Erectile dysfunction
impotence
Erectile dysfunction is a common problem in older men. But it can be frustrating and distressing to live with. Our consultants can talk you through the many treatments that can help.
What is erectile dysfunction?
Erectile dysfunction or ‘ED’ is also known as impotence. It means you can’t get an erection, or keep one for long enough to have sex.
Erectile dysfunction can cause a lot of stress and worry, which can have a big impact on your emotional and mental health. It can put a strain on relationships too. Many men feel embarrassed, ashamed or low about themselves.
But actually, it’s very common, especially in older men. Erectile dysfunction is thought to affect around half of men aged 40 to 70 to some degree. Lots of younger men get it too. It can often be a sign of other health conditions, like cardiovascular disease and diabetes. So it’s important that you seek help.
Erectile dysfunction symptoms
Erectile dysfunction can mean you either:
- Are unable to get an erection
- Are unable to keep an erection long enough to have sex
You may find these difficulties only affect you at certain times or in certain situations. For example, you might only have trouble getting an erection when you’re having sex or with a partner, but still have early-morning erections. Or you may find you can’t get an erection at any time.
You may also find it hard to get aroused and have a low sex drive.
Depending on the cause, your symptoms may have started suddenly, or they may have come on gradually.
Erectile dysfunction causes
There are lots of different causes of erectile dysfunction. These can be physical or psychological, or you may have a mixture of both.
Physical causes may include:
- Cardiovascular disease, including high blood pressure, high cholesterol and peripheral arterial diseases
- Conditions that affect your nerves, such as Parkinson’s disease, stroke and multiple sclerosis
- Diabetes, which can damage nerves and blood vessels
- Hormonal problems
- Damage from surgery or radiotherapy in your pelvis
- Anatomical abnormalities affecting your penis
Psychological cause can include:
- Feeling stressed or anxious
- Having relationship problems
- Not feeling aroused
- Depression, or other mental health problems
Certain medicines may also cause erectile dysfunction. These include antidepressants, diuretics and medicines for high blood pressure.
Lifestyle factors, like obesity and smoking can also contribute to erectile dysfunction.
Cardiovascular disease and erectile dysfunction
Cardiovascular disease is the most common underlying reason for erectile dysfunction. With cardiovascular disease, you get a build-up of fatty deposits in your arteries, called atherosclerosis. This can lead to your arteries becoming blocked.
If the blocked blood vessels are carrying blood to you penis, it can cause difficulties getting an erection. The same process can affect the blood vessels supplying your heart. This can cause problems like heart disease and stroke.
Because of the close links between the two, erectile dysfunction can often be an early sign of heart disease. Your doctor will discuss this with you. They may suggest that you see a specialist in heart disease for further assessment.
Erectile dysfunction diagnosis
All men may have erection problems from time to time. But if you’re experiencing erectile dysfunction symptoms regularly, get it checked out with a doctor. As well as helping to address sexual problems, it’s important for your doctor to check for related problems, like cardiovascular disease and diabetes.
Your consultant will talk to you about your symptoms, medical history, lifestyle and sexual relationships. They may ask you to complete a questionnaire too, to find out more about the difficulties you’re having. We know it can feel awkward or embarrassing talking to a doctor about these things. But erectile dysfunction is a very common problem. Your consultant will have seen men with this problem many times before.
As part of their assessment, your consultant may also:
- Check your blood pressure, heart rate, weight and waist measurements
- Examine your genitals for signs of abnormalities
- Suggest a digital rectal examination to feel inside your back passage, if you have signs of prostate problems
- Arrange blood tests to check for diabetes, high cholesterol, and hormone levels
Most men won’t need any further assessment or investigations. But there are more specialist tests that can help to diagnose the cause of erectile dysfunction. Your consultant will advise you if they think these would help.
Erectile dysfunction treatment
There are several different effective treatments for erectile dysfunction. Your consultant will advise what options are best for you. This will depend on what’s causing your erectile dysfunction. They may include one or more of the following.
