Treatments

Erectile Dysfunction

About Erectile Dysfunction (ED)

Erectile dysfunction is when a man is unable to gain or maintain an erection hard or for long enough to achieve satisfactory sex. Erectile dysfunction (ED) is common and can be very distressing, it is nothing to be ashamed or worried about. The likelihood of ED increases by 10% with each decade of age. In other words, 50% of men in their 50s are likely to experience mild or moderate impotence. Studies show that over 50% of men will experience erection problems in their lifetime. ED is due to the lack of blood flow to the penis, resulting in the inability to gain or maintain an erection, which can in some cases result in social and/or mental health issues such as anxiety, low self-esteem and relationship problems. All men that experience erectile dysfunction should inform their GP about it.

Overview

How does an erection work?

An erection occurs when there is increased blood flow to the penis, which happens during arousal. The increased blood flow causes the penis to become enlarged, elongated and firm.

When you are aroused, there is mental or sensory stimulation, which causes the muscles in the penis to relax. This allows blood flow into the penis, causing the penis to expand. An erection ends once the muscles in the penis contract, which causes the blood to be carried away from the penis, resulting in it becoming flaccid again.

Is erectile dysfunction the same as premature ejaculation?

No. Both are types of male sexual dysfunction but they are different things. Unlike erectile dysfunction, premature ejaculation allows for an erection to occur and you are able to maintain an erection, you just have an orgasm before a satisfactory duration. With ED you are unable to even gain or maintain an erection.

How can I treat erectile dysfunction?

There are different ED treatment options available such as natural/lifestyle treatments, counselling, vacuum constriction devices, surgery, male hormone replacement therapy and erectile dysfunction prescription medicines.

 

References:

https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/

https://cks.nice.org.uk/topics/erectile-dysfunction/

http://www.bssm.org.uk/wp-content/uploads/2018/09/BSSM-ED-guidelines-2018-1.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118395/

https://www.nhs.uk/medicines/sildenafil-viagra/

https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/

Causes

What causes erectile dysfunction?

Erectile dysfunction can be caused by psychological or physical problems or even a combination of both. The primary cause of erectile dysfunction is ageing, however this does not mean to say that you will not experience this if you are young as there are other causes too. 40% of men aged 60+ experience ED so if you are in this age bracket there is nothing to worry about, if you are younger you should speak to your GP in order to help identify a cause. There are various psychological and physical causes that can be investigated.

Psychological vs Physical causes of erectile dysfunction

If a young male is experiencing erectile dysfunction, in most cases the cause is psychological but a physical cause should not be ruled out, therefore it is important to speak to your GP in order to identify the cause. Older men experience ED at a higher rate than younger males, so if you are experiencing erectile dysfunction and you are above 60 years old, there is nothing to be alarmed about.

The psychological causes of impotence include:

-Stress or tiredness

-Anxiety or mental health issues

-The pressure to perform sexually

-The physical causes of impotence include:

-Smoking, alcohol and recreational drug use

-Side effects from prescribed medication

-High blood pressure or narrowing of blood vessels in the penis

-Hormonal problems

-Being overweight

-Stress, depression and anxiety

The risk of erectile dysfunction occurring is increased by stress and/or depression/anxiety. A delicate balance of hormones and nerve impulses are required to gain and maintain an erection. Stress and depression both disrupt this balance, resulting in ED.

Depression can be caused by ED too, similarly to anxiety, due to a decrease in confidence and feelings of inadequacy.

-Low testosterone levels

Testosterone levels naturally decrease as men get older, which can cause erectile dysfunction. If you believe you have low testosterone levels, consult your GP as they may offer you male hormone replacement therapy.

-Porn-induced erectile dysfunction

Studies have shown that the overconsumption of pornography in younger males is a psychological factor that has resulted in erectile dysfunction. This can be treated by reducing the use of pornography and seeking appropriate professional assistance.

-Drinking and smoking

Alcohol and nicotine (the addictive substance in cigarettes) both restrict the blood flow to the penis, therefore heavy episodes of smoking or drinking can induce erectile dysfunction. This can be treated by reducing the amount you smoke and/or drink. Both smoking and drinking also have long term effects on a man's sexual performance.

