Erectile Dysfunction

Erectile dysfunction (ED) is the inability to obtain or maintain an erection firm enough for satisfactory sexual intercourse or activity. It is the most common form of male sexual dysfunction and is increasingly prevalent with age. Approximately 40% of men are affected by age 40 and nearly 70% are affected by age 70.

There are no uniform criteria defining how consistent the problem has to be and for what duration it must be present to be considered ED. Though it is not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s! ED can be an early sign of a more serious underlying health issue, and finding and treating the cause is a vital first step.

What are the causes of ED?

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. ED can result from a problem with any of these. Likewise, stress and mental health concerns can cause or worsen the issue. Sometimes there may be multiple causes responsible. These include:

    • Cardiovascular issues eg. Heart disease, High cholesterol leading to blood vessel blockage (atherosclerosis), Hypertension and Diabetes

    • Hormonal imbalances eg. Testosterone Deficiency Syndrome (TDS)

    • Penile issues eg. Phimosis and Peyronie’s disease

    • Prostate issues eg. Prostatitis and Benign Prostatic Hyperplasia (BPH)

    • Sleep disorders eg. Obstructive Sleep Apnoea (OSA)

    • Neurological conditions eg. Parkinson’s disease

    • Side effect of medications used to treat other health problems

    • Diseases, injuries or surgeries that affect the pelvic area or spinal cord

    • Surgery or radiation therapy for cancers in the lower abdomen or pelvis eg. bladder, prostate or colorectal cancer

    • Stress at home or work

    • Stress from social, cultural or religious conflicts

    • Worry about sexual performance

    • Depression, anxiety or other mental health conditions

    • Relationship conflicts

    • Chronic smoking

    • Alcoholism and other forms of substance abuse

    • Obesity

    • Sedentary lifestyle

    • Lack of aerobic exercise

What are the complications of ED?

  • Stress, anxiety, embarrassment or low self-confidence

  • An unsatisfactory sex life potentially causing relationship problems

  • The inability to get your partner pregnant

What can I expect at my visit?

Usually, a diagnosis of ED can be made simply from providing a detailed medical history and undergoing a physical examination. Depending on the suspected cause, your doctor may recommend further investigations such as blood tests to check hormone levels for example, urine tests or an ultrasound scan to assess the blood flow of the penile vessels.

What are the treatments available for ED?

The first step in treating ED is to treat any health conditions that might be causing or contributing to the ED. Sometimes, correcting the underlying cause may resolve ED altogether.

Specific treatments for ED include:

    • These are known as phosphodiesterase type-5 inhibitors (PDE5I), of which Viagra (the famous blue pill) is one of them. PDE5Is enhance the effects of nitrous oxide, a natural chemical produced by the body that relaxes muscles in the penis. This increases blood flow and helps in getting and maintaining an erection in response to sexual stimulation.

    • They are usually taken on demand and for best results, should be consumed about an hour before sex.

    • PDE5Is are effective in approximately 7 out of every 10 men. Response rates are lower for diabetic and cancer patients.

    • Possible side effects include headache, giddiness, nasal congestion, nausea, flushing and indigestion.

    • It is best to consult your doctor before starting on PDE5Is. They should not be used in patients with heart conditions who might be on a class of drugs called nitrates, or those who suffer from low blood pressure (hypotension).

    • This is a non-invasive, painless and safe treatment which uses low intensity focussed sound waves to help promote healthy penile blood vessels and tissues, and stimulate the growth of new blood vessels.

    • ESWT requires a course of treatment sessions over several weeks and the patient should start seeing a noticeable improvement to the erections after about 3 to 4 sessions. You should expect the results to last for about a year or so.

    • ESWT is mainly effective when the primary cause of the ED is related to blood vessel blockage. Speak to your doctor to find out if ESWT is indicated for you.

    • A medication called Alprostadil can be injected into the side of the penis using a very fine needle. This is usually recommended to men who do not respond to oral medications. This method tends to produce a reliable erection, with success rates as high as 85%.

    • The medication is to be self-injected before sex. Your doctor will demonstrate the injection technique to you so that you may be able to do it safely on your own.

    • Each injection is dosed to allow for an erection that lasts for about an hour. As this erection is not regulated by the penile nerves, you may notice that your erection persists even after orgasm.

    • As the needle used is very fine, the pain from the injection site is usually mild, and most men get used to it quite quickly.

    • Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of scar tissue from multiple injections.

Don’t suffer in silence.

If you think you may be suffering from ED, please contact our clinic to make an appointment today. We are here to help.