Erectile Dysfunction

On occasion, all men have difficulty getting an erection. This can be due to the temporary influence of alcohol, stress or tiredness. It only becomes a problem when the lack of erection is ongoing and it affects your sex life or self-esteem. The inability to get an erection can also be a symptom of serious illness and should not be ignored.

The definition of erectile dysfunction is when:

• You have difficulty getting an erection
• You have difficulty sustaining an erection
• You have a lack of sexual desire and are unable to become sexually stimulated

If you are experiencing erectile dysfunction, it's important to see your doctor to rule out any underlying illness. Your doctor is likely to perform some tests. These include:

• A blood test to check for illnesses such as diabetes or low testosterone levels
• A physical exam of your genital area to check for abnormalities or nerve damage
• A urine test to check for diabetes and other illnesses
• An ultrasound to check for blood flow problems. This is most likely to be carried out at a hospital
• An overnight test to check if you involuntarily get erections during your sleep. This involves strapping a device to your penis. If you do experience unconscious erections, it indicates a psychological issue
• Psychological discussions. You may be asked to fill out a depression questionnaire or talk about any relationship issues you are experiencing

Your doctor will diagnose erectile dysfunction according to the results of tests. The cause may be immediately obvious or it could take some time to uncover the reasons. Some men find they are experiencing a mixture of several problems.

Multiple processes and interactions need to happen for the penis to fill with blood and become firm enough for penetrative sex. It involves physical actions like blood flow, nerves, hormones and muscle interaction as well as psychological responses like emotions and sexual response. If one of these aspects malfunctions then erectile dysfunction can occur.

A problem faced by many men is that once erectile dysfunction has happened then worrying or stressing can cause it to happen repeatedly. For example, you may have experienced tiredness that prevented an erection, and the next time you tried to have sex you couldn't get an erection. This type of performance anxiety can be common.

The physical causes of erectile dysfunction

The penis is a complex structure full of spongy tissues that fill with blood when sexually stimulated, but some physical conditions can stop the chambers filling with enough blood to make the penis firm. These include:

• Heart disease including high cholesterol, high blood pressure and clogged arteries. These conditions fill the arteries with fat deposits and constrict them. It's known as atherosclerosis and is a common reason for erectile dysfunction.
• Diabetes can damage the penile nerve endings that result in a loss of sensation.
• Obesity causes heart disease and puts pressure on your vascular system. This can lead to a lack of blood flow into the penis.
• Metabolic syndrome which is a collection of conditions including a fatty waist, high cholesterol, high insulin and raised blood pressure.
• Smoking. Nicotine causes your arteries to constrict so blood flow to the penis (and all other organs) is restricted. Without sufficient blood flow the penis cannot become erect.
• Alcoholism and drug use adversely affect your blood flow.
• Parkinson's disease, multiple sclerosis, and Peyronie's disease can all interfere with the erectile process. Peyronie's disease refers to the buildup of scar tissue in the penis.
• Prescription medicines including antidepressants, antihistamines, high blood pressure and pain medications can prevent erections and sexual stimulation from occurring.
• Prostate cancer and enlarged prostate gland treatments can damage the penile tissues and nerves.
• Pelvic or spinal injuries can prevent stimuli messages from the brain reaching the penis.
• Sleep disorders and lack of sleep can lower the production of testosterone, which is essential for erections. Men with sleep apnoea are more likely to experience erectile dysfunction.
• Spending more than three hours a week on a bike saddle can damage your nerves and lead to erectile dysfunction.

As men grow older, the physical causes of erectile dysfunction become more common. You might need more direct stimulation to achieve an erection. This can indicate poor health and warrants a doctor's visit.

The psychological causes

The brain is a much underestimated trigger for erectile dysfunction.

All sexual response starts in the brain beginning with sexual excitement or feeling 'turned on'. From these sensations, the brain sends signals to open penile blood vessels and allow the corpora cavernosa chambers to fill with blood and make your penis erect. At any point during this process, the brain can prevent an erection from forming. Your brain can also stop erections during sex.

The main psychological reasons are:

• Everyday worries and concentrated stress, perhaps due to a family problem or work project, can affect erections.
• Depression is a serious condition that can lead to a lack of interest in sex and an inability to enjoy sexual stimuli. Antidepressant medication can also interfere with the erectile process.
• Relationship problems including guilt, boredom and communication problems.
• Past trauma such as sexual abuse, an unhappy association with sex or sexual orientation confusion can produce erectile dysfunction.
• Performance anxiety either from lack of confidence in sexual skills (most common in younger men) or stemming from previous failures to achieve an erection.

