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Erectile Dysfunction

 


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Condition
Erectile dysfunction (ED); impotence
Class
Sexual health
Description
Erectile dysfunction, previously or sometimes referred to as impotence, is when a man can not achieve or maintain an erection of the penis that will allow him to have successful sexual intercourse. Erectile dysfunction is a common problem which affects at least one in every ten men and the proportion affected increases with age; an estimated 2.3 million men in the UK.
Causes
A lot of men will have experienced the odd occasion when they have had problems getting an erection, whether it is because of stress, tiredness, anxiety or too much alcohol. This is normal and is nothing to worry about. In fact, worrying about it can sometimes make the problem worse and can lead to more anxiety and stress with the man being more preoccupied with 'fears of failure' than feelings of arousal.

Erectile dysfunction is caused by a combination of physical and psychological factors. Erectile dysfunction that comes on gradually is more likely to have a physical basis, while a sudden onset normally means a psychological basis, especially if the man gets an erection in some circumstances but not in others.

Normally, when a man is sexually aroused, more blood flows to the penis. This blood fills the spongy tissue in the penis, causing it to swell and producing an erection. Anything that affects the blood supply to and from the penis can affect the ability to maintain an erection. Physical factors affecting the normal blood flow to the penis include ageing, diabetes or high cholesterol levels. Damage to the nerves in the penis as can happen in multiple sclerosis, stroke or spinal injuries can also be responsible, as can hormone imbalances. Some prescription drugs such as blood pressure tablets and antidepressants can also cause erectile dysfunction. Alcoholism, drug abuse and heavy smoking can also be to blame.

Psychological factors include relationship problems, stress, anxiety, depression and fatigue.
Symptoms
Symptoms of erectile dysfunction are a persistent or recurrent problem in achieving and maintaining an erection that is sufficiently hard and lasts sufficient time to allow sexual intercourse.
Treatment
Mechanical methods such as vacuum pumps provide a non-drug approach to treating erectile dysfunction. A plastic cylinder is put over the penis and an attached vacuum pump is used to draw blood into the penis. When an adequate erection is achieved, a tension band is slipped around the base of the penis. The band stops blood from draining from the tissues in the penis and maintains the erection. Once sexual activity is complete, the band is withdrawn, allowing the penis to reduce in size.

Drug treatment may also be used. Drugs known as phosphodiesterase inhibitors, such as sildenafil, tadalafil and vardenafil taken in the form of a tablet increase blood flow to the penis producing an erection when sexually aroused. Alprostadil is another type of drug, called a prostaglandin, which may be injected directly into the side of the penis or inserted into the urethra (the tube through which urine comes out). Alprostadil dilates or widens the blood vessels in the penis, allowing more blood to flow in to the tissues to produce an erection.

Other treatments include hormone treatment, penile prosthesis (splints inserted into the penis) and surgery to correct blood flow to the penis.
When to see your pharmacist
You should tell your pharmacist if you are taking any medicines for the treatment of erectile dysfunction and you suffer from any heart problems or if you are taking any other medicines. There is a risk that the effects of certain medicines, particularly nitrates for the treatment of angina, can be increased resulting in a dangerous fall in blood pressure. If you have noticed that you are getting problems with your erection more frequently, tell your pharmacist as there is a chance that some of the medicines you are taking to treat other conditions may be the cause of your problem.
When to see your doctor
Do not be embarrassed if you suffer from episodes of erectile dysfunction, go and talk to your doctor. Your doctor will examine you and will be able to determine whether you have physical or psychological factors that are preventing you from having an erection. If the doctor decides that you require mechanical or drug treatment for erectile dysfunction you will be given a prescription. However, treatments for erectile dysfunction are only available on the NHS for men with certain other medical conditions including diabetes, multiple sclerosis, Parkinson's disease and certain spinal injuries or kidney problems. If you do not fall into one of these categories, you will have to pay to obtain your treatment on a private prescription.
Living with erectile dysfunction
If you have noticed that you find it difficult to have an erection or to sustain an erection, the first thing to do is not to dismiss it or to worry about it. Be honest with yourself and with your partner, talk about the way you feel and the way that your partner feels. Sometimes, just bringing things out in to the open, or changing what you do during love-making, may help remove any pressure you may feel about your sexual performance.

Try not to feel frustrated or angry as this will only tend to make things worse. Learn to relax before and during love-making. Simple lifestyle changes, particularly learning to cope with stress and anxiety can help alleviate the problem of erectile dysfunction arising from psychological factors.

Learn to look after yourself. If overweight, try to lose weight. Keep fit by taking regular exercise, heating healthily, stopping smoking and reducing alcohol consumption. Make sure that you get enough sleep by not staying up late into the night watching television or sitting in front of the computer.

If you still experience erectile dysfunction, both you and your partner should go to see your doctor. It is only by both of you being present that the doctor can begin to understand what you both expect from your love-making. If your doctor thinks that the cause of erectile dysfunction is psychological, it may be suggested that you both go to see a counsellor or sex therapist. Again, it is important that you both go together to achieve proper advice.

If your doctor decides that treatment for erectile dysfunction is appropriate, both you and your partner should discuss the options available, what to expect and how to use them properly. You may want to try mechanical devices before using drug treatment or try drug treatment first. It is important to be patient, the method you choose may not work the first time or every time.

If your doctor has advised you that your erectile dysfunction may be linked to another condition such as diabetes or high cholesterol levels. Follow your doctor's advice in controlling these conditions too.

Although for most men, treatments for erectile dysfunction are not available at NHS expense. It is strongly advised not to be tempted to buy products such as Viagra over the internet. There have been many reports of counterfeit medicines that not only do not work but can be downright dangerous.
Advice to partners
Look on erectile dysfunction as a problem shared is a problem halved. Talk with your partner, try to understand his feelings and let him know yours. Talk about what each of you expects from your love-making and what each of you can do to help. Be supportive and if you need to go to a doctor or counsellor, go along together.
Useful Tips
  • Give up smoking
  • Cut down on your alcohol intake
  • Try to reduce stress and anxiety
  • Discuss your erection problems with your partner - 'pressure to perform' can make matters worse
  • Go to your doctor with your partner
Further information
Sexual Advice Association
Helpline: 020 7486 7262
www.impotence.org.uk


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