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Erectile dysfunction, frequently referred to as impotence, is the persistent or recurrent inability to attain or maintain an erection sufficient to complete sexual intercourse or another chosen sexual activity.
It is a common problem which affects at
least one in every ten men. This means that there are an estimated 2.3 million
men in the UK suffering from erectile dysfunction. Regrettably, only about 10%
of sufferers actually receive treatment. The number of men suffering erectile
dysfunction increases with age.
Few men go throughout life without experiencing occasional failure to attain or maintain an erection. This usually results from stress, tiredness, anxiety, or excessive alcohol consumption. This is nothing to worry about. However, worrying about it may set the scene for a more persistent problem due to "fear of failure". The man becomes so preoccupied with previous erectile failure that he is unable to enjoy the arousal feelings associated with sexual stimulation. And this, in turn, decreases his sexual arousal and stops erection from occurring.
Until about 20 years ago, erectile dysfunction
was considered to be caused almost entirely by psychological factors but we now
know that physical conditions are present in about 75% of male sufferers. However,
the majority of men with erectile dysfunction experience a combination of psychological
and physical causes.
Men whose erectile dysfunction is of a physical origin often experience a gradual onset of erectile failure which tends to occur with all sexual activities.
Physical causes of erectile dysfunction include:
deficient blood flow to the penis such as resulting from blocked arteries
excessive drainage of blood from the penis ("venous leak")
damage or diseases affecting the nerves that go to or from the penis
hormone abnormalities
side effect of prescribed drugs
alcoholism and drug abuse
diabetes GO TO: http://www.thediabetesvillage.co.uk/ (for diabetic related product information)
heavy smoking
high cholesterol
diseases affecting the erectile tissue of the penis
neurological diseases, stroke
severe
chronic diseases such as kidney and liver failure
An erectile dysfunction with a sudden onset in men who can achieve erections under some circumstances but not others suggest a psychological cause. Sometimes the triggering factor can be easily identified such as a serious disagreement with the partner; being interrupted while making love or excessive worry at work.
Psychological causes of erectile dysfunction include:
stress and anxiety from work or home
marital conflicts and dissatisfaction (as can also occur with premature ejaculation)
depression
sexual boredom
unresolved sexual orientation
It is important to remember that over the last few years there have been major advances in the treatment of erectile dysfunction and the majority of sufferers can now be treated effectively. Some lifestyle changes are worth considering before medical advice is sought. These include quitting smoking, reducing alcohol intake and trying to reduce stress and anxiety. If such changes do not solve the problem, then the man should seek medical advice.
In the first instance the man with erectile dysfunction should consult his general practitioner. GP's differ in the services they offer men with erectile dysfunction. At one end of the scale there are some general practitioners who have set up clinics within their surgeries and are able to offer a full range of treatments. Others will not treat erectile dysfunction themselves and will refer patients to specialists. If matters fail to improve, it would be reasonable to ask to see a specialist or contact The Impotence Association. The names of local specialists can be obtained from the Association.
The first one or more appointments at the clinic are generally for assessment. This aims at trying to identify a possible cause for the erectile dysfunction and to check your general health. The doctor will ask you about the problem and questions about your general health and the treatments you may be taking for your medical or psychiatric conditions. You might also be asked about your previous sexual function and, if appropriate, questions about your relationship with your partner. You will then undergo a physical examination during which your blood pressure will be checked, the pulses in your legs palpated and probably a check of your reflexes. Your penis and scrotum will also be examined and you will be asked to provide a specimen of urine for examination. A sample of your blood may also be collected for laboratory tests which will probably include testosterone (male sex hormone) measurement.
If referred to a hospital clinic, at the first visit some doctors inject a small dose of a drug into the shaft of the penis which may induce an erection. Others do this at a subsequent appointment. This is to see whether you can attain and maintain an erection. If the injection does not result in a sustained erection, then larger doses of the drug may be given at subsequent appointments.
In some cases, the doctor may organise
further tests which may involve monitoring blood flow in the penis, measuring
the pressure inside the penis, and X-rays of the arteries supplying the penis.
These tests are not necessary in every sufferer. At the end of the assessment
process, the doctor will be able to offer you treatment which is best suited to
your particular case. The doctor may also recommend the changing of prescription
medicines.
When psychological factors or difficulties in the man's relationship with his partner are considered an important cause for erectile dysfunction, a course of sex or couple's therapy might be recommended. It is very useful in helping couples re-establish a sexual relationship when there has been a long period without sexual interaction because of erectile dysfunction. Sex therapy is sometimes advocated in combination with other forms of treatment.
Several different designs of constriction devices are available. Essentially the device consists of a plastic cylinder connected to a pump, which may be either hand or battery driven, and one or more tension rings. The penis is inserted in to the cylinder and activation of the pump removes the air from within the cylinder so creating a vacuum. This results in blood being drawn into the penis, which immediately enlarges in a similar way to a natural erection. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection. The vacuum within the cylinder is then released and the cylinder removed from the penis. It is important that the tension ring is also removed within 30 minutes. For medical suppliers click here or contact the Impotence Association Helpline.
