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Erectile dysfunction is a condition where the man cannot sustain an erection long enough for satisfactory sexual activity to occur. The condition is also known as impotence and is rarely talked about openly, but erectile dysfunction is relatively common, affecting around 10% of all men.

This article on erectile dysfunction is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.


What are the causes?

An inability to maintain an erection can be put down to three main causes: psychological, physical, and medicinal.

1. Psychological causes include stress, anxiety, relationship problems, and depression.

2. Physical causes of erectile dysfunction can be attributed to four main health problems:

  • Vasculogenic conditions, which affect the blood flow to the penis, such as heart disease, arteriosclerosis, high blood pressure, and diabetes
  • Neurogenic conditions that affect your nervous system, such as multiple sclerosis, Parkinson's disease, spinal problems, or tumours
  • Hormonal conditions, such as hypogonadism, problems with the thyroid, and Cushing's syndrome
  • Anatomical conditions that affect the physical structure of the penis, such as Peyronie's disease, and hypospadias

3. Sometimes, when taking a medicine, it can have an unwelcome side effect. Medicines that can cause erectile dysfunction include:

  • Diuretics – drugs that increase the rate of urination, often used to treat high blood pressure (hypertension), heart failure, and kidney disease
  • Antihypertensives – drugs that lower blood pressure, such as beta-blockers, used in the treatment of hypertension
  • Fibrates – drugs used to bring down cholesterol levels
  • Antipsychotics – drugs used to treat psychotic conditions
  • Antidepressants – medication given to relieve the symptoms of depression
  • Steroids – a class of drugs used to treat a wide range of conditions including AIDS, steroid hormone deficiency, and other diseases that cause loss of muscle mass
  • Immunosuppressants – medicines to suppress the immune system
  • H2-antagonists – drugs used to treat stomach and duodenal ulcers, heartburn, and other conditions that cause the production of too much stomach acid
  • Anticonvulsants – medicines most commonly used to treat epilepsy, but sometimes also to help bipolar disorders

If you think the medication you’re taking could be causing you to experience erectile dysfunction, contact your GP to ask if there are any alternatives. However, it’s very important not to just stop taking the medication before talking to your doctor as doing so could adversely affect your health.

Other causes of erectile dysfunction include obesity, smoking, alcohol, tiredness, and the use of street drugs, such as cannabis, or cocaine. Sometimes people who cycle regularly (more than three hours a week) can experience impotence as this activity can place pressure on nerve endings in the penis.

Treatments

Treatments for erectile dysfunction depend on the cause of the problem.

Self-help treatments

  • Give up smoking
  • Lose weight
  • Moderate your alcohol consumption
  • Stop using street drugs
  • Start taking regular exercise
  • Reduce the number of hours you cycle each week

Medicine treatments (PDE-5 Inhibitors)

These drugs work by temporarily increasing blood flow to the penis and are the most commonly prescribed drugs for erectile dysfunction. They include sildenafil (known by its brand name, Viagra), tadalafil (known by its brand name Cialis), and vardenafil (known by its brand name Levitra). Occasionally, if you’re unable to use the above drugs or do not respond to them, you may be prescribed a synthetic hormone called alprostadil. Injected directly into the penis, or in tablet form placed just inside the urethra, it produces an erection that can last anywhere between five to thirty minutes.

Hormone therapy

If your erectile dysfunction is caused by hormonal imbalance, your endocrinologist can prescribe synthetic hormone injections to redress the balance and eliminate the cause of the impotence.

Penis pump

This is a device that can give you an erection for around thirty minutes if used in conjunction with a rubber ring. You place a tube over the penis which is connected to a pump. This is used to create a vacuum causing blood to rush to the penis, giving you an erection. If you then place a rubber ring around the base of the penis, the erection can be sustained long enough for satisfactory sexual activity. However, the penis pump should only be used occasionally as repeated use could damage the tissues of the penis, leading to worsening impotence.

Surgery

If all other methods have failed and there’s an obvious anatomical problem or blockage to the blood supply of the penis, then surgery can be an option.

Counselling and therapy

If the underlying cause of your erectile dysfunction is psychological, counselling can be of great help to enable you to understand any ‘hidden’ (unconscious) psychological issues you have with yourself or your partner. Understanding brings acceptance, and can reduce anxiety, which in turn can lead to the end of erectile dysfunction. Cognitive behavioural therapy is a stronger type of therapy to help you alter the way you think about things. It’s known that unrealistic, negative thoughts and assumptions about yourself and your relationship can sometimes cause erectile dysfunction. Cognitive behavioural therapy helps you to completely change these damaging ways of thinking, relieving pressure, stress and anxiety, and in turn eliminating impotence.

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