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Erectile dysfunction

Also known as impotence, erectile dysfunction — or ED for short — is much more common than you might think

Research suggests that erectile dysfunction affects up to one in five men (approximately 4.3 million men) across the UK.1 We are seeing increasing numbers of patients visit our Circle Health Group hospitals for advice and treatment for this common condition.

One of the biggest misconceptions about ED is that it is a natural part of the ageing process that should just be accepted.

While it’s true that it is more commonly experienced by older men, it doesn’t mean that you have to give up on having an active sex life — quite the opposite. Whatever is causing your erectile dysfunction, there are treatments that can help you to rediscover a fulfilling and satisfying sex life.

Feeling embarrassed? Don’t be. Countless men visit consultant urologists at Circle Health Group hospitals every year, seeking advice and support for erectile dysfunction. All of our patients are treated with the utmost confidentiality, meaning that you can feel comfortable and secure when asking for help.

“Sex is related to quality of life. Our aim is to help anyone who wants to enjoy a healthy, fulfilling sex life to achieve this. Age is no barrier.”

Mr Giangiacomo Ollandini, consultant urological surgeon at The Saxon Clinic in Milton Keynes

Erectile dysfunction is characterised by the inability to either get or maintain an erection that is firm enough to enjoy sexual activity.

Some men may also experience premature or delayed ejaculation. This may happen intermittently — which is very common — or become a chronic problem that affects your ability to enjoy a normal, active sex life.

The penis is much more complicated than it looks from the outside and is made up of several different parts. To be able to understand erectile dysfunction, it’s necessary to also understand how you get an erection in the first place.

The mechanics of erectile dysfunction

Running along the entire shaft of the penis are two, cylinder-shaped chambers called the ‘corpora cavernosa’. These are packed with blood vessels, tissue and open pockets, with two main arteries running along each. The arteries and veins within the corpora cavernosa move blood in and out of it to keep the tissues of the penis healthy.

When you get an erection, chemicals in your brain send messages to the blood vessels within the penis, telling them to relax. This causes them to get larger. When this happens, more blood than usual can flow into the area. At the same time, the veins close, trapping this excess blood in the corpora cavernosa, resulting in pressure that triggers an erection.

Once you’ve ejaculated, or you are no longer aroused, the blood flow to the penis stops and the veins open, enabling blood to leave it and your erection to soften.

There are many possible causes of ED. Erectile dysfunction causes can broadly be split into two different classifications — psychological and physical.

Understanding the cause of your erectile dysfunction is vital, as it can affect which treatments are most likely to be successful in helping you to rediscover firm and sustainable erections.

Physical causes of erectile dysfunction

In lots of cases, erectile dysfunction is caused by physical reasons. This is known as organic erectile dysfunction.

Organic ED refers to erectile dysfunction that is primarily caused by physical factors that impair the delivery of adequate blood flow to the penis, making it difficult or impossible to get or sustain an erection.

There can be a variety of reasons why this happens. In fact, in many cases, organic erectile dysfunction can be a sign of an underlying health condition that requires treatment.

Some of the best-known physical causes of ED include:

Many people are surprised to learn that ED can even be a precursor to a cardiovascular event, such as a heart attack or stroke.

Mr Ollandini explains, “Erectile dysfunction is an independent cardiovascular risk factor. While someone with ED may not necessarily go on to have a cardiovascular event, research shows that someone who has had a cardiovascular event has almost certainly experienced ED in the recent past”.

Psychological erectile dysfunction causes

Psychological erectile dysfunction — sometimes known as psychogenic erectile dysfunction — refers to erectile dysfunction that is primarily caused by psychological factors.

Some of the most common triggers of psychogenic ED include:

The brain plays a key role in triggering an erection, by sending signals to the nerves in the penis to increase blood flow. There can be many emotional issues or psychological reasons that interfere with this process, causing erectile dysfunction.

Despite these two classifications, it’s important to note that men regularly suffer from ED caused by a combination of both overarching causes. However, as a general rule, younger men usually find that their ED is predominantly psychogenic, while for older men, their erectile dysfunction is predominantly organic.

The role of medication as a cause of erectile dysfunction

Another common misconception about ED is that it can be caused by taking certain medications.

While you’ll absolutely find it listed as a side effect of many medications, the reality is that, in the majority of cases, the problem existed prior to the drugs being taken.

Many of the medications that list erectile problems as a potential side effect are medications prescribed for psychological or cardiovascular conditions — which, as we know, are contributors to ED in their own right.

Mr Ollandini explains: “It is unlikely that taking a specific medication alone will cause erectile dysfunction. There is nearly always another underlying psychogenic or organic reason for someone to suffer from impotency.”

