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Also known as impotence, erectile dysfunction — or ED for short — is much more common than you might think
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.”
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.
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.
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.
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 — 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.
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.”
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.
You should arrange an appointment with your GP if you:
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.
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.
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.
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:
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.
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.
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.
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.
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.
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:
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”.
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.
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.
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.
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.
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.
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.
Sources and further reading
Clinical content provided by Consultant Urological Surgeon Mr Giangiacomo Ollandini at The Saxon Clinic in Milton Keynes.
1The global prevalence of erectile dysfunction: a review, BJUI
2Diabetes and erectile dysfunction, diabetes.co.uk