This is a highly effective form of treatment. The patient (or his partner) is taught to inject a drug directly into the shaft of the penis when he wants an erection. Erection usually follows within fifteen minutes of the injection. The procedure is easy to learn. Several different products are available.
This is an effective needle-free form of treatment. A small pellet of drug is introduced into the urethra (the tube through which urine is passed) using a special disposable applicator. The drug is then absorbed through the wall of the urethra and passes into the erectile tissue, giving an erection within 5 to 10 minutes.
There are currently two oral drugs licensed for the treatment of erectile dysfunction. One is a tablet taken one hour before sexual activity, the other is a tablet taken sublingually (under the tongue) twenty minutes before sexual activity. Both drugs are effective and do not cause an erection unless the man is sexually stimulated.
Another oral treatment which is not licensed is yohimbine. It is derived from the bark of an African tree and several studies have suggested it has a beneficial effect in enhancing erectile function.
Only a small proportion of cases of erectile dysfunction are caused by hormone abnormalities. The most frequent hormone abnormality is a reduced level of testosterone (male sex hormone) which can be restored by appropriate testosterone replacement. It is unwise to take testosterone preparations unless laboratory investigations confirm deficiency.
Essentially these are splints which are inserted surgically in to the penis. There are two main types: semi-rigid rods which maintain the penis in a state of rigidity all the time but which allow the penis to be bent downwards out of the way when not required. The second type is more sophisticated and involves insertion of a hydraulic device which causes stiffening of the penis when a pump (implanted in the scrotum) is activated. As implantation of penile prosthesis causes destruction of erectile tissue, they should never be considered until other forms of treatment have been tried.
A few cases of erectile dysfunction that are caused by abnormalities in blood-flow into and out of the penis can be treated by surgery.
Both NHS and Private clinic services can provide appropriate medical treatment. NHS services may sometimes be limited while some private clinics may offer a service but this may be at a relatively high price.
It is always important to ensure
that anyone offering a service has appropriate qualifications. In many private
clinics you may be seen by a physician or surgeon who also works within the NHS.
Qualified sex therapists will have BASMT Accred. after their names.
Yes. There is the old adage that a "problem shared is a problem halved" and this is certainly true in the case of erectile dysfunction. Sometimes partners, unintentionally, put a lot of pressure on men to "perform". If the man has difficulty with his erections this pressure can cause erectile dysfunction. Discussing the problem with his partner may relieve this pressure and restore normal erectile function. It is often helpful for the partner to accompany the man to the general practitioner and specialist.
A leaflet for partners of men with erectile dysfunction is available from The Impotence Association.
Ageing increases the risk of developing erectile
dysfunction but it is attitude, not age, that is the biggest barrier in treating
the condition. While some older men and their partners accept loss of erectile
function as a part of ageing and do not want treatment, others are unhappy about
losing such an important part of their lives. It is now considered acceptable
for men and women to continue an active sex life way into old age and no one should
be denied treatment for erectile dysfunction solely because they are too old.
Men in their 90s are now seeking treatment for erectile dysfunction and generally
respond to the types of treatment offered to younger men.
The Impotence Association is here to help. We cannot give individual medical advice, but we can answer your questions on all aspects of impotence and put you in touch with local specialist practitioners. Please feel free to write or telephone our Helpline. We have a number of factsheets on impotence and related problems. Please send a large SAE when writing for information.
The Impotence
Association
PO Box 10296
London
SW17 9WH
Telephone: 020 8767 7791
The Impotence Association is a registered charity no. 1056307
We hope that you found this leaflet helpful. Each year we send out over 30,000 leaflets and help more than 20,000 people directly through our Helpline service. This is why we need your help today.
The Impotence Association is a registered charity and we rely on voluntary contributions to carry out our work. By supporting The I.A. you can help give sufferers and their partners the information and advice they need to cope with impotence.
Please help us to continue this vital work by making a donation or becoming a member of The Impotence Association. Please call our Helpline for more details on 020 8767 7791. As a Member of the I.A. you will receive copies of our regular newsletter One in Ten including information on the latest medical developments and free copies of all our factsheets. Complete our on-line registration form NOW.
British Association for Counselling
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Tel: 01788 578328
British Association
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PO Box 13686
London
SW20 9ZH
(please enclose SAE)
Relate
Helpline: 01788 573241
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Diabetic Association
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SPOD
(Sexual & Personal
Relationships of People with a Disability)
286 Camden Road
London
N7 0BJ
Tel: 020 7607 8851 (Tues/Thurs 10.30am - 1.30pm Wed 1.30pm - 4.30pm)
Men's
Health Matters
100 Blythe Road
London
W14 0HB
Advice line:
020 8995 4448 (Mon - Fri 6pm- 10pm)
Information courtessy of: The Impotence Association
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