Erectile Dysfunction

Inability to achieve or sustain an erection

  • More common with increasing age
  • Smoking, alcohol, stress, and the use of certain drugs are risk factors
  • Genetics is not a significant factor

Most men experience temporary difficulty in achieving or maintaining an erection at some time in their lives. Such occasional erectile dysfunction is normal. Persistent, long-term difficulty in achieving an erection may indicate a physical cause and should prompt you to seek medical advice. Erectile dysfunction over a long period often results in distress for both the individual and his partner. Despite this, only 1 in 10 men who has the condition seeks medical advice.

What are the causes?

Erectile dysfunction can be due to a physical or a psychological disorder and in many cases may be a combination of the two. Anxiety disorders and depression can lead to erectile dysfunction, and may themselves be a reflection of stress in a man’s life, a relationship difficulty, or fear of sexual failure. The condition may also be a side effect of drugs, including certain antidepressants and antihypertensives. The risk of erectile dysfunction can be increased by factors such as tiredness, heavy drinking, and smoking.

The condition is more common in middle-aged and elderly men and often has a physical cause. The most common cause is a vascular disease, such as atherosclerosis, that reduces the blood supply to the penis. Occasionally, the blood supply may be reduced as a result of pelvic injury. Erectile dysfunction can also result if the nerves supplying the penis are damaged due to surgery, such as operations on the prostate gland (see Partial prostatectomy, and Radical prostatectomy), or to conditions such as multiple sclerosis or diabetes mellitus. Rarely, it is due to low levels of the sex hormone testosterone.

Episodes of sudden and intermittent erectile dysfunction usually have a psychological cause. Erectile dysfunction that develops gradually and is persistent or progressive is primarily due to physical causes.

What might be done?

If you have persistent problems with erectile dysfunction, you should consult your doctor. He or she will ask if you have full morning erections. If you do, it is more likely that your erectile dysfunction has a psychological cause. Your doctor will also ask about your lifestyle and about any medication that you use to see if there are factors contributing to your problem that can be altered.

The doctor may give you a physical examination and may take a blood sample to check for diabetes mellitus and to measure your testosterone level. You may also be referred to a specialist for Doppler ultrasound scanning to assess the blood flow to your penis.

If the blood vessels to the penis are damaged by pelvic injury, surgery may restore normal blood flow and allow you to achieve an erection. Your doctor may change your medication if drug treatment is a likely cause. If you have diabetes, your doctor should make sure that it is well controlled to prevent further nerve damage.

In addition, if your doctor suspects that an aspect of your lifestyle is causing your condition, he or she may suggest changes that you can make, such as reducing stress or your alcohol intake.

If the erectile dysfunction appears to have a psychological basis or if you have difficulties in your relationship, your doctor may suggest that you and your partner consult a sex therapist or a counsellor (see Sex therapy).

In cases where the underlying cause cannot be treated, a range of drug treatments and physical aids is available.

Drug treatments

The oral medications sildenafil, tadalafil, and vardenafil have proved effective in treating erectile dysfunction in many men. These drugs relax the muscles of the penis and the walls of the arteries that supply blood to the penis. More blood then flows into the penis and an erection can occur more easily. A medical assessment is needed before taking these drugs as they may cause serious side effects in some men and may also interact with other drugs.

The drug alprostadil may also help you to achieve an erection. This drug can be inserted into the urethra (the tube through which urine and semen leave the body). Alternatively, the drug is injected directly into the penis. However, alprostadil can sometimes have serious side effects. For the small number of men with low testosterone levels, testosterone injections may be effective.

Physical treatments

There are many physical aids that can help you to achieve and maintain an erection. The vacuum constriction device consists of a cylinder that is fitted over the penis. A hand-held pump is used to create a vacuum in the cylinder, causing the penis to fill with blood and become erect. The cylinder is then removed and the erection is maintained by a special rubber band fitted on the base of the penis.

An alternative is a penile prosthesis, which is surgically implanted into the penis. One type consists of paired rods that enable the position of the penis to be adjusted manually. However, once the rods are implanted, the size of the penis cannot be altered. Another device is the inflatable penile implant, which consists of paired cylinders and a small pump. The pump can be triggered to inflate the cylinders, which then hold the penis erect. When not in use, this implant enables the erection to subside.

The outlook for the condition is good. In many men, the cause can be treated, but if this is not treatable, drugs and physical aids are usually effective.

Self-Help: Communicating your Sexual Needs

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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