If you are experiencing erectile dysfunction it's important to seek out medical help. There are numerous medications and support systems to help you through. The majority of men are able to have sex again.

One of the biggest challenges facing men with erectile dysfunction is finding out why it's occurring. It's important to assess your health so that you can be treated in the most appropriate way.

Your Health

The first aspect your doctor is likely to tackle is your health. Heart disease can be fatal and an inability to get an erection can highlight a narrowing of the veins that is associated with heart disease. Poorly controlled diabetes can also affect sexual performance. If either of these health issues are diagnosed, you will receive specialist support to manage the condition. When an underlying health issue is addressed erectile dysfunction issues may improve without any other intervention.

Your Lifestyle

If lifestyle aspects are thought to be affecting your sexual performance including smoking, drinking too much alcohol, substance abuse or being overweight you will be advised to modify your behaviour.

Oral Medications

Oral medicines such as Viagra or Cialis are effective at combating erectile dysfunction. These are called PDE-5 inhibitors and work by relaxing and opening up the blood vessels to allow blood into the penile chambers. Men find these medications helpful and many are taken worldwide.

Injections

Self-injectable medications that are injected directly into the penis are another way to treat erectile dysfunction. Needles are very small and fine so pain levels are kept to a minimum. An injection will last approximately 20- 40 minutes.

Suppositories

Some men have success with penile suppositories. These are placed inside the urethra with a special applicator. An erection will appear quickly and can last 30-60 minutes.

Testosterone Levels

For one of the tests, your doctor may do a blood test during the consultation to check your testosterone levels. If they are found to be low, you can take medications to raise them. Testosterone replacement is delivered in the form of tablets, gels, gums, patches and injections. Once your testosterone levels are within the normal range your erections should return.

Other Medication Side Effects

Medications can directly interfere with sexual performance. As men grow older they tend to take more medicines, which could be one reason why older men experience erectile problems more often.

Your doctor will examine your current medical record and if possible change medications to ones that do not interfere with sex. If it's not possible to change your medication then your doctor may prescribe an oral erectile dysfunction medication or other support.

Penis Pumps

Sometimes medications are not suitable, in which case physical interventions can help. Penis pumps create a vacuum that pulls blood into your penis. You must use these carefully as they can cause damage. Once the pump has created an erection firm enough for sex, you need to place a ring on the base of your penis to hold the blood in place.

Implants

Penile implants are usually a last resort. Surgical techniques can implant either two inflatable cushions or semi-rigid rods to create an erection. Inflatable cushions can be pumped up when required. Rods are constantly firm but are bendable.

Counselling

If erectile dysfunction is caused by psychological reasons then counselling, talking therapies or couples counselling may be an appropriate treatment. Untying mental blocks can release tension and solve relationship problems.

Depression and anxiety are major causes of sexual problems in men and women. They can be treated effectively with medications and counselling support. If you think you're depressed see your doctor as soon as possible. Your doctor will suggest the most appropriate treatment for you during consultation.

Buying treatment for erectile dysfunction online is safe if you use reputable sites.

When buying erection medications online you should use a quality site that displays the pharmacy logo and is registered with the Royal Pharmaceutical Society of Great Britain. You should also be required to undertake a consultation and have your prescription request reviewed by a qualified and registered doctor.

There are still outlets that sell black market, unregulated erectile dysfunction medications and these should be avoided not matter what the cost saving. Sites that do not offer a consultation service or deliver medicines from a registered pharmacy cannot guarantee your safety.

Herbal erectile dysfunction medications are available over-the-counter and online. These are not regulated and contain ingredients that are not verified as supporting erectile dysfunction. Ingredients like black cohosh and ginger have been used for centuries to boost libido, but there is no evidence they work. There are no guarantees that these herbal remedies contain what they list on the ingredients.

When you're looking to buy medicine online you should stick to quality UK sites with all the relevant logos and a secure consultation service. If you are unsure call the Patient Support line to ask any questions you need to be satisfied.

It's not possible to buy Viagra or any other erectile dysfunction medications over-the-counter because they require a prescription.

Physical options

Seeing your doctor is important to rule out critical conditions such as heart disease and diabetes. If left untreated, heart disease in all its form can cause life-altering, disabling and even fatal heart attacks or strokes. Your doctor needs to rule these out before prescribing any support medication such as Viagra.

If you have high cholesterol you may need to take statins to lower your levels and high blood pressure can be managed with medication. Diabetes must be controlled or it can cause nerve damage and lead to critical insulin levels that result in coma. Erectile dysfunction is a symptom of these conditions, as well as being a condition in its own right.

Lifestyle changes are important if you want to manage erectile dysfunction. Many physical cases are caused by ill health. Your doctor will prescribe medications to manage serious health conditions but changing your habits can save your life and reduce the frequency of erection problems.

