Erectile Dysfunction

Erectile dysfunction, otherwise known as ED or impotence, is the condition of being unable to get or maintain an erection suitable for satisfactory sexual intercourse. 1

It is a common condition that most males will experience at some stage in their life, though it is most prevalent in older men. ED is almost always manageable, although it can be recurring, depending on whether the cause is short-term and treatable, or ongoing. 1

The possible causes of Erectile Disfunction are numerous. Physical causes include aging, high blood pressure, conditions which affect the blood vessels and/or nerves associated with the penis, and nerve damage to the area which occurs due to injuries, or certain surgeries such as prostate surgery. Psychological causes of ED include depression, anxiety and relationship issues.

In most cases, erectile dysfunction can be successfully managed, with treatment options depending on the root cause of the disorder. 1 Treatment may involve forms of sex therapy and counseling, exercises and lifestyle changes, Erectile disfunction pills and topical medications, pumps and - in severe cases ‒ prosthetics.

If you think you might have Erectile Dysfunction, try using Ada to find out more about your symptoms.

The symptoms of erectile dysfunction may include:

• An inability to get an erection
• An inability to maintain an erection during sexual activity

These symptoms may come and go over time or be situational, for example not present during masturbation but present with a partner. 1 If symptoms occur regularly or semi-regularly, visiting a doctor is advised.

The onset of ED may be different, depending on whether it is caused by physical or psychological factors:

If the causes of erectile dysfunction are physical in origin, the condition is more likely to appear gradually, with the problem occurring intermittently before becoming more frequent. A person’s sex drive is unlikely to be affected, unless the root cause is hormonal in nature.

Psychological causes typically result in the sudden onset of the condition. If a person is able to get and maintain a healthy erection sometimes, for example when masturbating or on waking, it may be a sign that their erectile dysfunction is psychological in origin. If you are affected by unexplained ED, you can get a free symptom assessment at any time by downloading the Ada app.

Finding a treatment approach that can cure erectile dysfunction usually depends on identifying its root cause.

Erectile dysfunction can be caused by a variety of physical and psychological factors: 1

Most cases of erectile dysfunction are caused by physical factors. The most common cause for erectile dysfunction is reduced blood flow to the penis. This happens as a result of a narrowing of the arteries in the penis.

Conditions which can lead to the development of erectile dysfunction include: 2

• Diabetes, which can affect the function of the blood vessels and nerves
• Parkinson’s disease, either as a side-effect of medication or due to the condition itself
• Multiple sclerosis, a condition associated with progressive damage of the nerves, including those associated with getting and maintaining erections
• Stroke

Other factors which are recognised as physical causes of erectile dysfunction include:

• Excessive intake of alcohol or drugs, which can impair the ability to get or maintain an erection.
• Medications which cause ED as a side-effect, such as certain kinds of antidepressants, beta blockers and some diuretics
• A lack of certain hormones, particularly testosterone. (ED caused by hormone deficiencies is uncommon.)
• Damage to the nerves in the penis as a result of surgery to nearby areas, such as prostate surgery, or from an injury, such as a spinal cord injury

Prostate surgery procedures can directly disrupt the nerves and blood vessels that control the way erections form. 3 For this reason, all prostatectomies will compromise erectile function, at least initially.

Up to 50 percent of men who have had a successful nerve-sparing procedure, i.e. the nerves were left untouched as planned during the procedure, regain their pre-prostatectomy erectile functionality during recovery, within one year.

For men who have not had nerve-sparing procedures, it is usually still possible to recover most or the entire extent of their pre-treatment erectile capability. In cases where spontaneous erections are no longer possible, there are several possible treatment options which may help with overcoming erectile dysfunction after a prostatectomy. These include:

• Oral medications (e.g. Viagra®)
• Topical medications (e.g. Vitaros©)
• Vacuum pumps
• Implants

All of these medications work by increasing blood flow to the penis, causing an erection. (For more information about Erectile Dysfunction treatment after having prostatectomy, see treatment.)

A range of mental health issues can lead to the development of Erectile Dysfunction, including:

• Depression
• Stress/pressure
• Anxiety
• Relationship issues

Purely psychological causes for Erectile Dysfunction are less common, limited to approximately 10 percent of cases. 1

Risk factors for Erectile Dysfunction include:

• Aging ‒ ED is more common among middle-aged and older men
• High blood pressure
• High cholesterol
• Smoking
• Injuries to the groin
• Surgery (such as prostatectomy).

