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Erectile dysfunction

Introduction

Erectile dysfunction is when a man keeps having difficulty getting or keeping an erection. He may then have difficulty having sex or performing other sexual activities such as masturbation.

Erection problems are very common. The Sexual Dysfunction Association estimates that 1 in 10 men in the UK have recurring problems with their erections at some point in their life.

Most men have difficulty getting an erection from time to time, due to stress, tiredness, drinking too much alcohol, or simply not being in the mood. If it only happens now and again, then its usually nothing to worry about.

But if you keep finding yourself unable to get or keep an erection and its preventing you carrying out your normal sex life, disrupting your relationship, or making you depressed, you should seek help from your GP.

Many men are too embarrassed to talk about problems with their erections, or are worried about wasting their GP's time. But it is worth seeking help, because your GP will often be able to give you some simple advice or treatment that could solve the problem.

Please see the separate articles for information on ejaculation problems, priapism (painful persistent erection), and infertility.

Symptoms

The symptoms of erectile dysfunction are:

• · not being able to get an erection, even when you are exposed to sexual situations or material such as a sexy scene in a film, which would normally give you an erection, and/or
• · if you do get an erection, it does not last or it is not hard enough for you to complete sexual intercourse or perform another regular sexual activity.

Occasional erection difficulties are not symptoms of erectile dysfunction - it is only a problem if it keeps happening, if it interferes significantly with your sex life and relationships over a period of time, or if it is causing you to feel unhappy or depressed.

Sometimes men are too embarrassed to admit they have an erection problem and try to hide it, even from their partner. If you suspect your partner has an erection problem, it can be difficult to start a discussion about it, but it could be a possible reason for a man to avoid sex.

It is important to treat the matter sensitively, because in many cases erectile dysfunction is caused by a psychological problem, which may get worse if you get angry or argue about it.

Erection problems may improve or even disappear if you do not make a big issue out of having sex and find other ways to be intimate. This can take the pressure off him to perform. If your partner will not discuss his erection problems with you, gently try to persuade him to see his GP to find out if there is a medical cause.

Causes

Often erectile dysfunction has a physical cause, but sometimes it is a psychological problem. Most frequently it is a combination of the two.

Physical causes

An erection works by allowing blood into the spongy tissues of the penis but stopping it from flowing back out again. Anything affecting the arteries, veins or nerves that supply the penis will influence the ability to have an erection. These can include:

• · Medicines such as anti-depressants and drugs for high blood pressure (such as ACE inhibitors and beta-blockers).
• · Alcohol, smoking, and taking illegal drugs.
• · Conditions that affect the nerves or blood supply, such as multiple sclerosis or a stroke.
• · Diabetes, which can sometimes cause a problem with the nervous system.
• · Blood vessel conditions such as blocked arteries (for example, caused by high cholesterol levels).
• · Hormonal conditions, such as not having enough testosterone in your body, or having too much of another hormone called prolactin.
• · Conditions affecting the erectile tissue of the penis, such as prostate cancer.
• · Serious long-term conditions such as kidney or liver failure.

As you get older, you're more likely to have another condition that causes erection problems, such as heart disease or diabetes. But that does not mean that you shouldn't seek treatment for your erection problems, as well as the underlying condition.

Psychological causes

Some of the most common psychological causes of erectile dysfunction include:

• · stress or anxiety,
• · depression, and
• · relationship or sexual identity issues.

Sometimes an occasional erection problem caused by a minor everyday problem such as a few too many drinks, or a particularly hard day at work, can begin a cycle of worrying. This can turn into a psychological cause of further erectile difficulties.

Diagnosis

Speak to your GP if you have erection problems that keep coming back. They will be sensitive and understanding, and will do their best to find the cause of your problem and treat it.

Some GPs will be able to diagnose and treat you themselves. Others might refer you to a specialist.

Whichever healthcare professional you speak to, it's important to tell them what happens (whether you do not get an erection at all, or if it does not last), and to let them know of any triggers you've identified such as stress or tiredness.

It's helpful to explain how your erection problem makes you feel, and when it usually happens for example, if it is only when you are trying to have sex, or if you never get an erection any more.

Tell them how long it has been happening, and how it compares to your previous sex life. If appropriate, they might also ask a few questions about your family and sexual relationships.

The GP or consultant will check your medical notes to see if there are any drugs or health conditions that might be causing your erection problems.

You may also have tests to look for physical causes of erectile dysfunction. Initial tests may include:

• · blood pressure measurement,
• · reflex check, to see if your nervous system is working properly,
• · physical examination of your penis and scrotum,
• · urine sample, or
• · blood sample, to look at your testosterone levels, blood sugar, and cholesterol levels.

If you are referred to a specialist, further tests might include:

• · An injection into your penis to see if you can get and keep an erection. This is sometimes called cavernosomotry, and is usually done if there is a suspected problem with the blood vessels leading to your penis.
• · Tests to check the blood flow and blood pressure in your penis, which may include an ultrasound scan to see if the blood is flowing correctly.
• · X-rays of the arteries supplying the penis, to look for injury or damage. This is sometimes called an arteriogram.

Treatment

Initial treatment can take the form of some basic self-help advice, such as limiting how much alcohol you drink, giving up smoking, reducing your stress levels, and trying to get more sleep.

Trying other ways to get intimate with your partner may help, and it might also relieve psychological issues if you discuss your problem with your partner or a close friend.

If prescription medications are the suspected cause, your doctor may change the type of drug you are prescribed to see if this helps.

If the diagnostic tests have found an underlying condition such as a hormone imbalance or kidney disorder, treatment for this condition may resolve your erection problems.

If you are obese (very overweight), recent research has shown that losing weight may help reduce erection problems, as well as boosting your overall health.

Talking therapies such as relationship counselling, cognitive behavioural therapy, or psychotherapy, may help you understand and solve any psychological causes of your problem.

Physical treatments for erectile dysfunction include:

• · Vacuum devices, which are pumps that are placed over the penis. They use suction to draw blood into the penis, and you need to put a special elastic band around the base of your penis to keep the blood in place while you have sex (you shouldn't leave the band on for more than 30 minutes).
   
• · Tablets that are swallowed, including sildenafil (known as Viagra), tadalafil (known as Cialis), vardenafil (known as Levitra) or yohimbine. Sildenafil, tadalafil and vardenafil seem to help most men with erection problems. They work by letting more blood flow into the penis when you get sexually excited. Yohimbine works by affecting the nerve signals that tell your brain to produce an erection.
   
• · Drugs placed under the tongue, such as apomorphine. This is placed under your tongue 20 minutes before sex, and it works by increasing the levels of a chemical in the brain that send messages to the penis.
   
• · Medicines that are rubbed in, injected into the penis or inserted into the urethra (urine tube). Alprostadil is one drug that can be used in all three ways. It works by widening the blood vessels in your penis so more blood flows in and makes your penis harder. Another drug commonly given through injections is papaverine, which has the same effect of widening the blood vessels.
   
• · Hormone treatments are appropriate for those who have too little testosterone or too much prolactin in their blood.
   
• · Rods or tubes implanted into your penis. This is usually only suggested if other treatments have not worked and there has not been sufficient medical research to say whether they are an effective treatment.
• Some treatments for erectile dysfunction are only available on the NHS in certain circumstances. In particular, medicine treatments for erectile dysfunction are only available on the NHS if you have certain specific medical conditions, or if erectile dysfunction is causing you severe distress.

Medicine guides


The list below is a combination of the generic and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.

The medicines listed below hold a UK licence to allow their use in the treatment of this condition. Unlicensed medicines are not included.

The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.

If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.

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