Erectile Dysfunction

Erectile dysfunction (E.D) is a term used to describe problems getting or maintaining erections, it can affect men of all ages.

Incidence

Up to 50% of men over 40 years old have some degree of E.D.(¹).
The majority of men with ED can be successfully treated.

Causes

The causes of ED include:

• Physical reasons affecting the blood supply or nerve supply to the penis
• Side effects of prescription medication
• Lower urinary tract problems
• Anatomical or structural problems with the penis
• Pelvic surgery and/or radiotherapy
• Hormonal imbalances
• Pelvic injury

Risk Factors

Erectile dysfunction has the same the risk factors as cardiovascular disease: 

• Smoking
• Obesity
• Increasing age
• Sedentary lifestyle
• Diabetes
• High blood pressure
• High cholesterol levels

Consultation

Includes:

• Detailed history concerning your symptoms
• Physical examination
• Investigations
  - Blood pressure
  - Blood tests for sugar, cholesterol, testosterone
  - Additional blood tests when indicated include checking hormone levels, thyroid and kidney function and Prostate Specific Antigen (PSA).
• Please note that some investigations and tests (including blood tests) would be billed in addition to your consultation

Treatments

Lifestyle changes including those listed below may be helpful in treating your erectile dysfunction:

• Exercising
• Losing weight
• Stopping smoking may be beneficial               

Tablets - PDE-5 inhibitors include three different drugs (Viagra, Cialis, Levitra):

They are the most commonly prescribed treatments for ED and work by improving the blood flow to the penis which produces a stronger and longer lasting erection.

In order for them to work sexual stimulation is required. Depending on the choice of drug their onset of action can range from 20 to 60mins and the period of time over which they work can also vary from 4 to 36hrs. It is therefore important to discuss which drug may be suitable so that potential side effects and complications can be avoided.

Injections or penile suppository:
These treatments contain the drug alprostadil which is either injected directly into the body of the penis or inserted into the ‘water pipe’ (urethra) with a special applicator.

Vacuum pumps:
A cylinder is placed over penis and a vacuum sucks blood into the penis making it erect. A constriction ring placed at the base of the penis traps the blood in the penis which maintains the erection.

Surgery:
Commonly this involves the insertion of a prosthetic implant into men who are not suitable for, or have not had success with medical treatments. Implants are inserted inside the penis. They are semi-rigid or inflatable silicone rods which are easily inflated or deflated as and when you want an erection. 

It is very important that men seek help for their ED so that they can be assessed, and treated. Most men with E.D. can be successfully treated and return to a normal sex life. It is important to realise that ED could be an early sign of problems that can lead to a heart attack or, stroke.

Other conditions relating to sexual function include:

• Problems with ejaculation – too early (premature), delayed or absent
• Problems with sex drive (libido)

Mr Gareth Brown has a special interest is helping men with erection dysfunction and other problems with sexual function. In his clinic at Vale Healthcare he is able to provide expert evaluation to determine the cause and most appropriate treatment option. 

References:

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151(1):54-61.