Erectile Dysfunction (ED) is defined as the ” inability to attain and or maintain an erection sufficient for sexual activity”
There are many possible causes of ED but it is now widely accepted that underlying much organic ED is endothelial dysfunction both of the arterial system in general, and of the lining of the sinusoids within the corpus cavernosum of the penis. This can be an early sign of cardiovascular change and therefore assessment and investigation can be preventative to further complications in life.
ED is very common and at least one in ten men will have erectile difficulties for a variety of reasons and at different ages
Vascular disease usually means that not enough blood enters the penis ,or it does not stay within the penis to maintain an erection. This can be as a result of smoking, heart disease, diabetes or high cholesterol
A significant part of our sexual function is controlled by centres in the brain. Therefore, neurological problems such as spinal cord injury, multiple sclerosis(MS) or surgery can mean that the messages from the brain conveyed to the penis do not produce a normal outcome.
Hormonal Levels are associated with ED, A low level of Testosterone can lead to erectile dysfunction and issues with sexual desire.
Medication Some medication can have the side effect of interrupting your erection, especially drugs used in antihypertension antipsychotics or anti depressants.
Psychological factors such as stress at work, financial stress, concerns within the relationship and lack of confidence can interrupt erectile function/
Diabetes is now an increasingly common disease presentation and an increasing cause for erectile dysfunction, with over 50% of diabetic men being affected
Chief amongst the recreational drugs is alcohol. Excessive alcohol abuse can lead to long term ED and also disorders of ejaculation or arousal.
Other recreational drugs are known to cause ED. These include cocaine, marijuana, amphetamines and anabolic steroids.
In recent years, the management of ED has been revolutionised by the introduction of oral therapies(PDE5 inhibitors); first sildenafil (Viagra®) and more recently tadalafil (Cialis®) and vardenafil (Levitra®). Depending on the type of PDE5 you may be prescribed it may take up to one hour before sexual activity
Can be delivered into the cavernosal tissues via the urethra. It is inserted into the urethra (the tube that carries urine from the bladder to the tip of the penis) in the form of a small pellet using a special applicator that comes with the product. The penis is then massaged to encourage distribution of the drug. The preparation is called MUSE, standing for Medicated Urethral System for Erection.
As the name suggests, these are drugs that are injected directly into the corpus cavernosum. (through the side of the penis)
Available since the 1980s, vacuum erection devices (VEDs) work by inserting the penis into a plastic tube, from which air is withdrawn. The resulting vacuum encourages blood to be drawn into the penis. Once the penis is erect, a constriction ring is applied to the base of the penis and the vacuum is released. Various types of device are available, using mechanical pumping or a battery-powered motor to produce the erection.
VEDs are effective, producing erections in 75-100% of men that try them and some studies have found that the acceptance rate is good.
Recent work presented at the European Society for Sexual Medicine (ESSM) in Milan and at the European Association of Urology in Paris, showed promising results when low energy shockwaves were applied to the penis of men with E.D. This technology, commonly used to break up kidney stones, appears to improve blood flow in the penis and aid erection. We at Mens Health Specialist and others consider it to have a place in management of this condition.
The assessment of all men with ED should encompass an attempt to identify any psychological factors that may be contributing to the problem. The presence of an identifiable organic course (e.g. vascular disease) does not preclude the compounding of the problem by psychological issues – chief amongst these may be performance anxiety.
Men may present with a sexual dysfunction, but his partner could have a sexual dysfunction as well. Indeed, sexual dysfunction in the partner may well be a contributory or even causal factor in the man’s erectile dysfunction or other disorder. Therefore Psychosexual Counselling is integral to all therapeutic regimens. (Sensate focus)