-High blood pressure

Untreated high blood pressure over a long period of time can damage your arteries causing them to narrow, which restricts blood flow to the penis, which can result in erectile dysfunction

However, high blood pressure medications can also cause erectile dysfunction. These medications reduce the intensity of blood flow to the penis, which may result in erectile dysfunction.

This is a frustrating situation for many men as not treating high blood pressure can cause erectile dysfunction but so can the medications that treat high blood pressure.

-Psoriasis

Psoriasis is a skin condition that causes flaky, silvery, itchy patches of skin, which commonly appear on the elbows, knees, scalp and back. Psoriasis has been linked to erectile dysfunction for the following reasons:

Psoriasis may appear on the penis

Psoriasis can lower self-esteem

Psoriasis is a risk factor for cardiovascular disease, which can lead to ED

There is currently no cure for psoriasis but soothing creams are available to relieve the symptoms.

Treatments

Natural/Lifestyle treatment

High blood pressure and high cholesterol are known risk factors of ED as they cause vessels to narrow, resulting in restricted blood flow, which causes ED. The most effective treatment for this is to prevent it in the first place. This can be done by making healthy lifestyle choices such as eating healthy and exercising.

A healthy diet - plenty of fruit, vegetables, whole grain foods, low fat meats and fish.

Exercising - at least 30 minutes of moderate intensity activity at least 5 times a week.

Alcohol - reduce alcohol intake to prevent not only short term ED but also long term ED, studies have shown impotence may persist with long term alcohol use.

Smoking - avoid or reduce the amount you smoke, smoking can clog your arteries restricting blood flow and nicotine can also restrict your blood vessels, resulting in ED.

Communication - whether that be with your partner, a doctor or in counselling. Good communication is one of the first steps in recovering from psychologically-induced erectile dysfunction.

Stress - trying to manage stress levels (e.g. by meditation or baths) has shown to reduce symptoms of ED and increase males’ sex drive.

Counselling

Erectile dysfunction can be frustrating and distressing, it can lead to a number of other problems such as anxiety, depression, low self esteem, low confidence levels and relationship difficulties. Counselling has been shown to be effective when used in combination with prescription medication.

Vacuum constriction devices

VCDs, also known as penis pumps work by creating a vacuum that draws blood into the penis, which causes it to swell and become erect. You should seek medical advice before using VCDs as use comes with risks and there is no solid clinical evidence that the treatment is effective.

Surgery

Surgery is often the last resort for when other treatment options have been unsuccessful. Penile implants may also help with ED, however these are only available privately, not on the NHS.

Testosterone replacement therapy (TRT)

As men get older, their testosterone levels decrease, which can result in ED. If you notice a change in your sex drive you should speak to your GP about getting your testosterone levels checked. If they are too low you may be eligible for testosterone replacement therapy.

Prescription medicines

Oral erectile dysfunction tablets are the most popular treatment. They have been proven to be effective against physiologically induced erectile dysfunctions. These may be used for short term or long term treatment. Examples include Viagra (sildenafil), Cialis (tadalafil), Daily Tablet Tadalafil and Levitra (vardenafil). The examples given all come under a drug class called PDE5 inhibitors, which work by increasing blood flow to the penis. It is important to note that taking these medications alone will not achieve an erection, to achieve an erection after taking these tablets, sexual stimulation and arousal is still required.

Symptoms

Symptoms

The main symptom of erectile dysfunction is the inability of a man to get or maintain an erection.

FAQ

  • Do I have erectile dysfunction because I am old?

    Erectile dysfunction is more common in older men, particularly aged 40 or above. This is because older men usually have pre-existing conditions such as high blood pressure, diabetes, high cholesterol and obesity, which all contribute to erectile dysfunction. The older you get, the lower your testosterone levels become as well, which also contributes to erectile dysfunction.

  • Can being tired cause erectile dysfunction?

    Yes. When you are tired you have a decreased sex drive (libido), so it is harder to gain and maintain an erection. This also happens when you are lacking in fitness.

  • Can masturbating cause erectile dysfunction?

    If you are masturbating several times in a short period of time, then yes you may experience difficulties in getting and maintaining an erection.