The first step in treating ED is getting a diagnosis of the root cause by visiting a doctor. They may ask typical questions regarding: 4

• The symptoms experienced
• The duration of symptoms
• General physical and mental health
• Levels of alcohol and drug intake
• Whether any other medication is also being taken

It may also be necessary for a person to answer questions about their sexual history. These may include:

• Details of current and past sexual relationships
• Information about sexual orientation
• Whether the dysfunction occurs all the time, intermittently or only in certain situations
• Whether ejaculation is possible
• Libido (level of sexual desire)

A doctor will perform a thorough physical examination to rule out any physical causes of ED. As narrowed blood vessels are the most common cause of Erectile Disfuntion, the doctor will usually examine a person’s cardiovascular condition as part of the diagnosis. This may involve testing for high blood pressure, checking for heart irregularities, as well as evaluating their weight and overall level of health.

Blood tests may also be ordered to check for underlying medical conditions that may be causing the condition.

In most cases, doctors will be able to suggest and prescribe treatment options. A person may also be referred to a specialist. Treatment methods will depend on the underlying cause of the problem, meaning the chosen method will differ from case to case.

Common treatment options for Erectile Dysfunction include:

If an underlying condition is causing Erectile Dysfunction, treating it will generally be the first step towards resolving ED.

If medications used to treat other conditions are thought to be causing erectile dysfunction, a doctor may be able to prescribe alternatives. 2

Good to know: Use of prescribed medication should never be discontinued without supervision by a doctor.

A range of lifestyle changes can help treat erectile dysfunction, including:

• Losing weight
• Reducing stress
• Quitting smoking
• Reducing alcohol and drug intake or giving them up completely
• Getting regular exercise

If stress, anxiety or depression are causing Erectile Dysfunction, counseling may be an effective treatment. If relationship issues are the cause, sex therapy or relationship counseling may prove successful.

In sex therapy, every session is confidential. You can attend on your own, however if your partner is affected, it is likely to be beneficial for both of you to attend. This form of therapy may lead to a better understanding of what you are experiencing, you may receive tasks and exercises to practice with your partner in your own time.

Relationship counseling, in which partners are prompted to explore the physical and psychological issues behind their sexual problems, may also be an effective method of overcoming Erectile Dysfunction. Partners are encouraged to become more aware of each other’s needs, allowing them to reach a solution which works for them both.

Oral medications which are used to treat erectile dysfunction come in the form of tablets or pills. The drugs most commonly used to treat ED are called phosphodiesterase-5 (PDE-5) inhibitors.

These medications work by counteracting phosphodiesterase-5 (PDE-5), a chemical naturally occurring in the body, thereby increasing blood flow to the penis during sexual stimulation.

PDE-5 inhibitors are the most commonly prescribed medication for treating erectile dysfunction. The most common types are:

• Sildenafil: (Viagra®)
• Tadalafil: (Cialis®)
• Vardenafil: (Levitra®)
• Avanafil: (Spedra®)

These medications work by artificially dilating the blood vessels in the penis, enabling improved blood flow. The effects of tadalafil can last for up to 36 hours, while the other three options generally last for around 10 hours. Each should be taken 30 to 60 minutes before engaging in sexual activity and will only take effect when one is sexually excited. 2

A doctor will be able to advise about which type of PDE-5 is most suitable for each person and the health risks and side effects that come with them.

Common side effects of PDE-5 inhibitors can include:

• Back pain
• Indigestion
• Migraine
• Muscle pain
• Blocked nose
• Nausea
• Vomiting

Rarely, in some cases, patients using PDE-5 inhibitors can experience severe vision problems: a temporary or permanent blindness which may be a sign of non–arteritic anterior ischemic optic neuropathy (NAION). Although this can be seen in patients who are using PDE-5 inhibitors, there is insufficient evidence to support a direct link to the development of NAION.

An efficient medication for assisting erectile function is thought to be alprostadil, a man-made version of prostaglandin E1, a substance naturally made in the body to help produce erections. Generally, due to the fact that it is a relatively new treatment with limited safety data, alprostadil will only be prescribed if other treatments, including counseling, lifestyle changes and PDE-5 inhibitors, have been ineffective or are unsuitable. It is administered in three main forms: 5

• As an injection, directly into the base of the penis
• As a small pellet, which is placed into the urethra (the opening on the tip of the penis)
• As a topical cream, applied to the urethra

Doctors will advise on which form of alprostadil should be used and give instructions on how to properly administer it at home. After application, an erection can usually be achieved in around 15 minutes.

