FAQs Erectile Dysfunction

Erectile dysfunction (ED), or impotence, means that you cannot get and/or maintain a proper erection. There are various causes, but in most cases ED is due to narrowing of the arteries that take blood to the penis. For some ED sufferers the penis becomes partly erect, but not hard enough to have sex properly. In other cases, there is no swelling or fullness of the penis at all.

Most men have occasional times when they cannot get an erection, especially when tired, stressed, distracted, or have drunk too much alcohol. For most men it is only temporary, and an erection occurs most times when you are sexually aroused.

Persistent or recurring erectile dysfunction can occur at any age, but becomes more common with increasing age. About 50% of men between the ages of 40 and 70 have ED. As do about 70% of men above the age of 70.

Physical Causes

These account for about 80% of cases, and usually the ED will develop gradually. Physical causes include:

• Reduced blood flow to the penis – the most common cause of ED in men over the age of 40. The arteries which take blood to the penis can become narrowed, meaning that the blood flow may then not be sufficient for an erection. Risk factors that increase the chance of arteries narrowing include age (getting older), high cholesterol, high blood pressure, diabetes, and smoking. This is explained in further detail further down the page.
• Injury to nerves going to the penis – this is most commonly caused by surgery to structures near to the penis, spinal surgery, a fractured pelvis, or radiotherapy to the genital area.
• Diseases which affect the nerves going to the penis – such as multiple sclerosis, Parkinson’s disease, or stroke.
• Side-effect of certain medicines – some antidepressants, betablockers and diuretics have been known to cause ED.
• Alcohol / drug abuse
  
• Cycling – after long distance cycling, due to pressure on the nerves going to the penis, from sitting on the saddle for long periods.

Psychological Causes

Usually, if erectile dysfunction is caused by phychological issues, it will develop suddenly and may resolve when mental state improves. Causes include:

• Stress
• Depression
• Anxiety
• Relationship difficulties

Reduced Blood Flow To The Penis

About 70% of ED cases are caused by reduced blood flow to the penis, due to narrowing of the small arteries in the penis.

What causes narrowing of the arteries are fatty patches or plaques that develop within the inside lining of arteries called atheroma. These plaques may gradually form over a number of years in one or more places in the body. Most commonly this is in the arteries going to the brain, heart, penis and legs. In time, the atheroma can become bigger and cause enough narrowing of arteries to cause symptoms and problems.

The following are risk factors for developing atheroma:

• Smoking – one of the biggest risk factors for developing an atheroma-related condition is smoking. It also doubles your chance of developing erectile dysfunction.
• High blood pressure
• High cholesterol
• Obesity
• Inactivity
• Poor diet
• Alcohol excess
• Diabetes

This same problem can occur in other arteries, such as the coronary arteries, causing angina and other heart problems. Similarly, narrowing of blood vessels to the brain is a risk factor for having a stroke and narrowing of blood vessels in the legs can cause peripheral vascular disease.

Erectile Dysfunction & Heart Disease

ED that is caused by narrowing of the arteries is considered an early warning that heart disease (or other cardiovascular diseases) may develop, since ED symptoms tend to develop faster than those associated with the narrowing of coronary arteries.

An international study found that men with ED are twice as likely to have a heart attack, 20% more likely to be admitted to hospital with heart failure and 10% more likely to have a stroke.

Any tests are usually performed to check on potential risk factors, which increase the risk of developing narrowing of the arteries.

Tests may include:

• Blood pressure check
• Blood sugar
• Blood tests – to check the level of cholesterol and other fats. Blood tests are also performed to rule out kidney disease and liver disease. If you have a low sex drive or a previous head injury, a blood test to check hormone levels may be advised.
• ECG and other heart tests if coronary disease is suspected.
• Urine test

If you have low sex drive, or if you have had a previous head injury, ED may be due to a hormonal problem. In this situation a blood test to check the level of the hormone testosterone (and sometimes prolactin) may be advised.

Oral medication

Most tablets work by increasing the blood flow to your penis. They do this by affecting cGMP, the chemical involved in dilating (widening) the blood vessels when you are sexually aroused. One drug, apomorphine works by increasing the level of certain chemicals in the brain which are involved in sending messages down nerves to the penis when you are sexually aroused.

Urethral medication

You can place a small pellet into the end of the urethra (the tube which passes urine and opens at the end of the penis). The pellet contains a similar medicine to that used for the injection treatment. The medicine is quickly absorbed into the penis to cause an erection, usually within 10-15 minutes.

Injection treatment

This was the most common treatment before tablets became available. It usually works very well. You are taught how to inject a medicine into the base of the penis. This causes increased blood flow, and an erection usually develops within 15 minutes.

Pelvic floor muscle exercises

A common treatment for incontinence in women is to strengthen the pelvic floor through exercise. Some studies suggest that strengthening the pelvic floor muscles in men can cure ED in some cases.

The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. One of these muscles (the bulbocavernosus muscle) also partly wraps around the base of the penis. This is involved with preventing blood escaping during an erection, (as well as being active during ejaculation, and when emptying the urethra of urine when finishing at the toilet).

To identify your pelvic floor muscles: firstly, contract the muscles that you would use to stop passing wind from your anus; secondly contract the muscles that you would use to stop the flow of urine. These are the muscles that can be trained and strengthened. Ideally you should see a physiotherapist for advice on exactly how to do the correct exercises.

Vacuum devices

These work by putting your penis into a plastic container and a pump then sucks out the air from the container to create a vacuum. This causes blood to be drawn into the penis and cause an erection. When erect, a rubber band is placed at the base of the penis to maintain the erection. The plastic container is then taken off the penis and the penis remains erect until the rubber band is removed (which must be removed within 30 minutes).

Penile prosthesis

A surgeon can insert a rod permanently into the penis. The most sophisticated type can be inflated with an inbuilt pump to cause an erection. The more basic type keeps the penis rigid all the time.

Treating an underlying cause

For example, treating depression, anxiety, changing medication, cutting back on drinking lots of alcohol, or treating certain hormonal conditions may cure the associated ED.

Lifestyle and other advice

ED is often a marker that heart disease or other cardiovascular diseases may soon develop. Review your lifestyle to see if any changes can be made to minimise the risk of developing these problems, such as stopping smoking, taking regular exercise or eating a healthy diet.

Counselling

Couple counselling or sex therapy can be useful. These are most useful if certain psychological problems are the cause of, or the result of, ED.