If you are overweight, obese or have heart problems your arteries may have narrowed. By exercising frequently and eating a balanced diet you reduce the likelihood of erectile dysfunction.

If you smoke it's worth quitting. Nicotine narrows the arteries and has an adverse affect on your erections. Excess alcohol and drug use has the same effect.

Lifestyle changes can be made in your own home and they will drastically improve your quality of life.

Another popular option are erectile dysfunction medications. These are taken orally and work by opening the blood vessels. This allows an erection to take place. Sexual stimulation is still required to produce an erection. Erectile medications are not 'aphrodisiacs'. An erection will not appear without stimulation.

There are several different types of erectile dysfunction medication including:

• Sildenafil (brand name Viagra)
• Tadalafil (brand name Cialis)
• Vardenafil brand names (Levitra and Staxyn)
• Avanafil brand name (Spedra)

Many men take these medications successfully but there are some who should avoid them. These include:

• Men taking nitrate drugs. Nitrates are prescribed for chest pain and angina. When taken with erectile dysfunction drugs, they can cause contraindications such as a dangerous drop in blood pressure. Recreational drugs known as 'poppers'; also contain nitrates and should not be combined with any form of erectile dysfunction medication.
• Men who have very low blood pressure or very high uncontrolled blood pressure.
• Men with liver disease or kidney disease that needs dialysis.

Side effects of erectile dysfunction medications include a flushed face, headaches and a stuffy nose but many men find the benefits outweigh these common side effects. If you experience an allergic reaction or severe side effect, stop taking the medicine and seek medical help immediately. Serious side effects are rare and highly unlikely to happen if you follow the instructions.

Psychological options

Stress relief and emotional support can make huge differences to men experiencing erectile dysfunction. Reducing your workload, implementing a manageable work/life balance and finding the time to relax are important if you are experiencing stress. Stress manifests itself in many forms. Sexual problems are common in stressed individuals.

Relationship difficulties can be worked through with couples counselling, or if your problem is personal then individual counselling may help. Past trauma requires specialist support and you should talk through these issues with your doctor to find the appropriate help.

Performance anxiety is a difficult cycle to break from. Sometimes this can be the sole reason for erectile dysfunction. Some men find that a short course of medication can restore their confidence and after they have successfully achieved an erection they no longer need it.

Left untreated erectile dysfunction can affect not only your sex life. Anxiety about your performance can lead to a drop in self-esteem, cause embarrassment and create relationship problems. If you are trying to start a family the pressure can increase and erectile dysfunction may mean you will not be able to conceive.

Erectile dysfunction can be prevented and reversed with lifestyle choices. If you are at the stage where you need medical intervention then these prevention strategies will also help get you back on track.

Exercise

Exercise is one of the most important factors in maintaining good sexual health. It helps you lose weight, strengthens your muscles, keeps your heart healthy and lowers stress. Try to get some exercise every day as part of your routine. This can include a walk during your lunch break, swimming after work or playing football and gardening on the weekend.

Medications

Erectile dysfunction medications can take the stress out of sexual problems. You can use them to break a cycle of performance anxiety as well as counteracting physical problems. Used alongside lifestyle changes medications are safe, effective and help many men with erection problems worldwide.

Smoking

If you smoke, then stop. Smoking has no benefits. It causes cancer, emphysema, gum disease and hair loss. Erectile dysfunction is also caused by nicotine's ability to constrict the arteries. When coupled with cholesterol it puts you in a dangerous position. Quit smoking. Your doctor can help you. There are medicines available to support such as nicotine replacement patches, gum or vaping cartridges.

Assess your diet

Too much fat, salt and sugar causes obesity, diabetes and raises your blood pressure. A Mediterranean diet is recommended for men experiencing erectile dysfunction. This includes lots of essential fatty acids found in oily fish, lots of fruit, vegetables and grains. Cut down on processed foods and snacks to lose fat and maintain a healthy weight.

Communicate with your partner

If you start to experience erectile difficulties, talk about them with your partner so they don't become an issue. Work through problems you have with open discussions and involve a counsellor if you want to.

Manage your existing health conditions

If you have diabetes, heart disease or another condition that could affect your sexual performance ensure you work closely with your doctor to prevent problems before they become an issue. Keep yourself as healthy as possible and take any prescribed medicines as instructed.

Erectile dysfunction affects millions of men in the UK. If you are experiencing a problem you are not alone. Medications, lifestyle choices and psychological support can make all the difference in building your sexual confidence. For most men who seek treatment erectile dysfunction is a temporary difficulty that can be overcome with appropriate treatment.