Erectile Dysfunction

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/

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.

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

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