Erectile Dysfunction (ED)
ED is an unfortunate condition because not only can it affect your sex life adversely – but men find it embarrassing, too. Which means they often don’t seek help for it, and the embarrassment further feeds into difficulties with sex. People often shy away from sex if they feel it’s not going to go well for any reason. Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. ED is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.
Causes of erectile dysfunction
Erectile dysfunction (ED) can have many causes, such as other medical conditions, certain medications and stress related (psychological) issues.
To understand more about the possible causes of erectile dysfunction (ED) it is useful to understand how erections occur. When a man becomes sexually excited, his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, causing the tissue to expand and harden. Therefore, anything that interferes with the nervous system or the blood circulation could lead to ED. Anything that affects libido (level of sexual desire) can also cause ED. Psychological conditions, such as depression, can reduce libido, as can changes in hormone levels
There are four main types of health conditions that can cause physical problems resulting in ED. These are:
- vasculogenic – conditions that affect the flow of blood to your penis, eg Cardiovascular disease, high blood pressure and diabetes.
- neurogenic – conditions that affect your nervous system, which is made up of your brain, nerves and spinal cord, eg multiple sclerosis, Parkinson’s disease, a spinal injury or disorder, a stroke
- hormonal – conditions that affect your hormone levels, eg thyroid conditions, or Cushing’s syndrome
- anatomical – conditions that affect the physical structure of your penis
In some men, certain medicines can cause ED, including:
- diuretics– medicines that increase the production of urine and are often used to treat high blood pressure (hypertension), heart failure and kidney disease
- antihypertensives – medicines, such as beta-blockers, that are used to treat high blood pressure
- antipsychotics – medicines that are used to treat some mental health conditions, such as schizophrenia
- antidepressants– medicines that are used to treat depression and some types of pain
- anticonvulsants – medicines that are used to treat epilepsy
- cytotoxics – medication used in chemotherapyto prevent cancer cells from dividing and growing
There are more medicines that can cause ED so speak to your Pharmacist or GP if you are concerned that a prescribed medicine is causing ED. Alternative medication may be available. However, it is important never to stop taking a prescribed medicine unless you are advised to do so by your GP.
Possible psychological causes of ED include:
- depression– feelings of extreme sadness that last for a long time
- anxiety– a feeling of unease, such as worry or fear
ED can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of ED.
There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:
- relationship problems, such as being unable to talk openly about any problems that you have
- lack of sexual knowledge
- past sexual problems
- past sexual abuse
- being in a new relationship
Other possible causes of ED include:
- excessive alcohol intake
- using illegal drugs, such as cannabis, heroin or cocaine
ED can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination.
Some things your GP may ask you about include:
- your symptoms
- your overall physical and mental health
- your alcohol consumption
- whether you take drugs
- whether you are currently taking any medication
Your GP will also need to ask questions about your sexual history. Try not to be embarrassed because ED is a common problem. You can request a male GP at your surgery if you prefer. ED that occurs all the time may suggest an underlying physical cause
The symptoms of ED can often be improved by making changes to your lifestyle. You can reduce your risk of ED by:
- losing weightif you are overweight
- giving up smoking
- moderating your alcohol consumption
- not taking illegal drugs
- exercising regularly
- reducing stress
As well as helping to improve your ED, these types of changes can also improve your general health.
Phosphodiesterase-5 (PDE-5) inhibitors are one of the most widely used and effective types of medication for treating ED. They work by temporarily increasing the blood flow to your penis.
In Ireland, commonly used PDE-5 inhibitors include:
- sildenafil– sold under the brand name Viagra
- tadalafil – sold under the brand name Cialis
- vardenafil– sold under the brand name Levitra
Sildenafil and vardenafil work for about eight hours and they are designed to work ‘on demand’. Tadalafil lasts for up to 36 hours and is more suitable if you require treatment for a longer period of time, for example, over a weekend.
Depending on the type of PDE-5 inhibitor you are taking and the dose, it should take about 30-60 minutes before it starts to work. With sildenafil and vardenafil, you should be able to have sex from one to 10 hours after taking the medicine. After taking tadalafil, the effects will last for up to 36 hours.