Lifestyle changes
Making some lifestyle changes can help with erectile dysfunction. Your consultant may suggest the following:
- Losing weight if you need to
- Getting regular exercise
- Giving up smoking
- Reducing your alcohol intake
Medication
If you have diabetes, high blood pressure or high cholesterol, it’s important to take any prescribed medicines for these.
Your consultant may also review any medication you’re currently taking that may have caused erectile dysfunction.
Your doctor may prescribe medicines that can help with erectile dysfunction. These include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Spedra)
These medicines work by increasing blood flow to your penis. But you still need sexual stimulation to get an erection.
If your erectile dysfunction is due to a hormone problem, you will need to see a specialist in hormonal problems for treatment.
Psychological support
If your erectile dysfunction is lined to psychological problems, your doctor may suggest some psychological support. Counselling, psychotherapy and sex therapy may help.
Specialist treatments
If other treatments haven’t worked, you may need to see a urology specialist. They may be able to offer more specialist treatments. These may include the following.
- Vacuum erection devices – you use these to suck blood into your penis and encourage an erection
- Injections into your penis – you self-administer these to produce an erection
- Medicated urethral system for erection (MUSE) – you insert a medicated pellet into your urethra (the tube that carries urine out of your body), to encourage blood flow to your penis
- Vascular surgery – to reconstruct blocked arteries supplying your pelvis or penis
- Penile prostheses (implants) – surgery to fit a prosthesis into your penis
Your specialist can help you decide what’s right for you.
Need to know
Symptoms and causes of erectile dysfunction
There could be a number of reasons why a man would experience erectile dysfunction, including:
- tiredness
- stress or anxiety
- too much alcohol
- medication
However it can also be a symptom of a more serious, underlying condition such as atherosclerosis (blocked arteries). This is a build-up of fatty deposits in the arteries and is associated with cardiovascular disease (CVD). Your arteries dilate when they carry blood to the penis during an erection, so erection problems can be a sign your arteries not functioning properly.
Other conditions erectile dysfunction is associated with include:
- diabetes
- high blood pressure
- hormone problems
Diagnosis
Erectile problems are very common and many men find that simple lifestyle changes can help.
However, if you are experiencing it more often, it’s important to get checked out. Your consultant will probably ask about your lifestyle and relationships to see what could be causing it, as well as carrying out health checks, including taking your blood pressure and doing a genital examination.
If they are concerned about cardiovascular disease, they may do a cardiovascular risk assessment. This calculates your risk of heart attack or stroke by looking at your medical history alongside your blood pressure and cholesterol results.
Potential treatment options
Treatment options for impotence will depend on the cause of the problem. It is often treated successfully with medication, such as:
- PDE5 inhibitors — including Viagra (sildenafil), Cialis (tadalafil) and Levitra (vardenafil)
- alprostadil — a hormonal treatment that can be taken as an injection or a pellet placed in the urethra
Men who do not wish to take medication can use a vacuum pump, which can be very effective by boosting blood flow to the penis.
If you are diagnosed with atherosclerosis, you will probably be prescribed medication such as aspirin to prevent blood clots developing and statins to help reduce cholesterol.
Our consultants
Our facilities
From complex urology surgery to straightforward cardiology tests and urology procedures, we provide exceptional care across our network of hospitals, outpatient centres and specialist clinics.
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The Princess Grace Hospital
42-52 Nottingham Place
London W1U 5NY
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The Wellington Hospital
Wellington Place
St John's Wood
London NW8 9LE
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London Bridge Hospital
27 Tooley Street
London
SE1 2PR
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The Harley Street Clinic
35 Weymouth Street
London W1G 8BJ
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The Lister Hospital
Chelsea Bridge Road
London
SW1W 8RH
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HCA UK at The Shard
The Shard
32 St Thomas Street
London SE1 9BS
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020 7079 4344