  • Can cycling cause erectile dysfunction?

    Excessive cycling can indeed cause erectile dysfunction, especially if your seat is applying pressure to your testicles. This applies pressure to the nerves in the bottom of your penis, which contributes to erectile dysfunction. The same thing can occur if you wear excessively tight clothing for long periods of time consistently.

  • How can I treat erectile dysfunction?

    This is dependent on the cause of ED, so it is very important to consult your GP to identify the cause. Once the cause is known, it is easier to suggest a treatment plan. Treatment options include medicine and lifestyle changes.

  • Is erectile dysfunction reversible?

    This depends on the cause of erectile dysfunction. If it is due to underlying medical problems, it is often quite difficult to completely reverse the erectile dysfunction, however there are many treatment options available to help live with the condition.

    Some causes are reversible such as excessive drinking and smoking, excessive cycling and excessive masturbation.

  • Can taking vitamins help my erectile dysfunction?

    Vitamins should not be used as the main treatment for erectile dysfunction as there is not much evidence for it. However, vitamin C, vitamin E and vitamin B complex are believed to assist in men suffering with ED. Vitamin C and vitamin B complex are thought to help with blood flow and vitamin E is thought to help with producing testosterone, which may lead to improvement of ED.

  • Which drug is best for erectile dysfunction?

    All erectile dysfunction drugs work in the same way, but they have slightly different properties. Different drugs work differently for everyone, so individuals will have different preferences. First line treatment in most cases is sildenafil, which is also the active ingredient in Viagra. Another popular drug is Tadalafil for erectile dysfunction, which is the active ingredient in Cialis.

  • Can I take Viagra if I have diabetes or cardiovascular disease?

    Yes. It should not be a problem to take Viagra or any other ED treatments if you have diabetes or cardiovascular problems. You must check that any of your current medications do not interact with the ED treatment that you would like to buy. Our online consultation will guide you through checking if any of your current medications interact with the ED treatment, you must be sure to answer all questions honestly.

  • Will just taking my ED tablet give me an erection?

    No. Sexual stimulation is required for these tablets to work. You will not get an erection just from taking the tablet.

  • What are the benefits of treating erectile dysfunction?

    Treating ED will not only improve your life in the bedroom, but it may improve your life overall. It may improve your self-esteem, boost your confidence, increase your blood flow and circulation and it may even inspire you to live a healthier lifestyle.

  • Can I prevent myself from getting erectile dysfunction?

    You may not be able to prevent it completely as one reason males may experience ED is due to ageing, which is not preventable. However, there are many things you can do to lower your risk of getting ED. This includes:

    -Drinking less alcohol

    -Quitting smoking

    -Remain sexually active to promote body positivity

    -Keep your fitness levels high

    -Eat a balanced and healthy diet

  • What should I do if my erectile dysfunction symptoms persist?

    Do not suffer in silence, it is important to discuss the matter with your partner and your doctor for emotional and professional support. It is nothing to be ashamed about and it is a common condition. Speaking to a doctor may help identify the underlying cause, which will then make it easier to treat the symptoms.

  • Can I take ED tablets after having a stroke?

    Yes you can but you should wait at least 3 months after your stroke before starting treatment again.

  • Are there any herbal remedies that treat erectile dysfunction?

    There have been suggestions of some herbal remedies that may help with ED, however there is no solid clinical evidence that these work.

  • Does having ED mean that there is something wrong with my health?

    In many cases of ED, the underlying cause is nothing to worry about. However, it is extremely important to identify the cause of your ED by speaking to your doctor in order to rule out serious health issues.

  • What dose of ED medication should I take?

    It is advised that you start off at the lowest dose available and see how well that works. Take a stronger dose the next time if the starting dose was insufficient.

  • Can I split my tablet to save money?

    This is not recommended by the manufacturer but it is commonly done. Bear in mind that splitting a pill will also half your dose.

  • Do ED tablets always work?

    ED Pills do work in most men. However if the penile nerves are damaged or blood circulation is restricted, the tablets may not always work. Men with low testosterone levels may also be resistant to tablet treatment. If one tablet does not work it is worth trying a different drug. If your symptoms persist you should consult your GP.

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