It may take longer to notice the effects of the tablet if it is taken with food, so you should take your PDE-5 inhibitor on an empty stomach. You can then eat after an hour without affecting the medicine. In general, at least two-thirds of men report having improved erections after taking one of these medicines. These medications are triggered by sexual stimulation, so you also need to be aroused for the medication to work.
PDE-5 inhibitors should be used with caution in men who have cardiovascular disease, such as coronary heart disease (when your heart’s blood supply is blocked or interrupted). However, sexual activity is also likely to be beneficial for your cardiovascular health. Your GP should discuss the risks and benefits with you and will prescribe PDE-5 inhibitors if you are fit enough.
You are also warned not to take PDE-5 inhibitors if you:
- have been advised not to take part in sexual activity or in activities that widen your blood vessels
- have low blood pressure(hypotension)
- have recently had a stroke
- have unstable angina– an underlying heart condition that causes symptoms such as chest pain
- have had a heart attack
- an eye condition that causes a sudden loss of vision
In some cases, PDE-5 inhibitors can still be used even if you are affected by one of these conditions. For example, after they have consulted an expert, your GP may advise that PDE-5 inhibitors are safe three to six months after a heart attack.
PDE-5 inhibitors can cause some side effects, including headaches and migraines, flushing (redness), nausea and vomiting and muscle pain.
If your ED does not respond to treatment, or you are unable or unwilling to use PDE-5 inhibitors or a vacuum pump, you may be given a medicine called alprostadil. This is a synthetic (man-made) hormone that helps to stimulate blood flow to the penis.
Alprostadil is available as:
- an injection directly into your penis – this is called an intracavernosal injection
- a small pellet placed inside your urethra (the tube that carries urine from your bladder to the tip of your penis) – this is called urethral application
In men who did not respond to PDE-5 inhibitors, alprostadil injections were successful in 85 out of 100 men. Alprostadil that is inserted into the urethra is successful for up to two-thirds of men.
Alprostadil should not be used:
- in men at risk of priapism (a painful erection that lasts for several hours) – for example, those with sickle cell anaemia
- alongside other ED medications
- if you have a penile implant or if you have been advised to avoid sexual activity
Urethral application may also not be used in:
- some men who have anatomical problems with their penis (conditions that affect the physical structure of the penis)
- men who have infections of their penis, such as balanitis(inflammation of the head of the penis)
Alprostadil can cause some side effects including:
- changes in your blood pressure
- pain in your penis
- urethral burning or bleeding
- reactions at the site of the injection, such as swelling
If a hormonal condition is causing ED, you may be referred to an endocrinologist.
Surgery for ED is usually only recommended if all other treatment methods have failed. It may also be considered in:
- younger men who have experienced trauma (serious injury) to their pelvic area – for example, in a car accident
- men with a significant anatomical problem with their penis
If your ED has an underlying psychological cause then you may benefit from a type of treatment called sensate focus. If conditions such as anxiety or depression are causing your ED, you may benefit from counselling.
Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your ED. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your ED. The counsellor can also provide you with some practical advice about sex.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have ED. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.
Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your ED – for example, to do with:
- your self-esteem (the way you feel about yourself)
- your sexuality
- your personal relationships
Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.
A vacuum pump is another treatment method for ED. It consists of a clear plastic tube that is connected to a pump. You place your penis in the tube and pump out all of the air. This creates a vacuum that causes the blood to fill your penis, making it erect. It may take several attempts to learn how to use the pump correctly, but they are usually very effective. After using a vacuum pump, nine out of 10 men are able to have sex, regardless of the cause of their ED.
You should not use a vacuum pump if you have a bleeding disorder or if you are taking anticoagulant medicines, which reduce the ability of your blood to clot.
Side effects of vacuum pumps include pain or bruising, although these occur in less than a third of men.
The bottom line is that ED affects lots of men, and can be distressing for the men involved and their partners. There are lots of very effective non-medication and medication-based treatments, so no one needs to be out there struggling with this on their own.
Grant’s pharmacy is open 6 days a week for any queries on the above or any other worry you may have. Every Grant’s Pharmacy has a private consultation room where you can discuss any personal ailments discreetly and without embarrassment. Pop in and experience a fast, friendly and informed service. Grant’s Pharmacy is located in Wexford town, in Enniscorthy town, in Arklow town – all beside Pettitts and in Gorey town opposite the GPO. Find us on Facebook.