Erectile dysfunction

Erectile dysfunction - most common causes and treatment options

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Erectile dysfunction (impotence) is when a man can't get an erection to have sex or can't keep an erection long enough to finish having sex. (It used to be called impotence).

Erectile dysfunction can occur at any age, but it is more common in men older than 75 years of age.

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What is an erection

The penis contains two chambers called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernous and is surrounded by the corpus spongiosum.

Figure 1. Arteries (top) and veins (bottom) penetrate the long, filled cavities running the length of the penis—the corpora cavernosa and the corpus spongiosum. Erection occurs when relaxed muscles allow the corpora cavernosa to fill with excess blood fed by the arteries, while drainage of blood through the veins is blocked. An erection occurs when blood is pumped into the penis and stays there, making it hard. It generally happens because a guy is thinking about sex, or because his penis is being stimulated - or both. The result is that signals go down the nerves that lead from his spinal cord to his genitals. They tell the blood vessels which supply the penis to open up. Blood flows in and the organ ‘blows up' like a balloon. A valve mechanism near the base of the penis keeps the blood from flowing out again – a least, until sex is over. As you can see, getting an erection is a complex process. It's awfully easy for various factors to interfere with it - for instance, worry, tiredness, too much alcohol or in later life, narrowing of the blood vessels. Nicotine is now known to narrow those vital blood vessels – which is why ED is much commoner in smokers. But often, there is nothing physically wrong with men who develop. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences.

What physical causes are there

Common physical causes include:

Diabetes

Smoking

Excessive drinking (hence the phrase ‘Brewer's droop')

Being obese and out-of-condition

Side-effects of certain drugs, notably ones for blood pressure and depression

Effects of recreational drugs.

Hypertension (high blood pressure)

Atherosclerosis (hardening of the arteries)

Stress, anxiety or depression

Fatigue

Brain or spinal-cord injuries

Hypogonadism (which leads to lower testosterone levels)

Multiple sclerosis

Parkinson's disease

Radiation therapy to the testicles

Feelings that can lead to erectile dysfunction

Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence

Feeling stressed, including stress from work or family situations

Being troubled by problems in your relationship with your sex partner

Feeling depressed

Feeling so self-conscious that you can't enjoy sex

Thinking that your partner is reacting negatively to you

How is erectile dysfunction diagnosed

Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you.

How is erectile dysfunction treated

Treatment depends on the cause of the ED. For instance, psychological causes may require:

commonsense advice to one or both partners

relationship counselling

counselling

psychotherapy

Erection-aiding drugs

Oral drugs which help produce an erection in response to sexual stimulation have revolutionised the treatment of ED over the last eight years. They don't work for everybody, but they do work for the majority – even in diabetes. They can also help people with neurological and spinal problems. Also, the choice of available drugs means that if one particular drug doesn't suit you, it's well worth trying one of the others. There are now only three orally-administered drugs available in the US. They all have side effects, only a few of which we can list here. For more information, read the package insert leaflet, and if in doubt ask your doctor. The oral drugs currently available are:

Other Drug Treatments for ED

It's also possible to give erection-inducing agents by:

pellets inserted down the urinary pipe

injections into the penis

These methods have become less popular since the increasing availability of oral drugs, but they suit a minority of men. You have to be quite brave to give yourself a jab in the penis. For details of side effects, consult your GP.