Alprostadil has significantly fewer and less severe side effects than most oral medications which can be used to treat erectile dysfunction. It works by widening the blood vessels and increasing the blood flow to the penis, causing an erection.

If side effects occur, these are usually non-serious and are limited to prolonged erections, pain and dizziness. 5 Another advantage of Alprostadil is that the dosage can be adjusted to determine the duration of an erection.

A commonly prescribed topical medication for ED is Vitaros©, a prescription medicine in the form of a cream, containing the active ingredient alprostadil. This is the newest form of alprostadil. 5

Vitaros comes in a single-use container with a plunger, barrel and protective cap, containing either 200 or 300 micrograms of alprostadil in 100 mg of cream. 5 The appropriate dose strength for each person is decided in consultation with their doctor.

Vacuum pumps can relieve the symptoms of erectile dysfunction. A specialized mechanical pump is used to cause an erection by placing it over the penis and sucking air out of the pump, drawing blood into the penis. Erections created with the use of a vacuum device require a band to be applied to the base of the penis to trap the blood for the duration of the intercouse. The band can then be removed afterwards.

For safety reasons, the rubber band should be removed within 30 minutes.

Penile prosthesis is a surgical procedure in which a rod is implanted inside the penis in order to simulate an erection. Advanced procedures involve the insertion of an inflatable rod. **This treatment method for ED can be considered when other conservative approaches are ineffective.

Though it may not always be possible to prevent erectile dysfunction, certain steps can be taken to reduce the risk of the condition. These include: 6

• Staying healthy, with regular exercise and a balanced diet,
• Stopping smoking
• Avoiding drugs and excessive amounts of alcohol
• Seeking treatment for conditions such as high blood pressure and diabetes

There are no serious physical complications associated with erectile dysfunction.However, the condition can negatively affect a person’s mental health, causing issues such as:

• Stress and anxiety
• Low self-esteem
• Embarrassment
• An unsatisfactory sex life
• Problems within a relationship

Q: What is the main cause of Erectile Dysfunction?
A: The root cause of ED is insufficient blood flow to the penis, which makes it difficult to get or maintain an erection. This can be due to a great variety of different physical and psychological reasons.

Q: What can cause young people to be affected by Erectile Dysfunction?
A: Unless it occurs due to a medical condition or structural damage to the nerves from surgery or injury, ED in young men is likely to be from psychological causes such as anxiety, depression and stress.

Q: Is there a permanent cure for Erectile Dysfunction?
A: Although there is no guaranteed cure for Erectile Dysfunction, there are a number of treatment options that can provide long-term relief. Doctors can help advise on the best treatment methods.

Q: Are there any home remedies or natural products that can be used to prevent or treat Erectile Dysfunction?
A: Seeking medical advice before using any home remedy is advised. Natural products are not recommended treatments for ED, because they are insufficiently scientifically researched for their effectiveness to be proven, and furthermore may be harmful in some cases.

However, a doctor should always be consulted before using natural products, particularly in conjunction with other medications to avoid cross-reactivity.

What pills are available to help treat Erectile Dysfunction?
A: Phosphodiesterase-5 (PDE-5) inhibitors are the most common pill-form drugs that are used to treat erectile dysfunction. Types include: Sildenafil (Viagra®), Tadalafil (Cialis®), Vardenafil (Levitra®) and Avanafil (Spedra®). A doctor should be consulted before using any of these pills as they may be unsuitable in some cases and/or cause intolerable side-effects.

Q: Does masturbating cause ED?
A: No, it is a myth that masturbating itself, even excessively, can cause ED. In fact, after a prostatectomy, a person is actively encouraged by their doctor to resume their sexual practices, including masturbation, as normal in order to restore sexual function.

Q: Does porn cause ED?
A: Porn-induced erectile dysfunction is a concept which was first identified by the Kinsey Institute in 2007, soon after internet-based pornography became a worldwide phenomenon. Research suggests a correlation between becoming addicted to watching porn and developing forms of sexual dysfunction, including ED. However, the full relationship between watching porn and developing ED is not yet fully understood.