 15-60 minutes before sexual intercourse is planned. Most men with impotence find that Viagra can improve the strength and duration of their erections. They work best in patients who have malfunction of nerves and least well in patients where there is reduction in blood flow. It is recommended that you try on six occasions as the medication is not always effective straight away. Rather than taking the tablet every time you want to have intercourse, some doctors recommend that you take a tablet each day or every other day.
There are restrictions to Health Service prescription for these drugs which your doctor will discuss with you. If you can’t have them on the Health Service your doctor will provide a private prescription for you.
There are some special drugs that can be injected directly into the side of the penis that stimulate blood flow and produce an erection. Your doctor can show you how to do this. There can be side effects with bruising and occasionally the erection lasts too long. If it is more than 4 hours you will need to seek help to stop the erection, otherwise it can damage the inside of the penis. Your doctor will have given you instructions about this. The same prescribing restrictions apply as for oral medication.
Other treatments for impotence
Vacuum pumps are cylinders that fit over the penis. The air is pumped out, which should draw blood into the penis and produce an erection. To maintain the blood when the cylinder is removed a band has to be placed at the base of the penis. This produces a lasting erection.
Vacuum pumps are usually very effective at creating a strong and lasting erection, but some patients find them off-putting because of the mechanical nature of the device. They are available on a Health Service prescription.
Penile implants can be inserted into the penis to provide a permanent but bendable erection. Other types of implant can be pumped up to produce an erection when it is needed. This is sometimes complicated surgery and there may be problems in your area with obtaining funding for inflatable prostheses on the Health Service.