The symptoms of erectile dysfunction are really very simple. People with the condition will likely experience one or more of the following:

  • Difficulty getting an erection
  • Difficulty sustaining an erection
  • Reduced sexual desire
  • Premature or delayed ejaculation
  • Interest in sex but difficulty performing

Erectile dysfunction symptoms will differ from person to person, some people may experience all of the above, others only on. Also, symptoms come and go for some people, while for others they remain consistent.

Most people will experience erectile problems at some point during their lifetime. Isolated episodes are rarely anything to worry about. However, when the inability to get or sustain an erection starts to affect your day-to-day life, it’s time to speak to your GP or healthcare provider.

You should arrange an appointment with your GP if you:

  • Are concerned about your erections, or you are experiencing other sexual issues such as premature or delayed ejaculation
  • You have been diagnosed with a health problem that has links to erectile dysfunction, including heart disease, high blood pressure or diabetes
  • You are experiencing other symptoms as well as those associated with ED

Despite how common erectile dysfunction is, many men still feel uncomfortable, embarrassed or even ashamed by their impotence. This can make speaking to a healthcare professional seem daunting.

Nevertheless, it really is nothing to worry about. It is estimated that half of all men between the ages of 40 and 70 will experience ED to some degree. This means that in a friendship group of six men, three of you are probably experiencing erectile problems — even if you aren’t all talking about it.

Getting diagnosed with erectile dysfunction at Circle Health Group

If you are experiencing regular erectile performance issues, your GP will almost certainly refer you to a consultant urologist to discuss what treatments are available to you. Urologists are specialists in diagnosing and treating disorders of the kidneys, ureters, bladder, prostate and male reproductive organs, and this includes erectile dysfunction.

When your GP mentions that they will refer you to a consultant, you can ask them to refer you to a urologist at your local Circle Hospital. If you have researched consultants already, you can ask your GP to refer you to a specific urologist. Otherwise, they can do you a general referral.

What to expect from your initial consultation at Circle Health Group

Your first visit to your consultant urologist may not seem all that different to when you visited your GP. That’s because it’s important for your consultant to find out everything about your medical history — something that we won’t have access to if it is your first visit to a Circle Health Group hospital.

You’ll be asked questions about your medical history, current health and any medications that you are taking, as well as about your current symptoms.

One of the first things that your consultant urologist will do will be to conduct a cardiovascular risk assessment. The reason for this is the close link between ED and cardiovascular conditions, and the likelihood that your erectile dysfunction may be a precursor to a cardiac event.

If this risk assessment determines that there is a high chance of cardiac problems, you’ll be referred to a cardiologist first and foremost. Treating underlying health conditions, including cardiovascular diseases, could improve your ED symptoms without the need for any specific ED treatment — benefitting your overall health and reducing your risk of a potentially life-threatening cardiac event.

“The overall health of a patient is just as important to us as treating their erectile dysfunction. If there is a serious problem with their cardiovascular health, we must address this before looking to treat their ED”, states Mr Ollandini.

Testing for erectile dysfunction

In addition to asking you about your symptoms, your consultant urologist may use a variety of tests and tools to confirm a diagnosis of erectile dysfunction.

These may include:

  • Blood tests: Blood tests can help to identify potential health problems that could be causing ED such as high blood pressure, high cholesterol, kidney problems and more.
  • Urine tests: A simple urine test can indicate diabetes. Erectile dysfunction is a common problem among men who have diabetes, affecting an estimated 35–75% of men with diabetes.2
  • Thyroid testing: Thyroid problems, such as an overactive or underactive thyroid, can create a hormonal imbalance that can make it difficult to get or sustain an erection.

If your consultant is able to rule out a physical cause for your ED, they may recommend that you undergo a psychological evaluation to determine if there is a psychogenic reason for the condition. This usually involves talking about what is happening in your life — with your relationships, friendships, children and work — to see if there have been any changes that may be causing stress, tension or other feelings which could be contributing towards ED. 

Every patient is different and, as previously mentioned, many men find that a combination of psychogenic and organic factors are responsible for their erectile difficulties.

Once you’ve been diagnosed with erectile dysfunction, your consultant urologist will start to talk to you about the different treatment options that are available to you.

The type or types that they recommend will probably depend on what they believe is the primary cause of your ED.

This is because if there is a definitive underlying cause, it is much easier and more effective to treat this first, which should result in an improvement in your ED symptoms. For example, if your ED is found to be a result of low testosterone, hormone treatment may be all that’s needed to combat your erectile dysfunction.

Medication for erectile dysfunction

There are a variety of medications that can be prescribed to treat erectile dysfunction.

