Erectile dysfunction

Erectile dysfunction or ‘ED’ is also known as impotence. It means you can’t get an erection, or keep one for long enough to have sex.

Erectile dysfunction can cause a lot of stress and worry, which can have a big impact on your emotional and mental health. It can put a strain on relationships too. Many men feel embarrassed, ashamed or low about themselves.

But actually, it’s very common, especially in older men. Erectile dysfunction is thought to affect around half of men aged 40 to 70 to some degree. Lots of younger men get it too. It can often be a sign of other health conditions, like cardiovascular disease and diabetes. So it’s important that you seek help.

Erectile dysfunction can mean you either:

• Are unable to get an erection
• Are unable to keep an erection long enough to have sex

You may find these difficulties only affect you at certain times or in certain situations. For example, you might only have trouble getting an erection when you’re having sex or with a partner, but still have early-morning erections. Or you may find you can’t get an erection at any time.

You may also find it hard to get aroused and have a low sex drive.

Depending on the cause, your symptoms may have started suddenly, or they may have come on gradually.

There are lots of different causes of erectile dysfunction. These can be physical or psychological, or you may have a mixture of both.

Physical causes may include:

• Cardiovascular disease, including high blood pressure, high cholesterol and peripheral arterial diseases
• Conditions that affect your nerves, such as Parkinson’s disease, stroke and multiple sclerosis
• Diabetes, which can damage nerves and blood vessels
• Hormonal problems
• Damage from surgery or radiotherapy in your pelvis
• Anatomical abnormalities affecting your penis

Psychological cause can include:

• Feeling stressed or anxious
• Having relationship problems
• Not feeling aroused
• Depression, or other mental health problems

Certain medicines may also cause erectile dysfunction. These include antidepressants, diuretics and medicines for high blood pressure.

Lifestyle factors, like obesity and smoking can also contribute to erectile dysfunction.

Cardiovascular disease and erectile dysfunction

Cardiovascular disease is the most common underlying reason for erectile dysfunction. With cardiovascular disease, you get a build-up of fatty deposits in your arteries, called atherosclerosis. This can lead to your arteries becoming blocked.

If the blocked blood vessels are carrying blood to you penis, it can cause difficulties getting an erection. The same process can affect the blood vessels supplying your heart. This can cause problems like heart disease and stroke.

Because of the close links between the two, erectile dysfunction can often be an early sign of heart disease. Your doctor will discuss this with you. They may suggest that you see a specialist in heart disease for further assessment.

All men may have erection problems from time to time. But if you’re experiencing erectile dysfunction symptoms regularly, get it checked out with a doctor. As well as helping to address sexual problems, it’s important for your doctor to check for related problems, like cardiovascular disease and diabetes.

Your consultant will talk to you about your symptoms, medical history, lifestyle and sexual relationships. They may ask you to complete a questionnaire too, to find out more about the difficulties you’re having. We know it can feel awkward or embarrassing talking to a doctor about these things. But erectile dysfunction is a very common problem. Your consultant will have seen men with this problem many times before.

As part of their assessment, your consultant may also:

• Check your blood pressure, heart rate, weight and waist measurements
• Examine your genitals for signs of abnormalities
• Suggest a digital rectal examination to feel inside your back passage, if you have signs of prostate problems
• Arrange blood tests to check for diabetes, high cholesterol, and hormone levels

Most men won’t need any further assessment or investigations. But there are more specialist tests that can help to diagnose the cause of erectile dysfunction. Your consultant will advise you if they think these would help.

There are several different effective treatments for erectile dysfunction. Your consultant will advise what options are best for you. This will depend on what’s causing your erectile dysfunction. They may include one or more of the following.

Lifestyle changes

Making some lifestyle changes can help with erectile dysfunction. Your consultant may suggest the following:

• Losing weight if you need to
• Getting regular exercise
• Giving up smoking
• Reducing your alcohol intake

Medication

If you have diabetes, high blood pressure or high cholesterol, it’s important to take any prescribed medicines for these.

Your consultant may also review any medication you’re currently taking that may have caused erectile dysfunction.

Your doctor may prescribe medicines that can help with erectile dysfunction. These include:

• Sildenafil (Viagra)
• Tadalafil (Cialis)
• Vardenafil (Levitra)
• Avanafil (Spedra)

These medicines work by increasing blood flow to your penis. But you still need sexual stimulation to get an erection.

If your erectile dysfunction is due to a hormone problem, you will need to see a specialist in hormonal problems for treatment.

Psychological support

If your erectile dysfunction is lined to psychological problems, your doctor may suggest some psychological support. Counselling, psychotherapy and sex therapy may help.

Specialist treatments

If other treatments haven’t worked, you may need to see a urology specialist. They may be able to offer more specialist treatments. These may include the following.

• Vacuum erection devices – you use these to suck blood into your penis and encourage an erection
• Injections into your penis – you self-administer these to produce an erection
• Medicated urethral system for erection (MUSE) – you insert a medicated pellet into your urethra (the tube that carries urine out of your body), to encourage blood flow to your penis
• Vascular surgery – to reconstruct blocked arteries supplying your pelvis or penis
• Penile prostheses (implants) – surgery to fit a prosthesis into your penis

Your specialist can help you decide what’s right for you.