You’ll be prescribed one at a time and asked to try each for a minimum of eight times to see if there is any improvement in your symptoms. If one medication isn’t effective during this time, you’ll be switched to an alternative.

These medications are usually delivered in the form of a tablet that is taken a short while before sexual activity. Patients are usually able to sustain an erection for several hours before their erection starts to diminish.

Penile injections for erectile dysfunction

If oral medications prove ineffective, you may be offered penile injection treatment. This is an injection of medication delivered directly into the side of the penis. Patients must self-inject under the supervision of a healthcare professional.

The effects of penile injections typically last between five minutes and two hours and may vary between patients. Penile injections should not be used more than three times in any one week, and never more than once per day.

Vacuum therapy for erectile dysfunction

Also known as an erectile dysfunction pump, this vacuum device is used to help patients achieve and maintain an erection by drawing blood into the penis via suction, which causes it to swell and become erect.

Once an erection has been achieved, a retaining band is slid down onto the lower end of the shaft to help maintain it for sexual activity. This band can be worn for a maximum of 30 minutes but must then be removed.

Penile implants for erectile dysfunction

As the name suggests, penile implants are artificial devices that are surgically placed inside the penis to help the patient achieve erections and enjoy sexual activity. Penile implants are usually reserved for men who have found other therapies to be unsuccessful. So you’ll likely be asked to try medications, injections and/or vacuum therapy first.

There are two types of penile implant available:

  • Inflatable implants are the most common and can be inflated or deflated by the patient at will. They use a fluid-filled reservoir implanted under the abdominal wall. When the patient wants to achieve an erection, they simply pump the saltwater fluid from the reservoir into the cylinders, causing the penis to stiffen and rise. After, just release the valve inside the scrotum to drain the fluid back into the reservoir.
  • Semi-rigid implants comprise of a series of segments with a spring at each end. It causes permanent firmness, and patients must bend their penis towards their body for comfort and concealment, or outwards for sexual activity.

Shockwave therapy for erectile dysfunction

The name may make this treatment sound drastic, but shockwave therapy is a highly effective treatment for erectile dysfunction that is pain free.

Shockwave therapy uses targeted sound waves to stimulate penis tissue and encourage blood flow to the area. This helps to repair and strengthen the blood vessels in the corpora cavernosa and encourage tissue repair where needed.

Shockwave therapy takes place over a series of appointments, each around 15 minutes in length. A wand remitting the soundwaves is placed near the penis, but there is no discomfort and no need for anaesthesia.

Mr Ollandini supports the use of shockwave therapy in cases of severe ED: “Even patients with absolutely no erection after using other treatments could achieve moderate success after shockwave therapy”.

There’s no guarantee that you won’t ever be affected by erectile dysfunction. Most people will experience isolated episodes during their lifetime — such as when they’ve consumed a lot of alcohol or had a very stressful day.

However, there are things that you can do to lower your risk of developing ED in the future. These same things have also been proven to be beneficial in reducing the effects of the condition for people who already experience episodes of ED.

Maintain a healthy weight

People who are overweight or obese are more likely to develop ED. The reason for this is that carrying excess weight places pressure on the cardiovascular system. This increases the risk of issues such as high blood pressure, heart disease and stroke — all of which are common causes of organic ED.

Eat a healthy, balanced diet

The body needs proper nutrition to function optimally. Eating a healthy, balanced diet that is rich in nutrition and low in salt, sugar and fat can help keep your heart healthy and reduce the likelihood of a cardiovascular event.

Quit smoking

It’s no secret that smoking is bad for your health, but did you know that it could also be bad for your erections? Nicotine causes blood vessels to become narrower, restricting the blood flow to the penis and making it harder to get and maintain an erection. 

Get plenty of exercise

Not only does regular exercise help you to maintain a healthy weight, but it is also excellent for cardiovascular health. Regular cardio-based activity improves blood flow and reduces stress on the heart and surrounding arteries, significantly lowering your risk of a cardiovascular event.

Read our top 10 tips to reduce male impotence

Erectile dysfunction isn’t something that you just have to accept as you get older.

Now, more than ever, there is a range of treatments and therapies that can restore your erection and your sex life. At Circle Health Group, our experienced specialists have helped thousands of men with their erection problems.

To find out how we can help you, get in touch today by calling us or using our easy online booking system.


Sources and further reading

Clinical content provided by Consultant Urological Surgeon Mr Giangiacomo Ollandini at The Saxon Clinic in Milton Keynes.

Further reading

1The global prevalence of erectile dysfunction: a review, BJUI

2Diabetes and erectile dysfunction, 

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